Community health worker testimonials
Community Health Workers (CHWs) play a key role in making the health system work, yet they face poor working conditions, small stipends, and long periods of no-pay and irregular working status. The TAC and SECTION27 have for a long time been trying to improve the plight of CHWs in our country, specifically trying to convince the national Department of Health to finalise the crucial policy on CHWs. More specifically, both organisations have been closely involved in the plight of CHWs in the Free State.
On the 15th of June 2014, over 3 800 CHWs received an email from the Free State Health MEC, ending their services. CHWs and the TAC members held several night vigils in a desperate effort to secure a meeting with the MEC. These night vigils followed a series of unanswered letters that had been sent to the MEC to request a meeting. On the 9th of July, the mostly elderly women were arrested outside Bophelo house. They are currently facing charges of breaking the law and their case continues. In the following pages, the NSP Review attempts to capture their stories.
CARING AND FEEDING
Novimbephi Dina Thedehae, Kutluaning, Odendaalsrus
I became a community healthcare worker in 2001. I was part of a support group called Tsepanang Community care support group. I joined this support group because I could see how people were suffering in my community and some did not want to go to clinics. They would rather be sick at home then join the long queues.
I started giving health talks to people in the community, especially those who were still in denial about their HIV status. The Department of Health then requested us to work with the local clinics and promised to give us a stipend every month. In 2010, Motsoaledi ordered us to do a six-month course in ancillary nursing; we received certificates at the completion of the course.
I was working at Boitusong Clinic before we got fired in June this year. My job entailed checking blood pressures and doing diabetes tests on every patient at the clinic every day. I would also give a health talk to patients at the clinic. Then after, I would take five patient files, collect their treatment from the clinic dispensary and deliver them to the patients’ homes.
One of the challenges I would face when delivering treatment to patients, was that some of patients did not have food to eat before taking treatment. I would then ask the clinic for Philani maize meal and make porridge for those patients before giving them their treatment.
Life has been hard after the termination of our contracts because we lost our source of income. I was the sole breadwinner at home, since my husband is unwell and unemployed. It is even hard that I have a child of school going age and I cannot afford to pay for his schooling. We are now reliant on his child support grant. We spend the whole R300 on food and it is not enough to cover our household needs
‘OUR PATIENTS HAVE BEEN SUFFERING’
Lindiwe Poonyane, JB Mafora, Bloemfontein
I worked for Netcare from the year 2007 until 2009. When my contract ended, I joined an organisation called Christian Free State Leaders Forum (CFSLF) and worked as a community healthcare worker at Batho Clinic. My willingness to help people motivated me to do a course in home-based care. The CFSLF provided us with gloves to use when bathing patients at home.
My work involved giving a health talk at the clinic in the morning, doing TB screenings, and then going to the communities to visit the critically ill, more especially those staying individually. I would clean, bath, cook for the patients and then give them treatment. I also collected different treatments at the clinic on their behalf and delivered them to their respective homes. When a patient did not have food, I used to take Philani porridge from the clinic and prepare it for the patient before giving him/her treatment. We were faced with a shortage of N95 gloves and that exposed us to the risk of contracting TB of all forms. I once contracted TB from caring for a TB patient who was staying alone in a poorly ventilated shack.
Our patients have been suffering ever since we stopped working. One of them is Pebane, a TB patient that defaulted and presented with symptoms of MDR-TB.After he contracted MDR-TB I ensured that he received his medication. After we stopped working, he stopped taking treatment because I could not collect it on his behalf. One day I received a call from his wife because he had become severely ill. We could not find transport to take him to hospital, so we carried him with a wheelbarrow to the clinic. He later died.
LOSING VITAL INTERVENTION
Lesley Kgathole, Thaba-Nchu
Lesley worked as a support group facilitator at Mafani clinic from 2011. The clinic offered potential facilitators a two-week training course. The group was formed to track defaulting patients and to help patients in denial of their HIV status to accept their status. This initiative was mainly targeted at men who were less likely to seek treatment.
Before the start of every session the facilitators would give a health talk to everyone attending the clinic, take out progress cards and register patients, weigh them and do observations of the vital signs including HIV and diabetes tests.
‘As facilitators, we sometimes host the candlelight sessions in our communities. The aim is to try and fight against the stigma associated with HIV,’ says Kgathole. People living with HIV and those who are still in the closet, and the community, are invited to attend. These sessions have brought positive results because now people are coming out and are now more accepting of their HIV status,’ he adds.
‘The clinic is faced with a lot of challenges especially now that we are out of work. Patients are defaulting because of the long waiting period at the clinics, and because of the shortage of staff. Most of my patients are persistently asking me about when I am coming back to work,’ he says.
