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March is Social Work Month Pediatric social workers: help starts here by Angel Payton-Harmon Ambulatory Care, Social Work Services The Outpatient Pediatric AIDS Clinic, better known as OPAC, provides medical care and case management for nearly 80 HIV infected children from 20 coastal counties. Nearly all of the children followed in the OPAC clinic were perinatally infected; however, referrals for teens contracting the virus through high risk behaviors are on the rise. HIV testing is also provided for infants who were born to women who are HIV positive.   OPAC is one of three federally-funded sites in the state of South Carolina which provide care for HIV positive children. The clinic receives Title IV funds from the Ryan White Comprehensive AIDS Resources E emergency (CARE) Act. The Ryan White CARE Act is the federal legislation that addresses the unmet health needs of people living with HIV/AIDS.  Funding is provided to support primary health care and support services. The CARE Act was named after Ryan White, an HIV positive teenager from Indiana. White was courageous in his fight against the virus and HIV/AIDS related discrimination. White helped to educate many about the virus, but most importantly what life’s journey is like for people living with the virus. The Pregnant HIV Positive Woman During an exposed baby clinic visit for her 1-year-old son, Ana* met with the OPAC social worker.  The social worker’s role in the clinic is to conduct a brief assessment for any social concerns. Ana shares that she is doing well and is praying that her son’s tests will continue to be negative.  HIV testing is provided to infants from six weeks of age until they reach the age of two. Ana reports that she and her significant other have been doing well and he continues to test negative. The social worker then inquired as to Ana’s thoughts for family planning. Ana was quiet for a moment and then shared that she might be pregnant.   A pregnancy test was offered. Ana was indeed pregnant. She was very excited about the news, but yet she was very concerned about what this would mean for her unborn child. Ana was not receiving any HIV care because she believes her life is in God’s hands. She just did not believe that any sort of medication was the answer for her. Ana firmly believed that God would heal her and protect her unborn child.   As a social worker in the medical field, I am well aware of the risks Ana was taking with her choice not be on any anti-retrovirals during her pregnancy. My job was to assist Ana without disrespecting her. Ana was willing to receive prenatal care; therefore I referred her to the OB clinic. I also arranged for Ana to meet with an Adult Infectious Disease physician who educated her about her care options. I also educated Ana about the Perinatal Prevention Case Management program for pregnant HIV positive women. The program provides HIV education, individual counseling, and the development of a risk reduction plan. Ana is now a part of that program. Sidney’s Way Sidney* is a 14-year-old girl who was born with HIV. She is bubbly and a lot of fun to be around.  But behind that great smile and charismatic personality, HIV has taken a toll on her body. She frequently visits  the Children’s Hospital Emergency Room and when she is admitted to the Children’s Hospital, she usually stays for a while.    After a long stay in the hospital, Sidney decided she just could not stay home any longer. She had grown tired of receiving homebound instruction and get well cards from her friends. She wanted to return to school. Sidney’s father, Brad, who is also HIV positive, wasn’t very sure of how to handle this request. School days for his daughter often meant hours in the nurse’s office to take her complicated regime of medications or going home early from simply being too tired to complete the day.      School meetings were not Brad’s favorite thing and he often felt intimidated. Sidney’s return to school would have to be carefully orchestrated. The OPAC social worker coordinated a meeting with school officials and other care providers. The OPAC social worker, along with Sidney and Brad, comprised a list of concerns and needs. At the meeting both Brad and Sidney actively participated.    It was decided that she would return to school for morning classes and her schedule changed to allow academic classes in the morning. She has a set of books at school and a set at home. She also has a motorized scooter to help her get around the large campus of the high school. Transportation to and from school would be provided by the school, as due to Brad’s failing health, he is unable to drive.   Advocating for Sidney’s desire to return to school and the coordination of services is just one of the many social work intervention provided to many OPAC families. Sidney is continuing along life’s journey by making the best of her teen years. The End of Life’s Journey A drive to Beaufort County is not out of the ordinary, because home visits are a part of the job for the OPAC social worker. I received a page during the weekend from the aunt of an OPAC patient. September* had suddenly taken ill and was admitted to a local hospital. September’s Aunt Mary had cared for her since September’s mother died nearly 10 years ago. September, now 19 years old, was suffering the same fate as her mother. Aunt Mary requested that the nurse case manager and I come down to visit September in the hospital.   As we started out on our drive to Beaufort, the cell phone rang. It was Aunt Mary with the news that September passed away the night before. In shock, we stopped at the nearest gas station to sit and reminisce about our time with September. We laughed, cried, and shared a bag of September’s favorite chips in her honor.   A few days later we drove down to Beaufort to pay our respects to September. She had a beautiful service. We presented Aunt Mary with a sympathy card from the team. She was also given a Willow Tree Angel….. the Angel of the Spirit, because even though September is no longer here, her spirit will always be a part of us as we continue to fight the battle against HIV/AIDS.   At the end of the day, when the endless paperwork is completed, phone calls returned, and e-mails answered; I can say that I love the work that I do. Many people ask “How can you do your job?” It's easy. I start it with a prayer and I end it by giving thanks for the people who I am able to help along life’s journey. * names have been changed. Editor's note: To honor MUSC social worker accomplishments and bring to light the issues faced by social workers every day, MUSC is celebrating National Social Work Month with a series of articles during March. Each week this month, The Catalyst will spotlight an MUSC social worker with “A Day in the Life of ……,” giving readers a glimpse into a typical medical social worker’s day.     Friday, March 17, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island papers at 849-1778, ext. 201.