ADDING COLOURS TO LIFE: AN INITIATIVE FROM ART CENTRE, MEDICAL COLLEGE THRISSUR

[BEST PRACTICE DOCUMENTATION UNIT OF KSACS]

ADDING COLOURS TO LIFE: AN INITIATIVE FROM ART CENTRE, MEDICAL COLLEGE
THRISSUR
====================================================================

Adherence to anti-retro viral therapy (ART) implies that the
medication is taken according to a treatment plan designed in
consultation with the patient and involves taking the recommended dose
at the recommended time and in the recommended way. Since HIV is a
retrovirus that mutates (changes its genetic structure) at an
extraordinary rate on a daily basis, adherence to the therapy is
inevitable to avoid drug resistance. Otherwise some strains of HIV
develop that are naturally resistant to the presence of one or more
drugs. HIV drug resistance refers to a reduction in the ability of a
drug to block replication of HIV.

In the case of children’s ART adherence interventions, consistency and
regularity of the child’s visits to the health care provider is
essential for adjustment of medication dosages as the child grows and
body weight increases. Explaining to children on the importance of
adherence is difficult due to the feeble understanding on why s/he is
taking the medications. As their cognitive level is weak, Children are
unaware about the implications and seriousness of the illness that he
suffers. They are often reluctant to adhere to the treatment regime
particularly due to the bad taste or frustration in having to take
medicine several times in a day and day after day. The reluctance may
impel them to avoid visits to the health care providers/ART Centers. A
great majority of the ART centres in the Kerala State have an adult
centered atmosphere, which may dispel children from their routine
visits to the Centre.

The staff team of ART Centre at Thrissur Medical College believes that
the ART adherence interventions in Children affected with HIV should
be child-cantered and appropriate. Hence they started a new initiative
aimed at making ART Centre visit a pleasure than a pressure to the
children. The health care team at the ART Centre recognizes that
giving the children an opportunity to draw and paint can improve their
creative thinking and enhance colourful thoughts and hopes in them.
Finding a reason other than the routine clinic visit can motivate the
children and caregivers in making the visit more comfortable. This
will in turn improve the beneficiaries’ compliance and adherence in
treatment.

The novel idea was conceived by Dr. Vineeth Kumar (Medical Officer),
who is an artist on his own and Ms. Preethakumary (Counsellor) under
the guidance of Dr. Ajithkumar (Assistant Professor) in the month of
February 2010 and was materialised on 12th March 2010. In this simple
intervention, the Centre distributes crayons and pictures for
colouring to the children who attend ART centres. They are expected to
bring back the pictures in the next visit when they come to collect
ART drugs. The painting brought by them will be displayed in the
notice board on the same day when these kids are waiting in the
waiting area. Some parents offered to buy crayons on their own as they
can afford to buy it. The Centre also encourages them to buy water or
oil colour, if they can afford it. In order to ensure maximum
participation, each of the ART team member acts as a catalyst. Every
child who brings back the painting gets a small prize like sweets or
pen. The best three paintings of each month will be awarded at a prize
in a small meeting conducted in the ART centre itself. The Centre
ensures that the prizes are useful items, like pens, books, Tiffin box
etc., and not anything exotic that is likely to invite questions from
peers or friends.

A total of 230 children are registered in this Centre, of them 105 are
undergoing the ART. In the month of March 2010, 80 children
participated and in April, 59 children participated in the drawing and
painting programme actively. Parents/care givers of these children are
also fascinated with the programme as it reduces rebelliousness in
medication and increases child’s interest in the ART Centre visit. In
order to improve imagination and creativity, now the Centre asks the
kids to do their drawings and paintings based on themes provided. The
response has been beyond expectations. Currently the whole project is
sponsored by the ART staff and the Department of Pediatrics at the
Thrissur Medical College.

The Staff members of the ART Centre are looking forward to expand
their child friendly initiatives. They are planning to conduct a mega
exhibition of the last six months collection of paintings on the next
children’s day. Similarly the staff team is zealous to support the
children by adjusting the follow-up date of visit to the ART Centre on
holidays/week-end, so as to avoid skipping school for the visit. They
are effectively utilizing the services of child specialists available
at the Psychiatry/Psychology Department to deal with the psychological
issues of the children. All these efforts will certainly make ART
visit more pleasurable to the children and their parents and it will
in turn improve the ART adherence and compliance among the children.