‘Among the patients that I have been seeing is Tebogo. Tebogo is HIV-positive and had TB as well. He struggled to accept his HIV status and even had to resign at work because of his poor health. After being cured of his TB, he stopped going to the clinic to collect his ARVs. He used to send his wife to collect the ARVs on his behalf but the clinic does not allow someone to collect medication on another person’s behalf more than three times in succession. He has now defaulted because he refuses to collect them himself. If the support group sessions were still running, Tebogo may have accepted his status by now,’ says Kgathole.
FINDING THE POSITIVE
Francis Ramankhathane, Turflaagte, Bloemfontein
Francis Ramankhathane is a husband and a father of four. He was also a rape victim when he was young – an experience that motivated him to help people in need.
Seeing how people with HIV were suffering in the early 2000s, he decided to join the Red Cross as a volunteer. In 2002, Ramankhathane acquired a First Aid certificate and worked as a community healthcare worker. ‘We would visit HIV patients, bath them, feed them and then give them garlic because ARVs were not widely accessible at that time,’ he says.
Just when Ramankhathane was driven by his passion to help the needy, a terrible tragedy was brewing. In 2002, Francis met a man who befriended him as he admired the job that he was doing for his community, not expecting anything in return.
One day, the friend invited him to his house to unwind. When they got to the house, the man pulled out a gun and started raping him. ‘As I was kneeling on the floor, I managed to grab a screwdriver under the bed and stabbed him unexpectedly.’ While the culprit was on the floor, he managed to escape and went back home. This was a very traumatic experience for him. ‘Being raped as a man is very demeaning, especially if you have four children that look up to you as their father,’ he says.
A few months later, he received a call from the rapist saying, ‘You can arrest me if you like but I have already infected you with HIV.’ He couldn’t believe it until he became sick and had his bloods taken. The results came back positive. ‘I shut myself out from the rest of the world, suicidal thoughts persisted as well, but God was there for me. I prayed and attended counselling until I accepted my status and was motivated to help others like me,’ he says.
Eleven years after the incident, he started opening up to people and started giving out talks to people with HIV because he felt empathy for those who were infected. Early this year, he undertook a course in Peer Education and HIV Counselling. In February, he was employed as an HIV counsellor at the MUCPP clinic. Each session entails praying, giving pre-counselling, testing and giving postcounselling to his patients.
He has established a good relationship with his patients. ‘I use an open-door policy with my patients, therefore I sometimes receive calls in the middle of the night from suicidal patients. But I do not mind because I see this job as my calling,’ he says.
Ramankhathane still counsels his patients even after losing his job as a lay counsellor. ‘My goal is to ensure that my community survives and has access to better healthcare services,’ he adds. Since he has been out his job, he relies on sewing as a way of generating income for his children to go school.
A PATIENT’S STORY
No healthcare workers, no dignity
Thandiwe Arens lives with her daughter Bulawa (32) about 15 kilometers from Bloemfontein. The township is made up of clustered shacks, with poor sanitation, communal taps and pit latrines. Most of these shacks are poorly ventilated, which enhances the spread of TB.
Bulawa tells the story of her mother, who was raped in 2010 by three young men, two of whom are her nephews. After raping her, they inserted a bottle inside her vagina and infected her with HIV. The trauma was so severe that she became mentally ill, could not talk and fails to recognise people, including her children. Moreover, Thandiwe cannot bath or feed herself.
Bulawa had to leave work to look after her sick mother. Because Thandiwe would run away each time she saw people around her, Bulawa resorted to chaining her to her bed or chair whenever she had to go out.
We found Thandiwe lying on the floor, with no idea of what was happening around her. Bulawa spoke with so much sadness in her eyes because seeing her mother in this way was very painful for her. ‘Knowing that my mother can not even recognise me and being unable to talk to her is very hard because I know how she was before,’ she says, tears in her eyes.
Thandiwe has just started taking treatment for epilepsy, which calms her down and stops her running away. But, after the community healthcare workers were put out of work, she had to stop taking ARVs, which her CHW had brought to her.
Mammolotsi Matsunyane, Motshabi, Bloemfontein
Community healthcare worker Mammolotsi Matsunyane had been serving her community since 2000, employed by the Department of Health at the Batho Clinic from 7 to 10am, Monday to Friday. She has had to work without uniform or any identification whatsoever. They worked without gloves or masks to protect themselves from contracting airborne diseases.
‘When I started working at the clinic, we were three but the other two had gone back to school. We did it voluntarily then later on a stipend was introduced of R250, in 2002, and now we are given R1 400. It’s not enough as we have to use the same money to assist our patients,’ she says.
When asked about her favourite patient, Ms Matsunyane told us about Irene who had been bed-ridden with bedsores. ‘I had to wash and dress the patient. She took the treatment and is now well and able to take care of herself. Such people motivate me to continue to be a healthcare worker,’ says Matsunyane.
