Village Clinic: Access delayed is access denied
On the first day of September 2015, two trucks clear a large plot of land to lay the foundation of the new Village Clinic. This should be a moment for celebration but Nonyameko Ntiyo is exasperated; construction of the clinic is long overdue.
Nonyameko is one of the patients of Lusikisiki Village Clinic who participated in an application to the Eastern Cape High Court declaring the relocation of The Village Clinic by the Eastern Cape Department of Health to inferior and inadequate facilities a violation of her constitutional right of access to health-care services. In the application filed in May 2013, the Treatment Action Campaign (TAC) requested the High Court to direct the Eastern Cape Health Department to provide a plan with clear timeframes indicating the short and long term plans the department would take to restore the adequate health-care services to the patients served by The Village Clinic. The department and the TAC reached a settlement, which was made an order of the court in November 2013. So began the long wait for the construction of a large permanent clinic in Lusikisiki.
The health facility has been a site of contention since it was erected in 2013 to replace a clinic inexplicably moved by the department in December 2012. Lusikisiki Village Clinic began as a park home. In 2004, nonprofit organisation Médecins Sans Frontières (MSF) added a second park home when it started its antiretroviral treatment campaign. Following interventions from MSF, the clinic was moved into a building formerly owned by mining giants AngloGold Ashanti in 2005 and a year later MSF handed it back to the department. The department ran the facility successfully until December 2012 when suddenly, and without explanation, it closed the clinic. In its place, the department erected tents as a clinic and an old park home as a dispensary on an open piece of land. The facility had no ablution facilities and patients were forced to use pit latrines on land owned by the Department of Public Works. There was no running water or electricity, a situation that prevented nursing staff from performing essential life-saving screens for pap-smears that detect cervical cancer, a condition for which women living with HIV are at higher risk.
Unhappy with the facility, the community of Lusikisiki took action. They approached the TAC, which acted on their behalf in the matter that resulted in a settlement. Following the settlement, the department built a temporary structure comprising two park homes. The first has a reception area and three offices, used as consulting rooms by doctors and nurses, and the second is the dispensary. It is here that Nonyameko comes to collect her ARV treatment each month.
When Nonyameko Ntiyo discovered she was HIV-positive in 2004, she immediately began lifesaving antiretroviral therapy, which she takes religiously except when there are drug shortages at The Village Clinic, as she testified in her affidavit. “I am living with HIV and am on ARVs. I also have tuberculosis and am receiving treatment for it. I use Village Clinic to collect my treatment and for any other medical issues that I may have. I have had difficulty getting my treatment since January 2013,” she explained. “In January, Village Clinic ran out of 3TC and I had to borrow pills from my neighbour. In February 2013, the clinic ran out of Kaletra, medication for the treatment of tuberculosis.” Nonyameko conducted a sit-in to make the point that she had the right to treatment and she did not want to default, yet the clinic continued in its failure to provide her with the treatment she needed.
According to Dr Willem Venter, a doctor with extensive experience in treating people living with HIV (PLHIV), “Patients must adhere to the treatment for it to be successful. Adherence rates of over 90 percent are required for HAART to be successful. Without access to HAART, HIV will progress to AIDS and the PLHIV will eventually die of an AIDS-related illness.” Nonyameko’s difficulties continue: when she heard her current medication, Abacavir, was not available at Village Clinic in its current home, she recounted her struggle to access the lifesaving treatment.
“I came to Village Clinic in April but they didn’t have my pills,” she recalls. “The nurses at the clinic said that the issue is at the depot but they told me to go to St Elizabeth to fetch them, where I only got two weeks’ worth of pills.”
Nonyameko lives in Mevana, some distance from Lusikisiki’s St. Elizabeth Hospital. She must take three taxis to reach the hospital and at R10 for each taxi, a return journey costs her R30 – a trip she can’t afford to make more than once a month because she is unemployed and survives on her disability grant. “I can’t keep going to the hospital, I don’t have the money. And my file is kept here at Village Clinic, so I wonder why my pills were not ordered,” she says. “In June, I returned to the clinic and still there were no pills.” Supply was finally restored in August, but Nonyameko is in constant fear that the next time she comes, her medication will not be available.
Correspondence with the Department of Health reveals slow progress in building a suitable clinic. Protracted negotiations for an appropriately located and large enough piece of land resulted in delays. Now that the land has been secured, the department says it will take another 18 months to construct a facility that will meet the needs of the people of Lusikisiki.
In the interim, mothers carry children wrapped in massive blankets and old women hunch over, bundled in coats to shield them against the cold, on their way to two pre-fabricated buildings on an open piece of ground. Once there, they huddle together on chairs outside the structure, waiting to gain access to the cramped clinic. The only shelter they have against the freezing wind is a corrugated iron roof on poles and no walls, sandwiched between the two park homes that serve as the clinic and the dispensary at Village Clinic.