Rapid Training on HIV Care in Mozambique

“Now let’s talk a little bit about tomorrow’s practicum placements,” says lecturer Gervasio Vachamuteco to 28 attentive students. They have been in this classroom in Nampula, Mozambique for 2 weeks, learning about the care and treatment of people living with HIV, and the management of opportunistic infections and drug side effects. As the late afternoon light streams into their classroom at the regional training center, it’s almost time for them to apply these new skills in the clinic. Tomorrow, their course will transition to 2 weeks of onsite practical experience, and the students will care for patients at hospitals and clinics in the Nampula area, under the supervision of experienced doctors.

But first, the tools of the trade. An assistant is passing out new stethoscopes and flashlights to the students, essential diagnostic tools that are often not available to them in their clinics.

“These are yours to keep,” the instructor tells them as they turn to their neighbors, laughing and jokingly peeking in each others' mouths with the new flashlights.

As one of Africa’s poorest countries, gearing up Mozambique’s already under-resourced network of public hospitals and clinics to provide HIV care and administer antiretroviral therapy is a daunting challenge.

Mozambique faces an HIV infection rate of 16% nationally; in some provinces it is as high as 25%. Facing this epidemic is a national network of hospitals and health centers where doctors are in exceedingly short supply. Instead, the front line of clinical care in many places is a cadre of health care workers, called “Técnicos de Medicina,” who receive 3 years of training in one of the country’s 13 regional health vocations institutes before being assigned to public service at a site in Mozambique’s broad public health system.

With support from the US President’s Emergency Plan for AIDS Relief (PEPFAR) and other donors, HIV antiretroviral treatment is becoming widely available across Mozambique. Still, initiating therapy, managing side effects, watching for drug interactions, and counseling adherence are all new skills that must be taught to health care workers before they can provide quality care. And until recently, the institutes’ 3-year Técnico de Medicina curriculum did not even include basic information about HIV care, let alone more advanced training on antiretroviral therapy.

I-TECH Mozambique is working with the Mozambique Ministry of Health on a multiyear project to reform the 3-year curriculum for Técnicos de Medicina, integrating comprehensive training on HIV and AIDS. The revised curriculum will begin to be implemented at all 13 of Mozambique’s regional health vocations institutes in 2011. Meanwhile, as an interim measure, I-TECH has worked with the institutes to add this 4-week HIV course for new Técnico de Medicina graduates: “Management and Care of HIV-Positive Patients,” called colloquially in Portuguese the “Disciplina.”

“Listen carefully. What do you hear?” asks Dr. Carlos Mucambe, watching as a student named Gonçalves uses his new stethoscope to listen to the lungs of a patient who has HIV. It’s the first day of their 2-week practicum, and Técnico Gonçalves is seeing patients in a sweltering room at the Mohala Expansao health center near Nampula, under the supervision and mentorship of Dr. Mucambe. The electricity has gone out today, and sweat rolls down everyone’s faces as two students and the doctor crowd around the shirtless patient on the examination table.

The Disciplina course’s progression, which includes classroom lectures, then small group work and role plays, followed by an intensive period of supervised practical experience, is carefully designed by I-TECH to maximize the transfer of learning and the acquisition of new skills and knowledge during the precious 4 weeks the students are given.

“This is one of the strengths of I-TECH,” says Dr. Pilar Martinez, an I-TECH lead for the program, as she watches Dr. Mucambe mentoring the Técnicos. “We bring a theoretical understanding of adult learning and skills transfer, and apply it in this real-world situation where every moment with these students is precious.” All too soon, these students will be back in their own clinics, facing their own patients and being forced to make hard clinical decisions. “So,” says Dr. Martinez, “we must absolutely maximize what we can teach them in 4 weeks.” With that, she turns back to Dr. Carlos, shakes his hand and thanks him, and heads for her car. She has Disciplina students at four more practicum sites she must check today; the roads are rutted and dusty, and the morning is already half gone.

Learn more about I-TECH Mozambique.

Learn more about clinical mentoring at I-TECH.