CUTTING JOBS; CUTTING CARE
I started working as a community healthcare worker (CHW) in August 2011; my contract expires in 2016. I was hired by the Department of Health under the medical male circumcision (MMC) programme. Two months later a non-governmental organisation called Lesedi le Chabile came to do a count of CHWs that are actually working in comparison to the number registered, and they ended up taking over.
When I started working, my salary was R1 100, it kept on increasing each year by a R100. This year I was earning R1 400. In March my salary stopped. We were told that the Health Department was having financial constraints, but we were urged to continue working. On 16 June our clinic managers received an email saying all CHW contracts had been terminated. I then went to the district manager to find out what was happening; he said he doesn’t answer to anyone but the head of department of the province.
I stay with five of my siblings; both our parents passed away and I was the sole bread winner. I am now doing piece jobs such as gardening in order to get money for food. Some days you find that there are no available jobs to do. I then go to the other CHWs and ask for help with food or money. We now survive on R10 electricity vouchers, just for cooking. It is really hard managing the home situation and also being the representative of all the CHWs in meetings. Sometimes I cannot go to find work because I am needed at a meeting. Attending these meetings also requires money for transport; it is so frustrating that I sometimes cannot afford even a taxi to town. The other CHWs sometimes give me money for transport to meetings because they know my situation.
Even today I still get men that come to my place and ask for both pre and post-counselling for medical male circumcision. I help them because I am passionate about my job and want to help the department reach the targeted number of MMCs performed. Initially, patients would come to me and ask for pre-counselling and I would counsel them. I would also give transport money to those who could not afford to go to hospital.
There is another patient by the name of Tello Radipodu, who is both HIV positive and has TB. He is bedridden and was benefiting a lot from the services of CHWs. He is unable to go to the clinic to collect his ARVs and the TB treatment. I still visit him but it pains me that I cannot collect treatment on his behalf, because the MEC Benny Malakoane gave an order that CHWs should be arrested if they are seen in the clinics. Tello has gone for days without both his treatment and I fear that his TB will advance to MDR (multidrug-resistant TB) because he has defaulted.
Patients and nurses at the clinics are begging us to go back to work because some are dying since we stopped working. Last month three died from my clinic because they had no carer. Some of the terminally ill patients do not receive care from their families. We, as CHWs, help reduce that burden by helping them with their treatment – we bath them and cook for them. We assess the patients and organise transport for those who need transportation to the hospital.
We are willing to go back to work for three months without pay to help the people that are suffering, but the MEC wants nothing to do with us. I feel that without CHWs there is no health service.
A LIFE OF SERVICE
Lahliwe Khanare, Ipopeng, Bloemfontein
Lahliwe Khanare first started working as a community health care worker in 1999. ‘I have always had a heart for people. My sister died of HIV. I saw how she struggled and with no one to support her and be there for her. I thought that I would like to make a difference in people’s lives so that they do not have to go through this alone,’ she says.
She has been a health community care worker at MUCCP clinic for 15 years, having trained in the TB DOT programme and done a home-based care course. ‘I have spent most of my life here. Nurses have come and gone and left me here. I even taught some of the young nurses who came to the clinic.’
As part of the Department of Health pilot programme, and paid a stipend of R250 a month, Khanare was supposed to work for only four hours a day, five days a week but there was too much work and not enough hours.
When Khanare’s stipend was increased to R1 400, she still did not get any medical aid or pension fund benefits from the Department of Health. She would like the department to employ her permanently, saying that the Department needs to invest in them as they have invested their time and energy in service to the Department. ‘When we started we were 82 and now there are only two of us left here. They told us we don’t qualify because we don’t have matric, yet when I came here I was 32 and today I am 49. There is no one who will employ me now. All I know is to be a healthcare worker. The Department must do right by us,’ says Khanare.
CARING FOR THE COMMUNITY
Elizabeth Sekoto, a Free State community healthcare worker
I live in Bloemfontein, in an area called Phase Two. In 2006, I did a course in home-based care. I then joined an organisation called Philani Home-Based Care as a volunteer. In 2012, I joined an organisation called Khonzani community healthcare workers, which works with the Oranje Psychiatric Hospital. I joined this organisation because I could see how people with mental disabilities were dying and not many people were interested in helping them.
I visited seven patients from three townships every day. I collected their treatment from the hospital and delivered it to their homes. Everyday I bathed, cooked and cleaned for my patients, who were unable to do things for themselves. After every visit, I had to report to the matron about the health progress of my patients.
At the hospital, some of the mentally ill patients became aggressive. These patients would sometimes beat us up and take our reading glasses. As community healthcare workers, we could not be protected from the aggressive patients because we were not permanent. Only the student nurses and professional nurses could be protected from those patients.
Four of the seven patients that I cared for have died since we stopped working; this is mainly because some were reliant on me doing things for them as they were unable to help themselves. Also, some had no transport money to come to the clinic for treatment and ended up defaulting.