Communities suffer as healthcare denied: Free State CHWs still dismissed

Virginia is a small gold mining town in the Free State. This once-lively town has slowed down significantly, with only a few of the mines still operational. The streets are quiet, and the first petrol station heading into the township closed years ago. Many of the residents describe it as a ghost town.

However, there is another challenge facing this mining town, not obvious if you are simply passing through. In June 2013, Dr Benny Malakoane, the MEC for Health in the province, dismissed over 3 000 community healthcare workers (CHWs). In doing so, he severed the only dignified and, for many, lifesaving connection to the public health-care system for thousands of poor people. These are people who were reliant on CHWs to bring them their medication, bathe them and often make sure they had a meal. With the loss of the CHWs, families have lost loved ones, children have become orphans and hundreds of people have lost lives that could have been saved.

Tears come to Diekesteng Malunga’s eyes when she talks about all the people that have died since she was dismissed from her job.

Diekesteng, known to the community as “Mma Mokoena”, lives in Meloding Township, Zone 14. It is only 10 minutes away from the town of Virginia, but the dusty shack-lined streets make it seem a world away. Mma Mokoena had been a CHW for 15 years. She started volunteering her time to the sick and needy within her community long before she became known as a “community health-care worker”.
“When we started this thing, we noticed that there were a lot of people suffering in our community, because they were sick and had nobody to help them,” she says. During the early 90s there was very little understanding of HIV/AIDS and people who had the disease were treated as outcasts, and had no support system.

“These people were sick and their families wanted nothing to do with them,” she says. In light of this, Mma Mokoena and another group of women banded together and started going door-to-door to see if there were any sick people who needed assistance. That was in 2000 and Mma Mokeona has not missed a single day since. She has served the community of Zone 14 selflessly, earning her reputation as the community’s “go-to woman”. Many of the people that have showed up on her doorstep over the years have been referred to her by neighbours and other patients.

“Why must people die?”
Sabelo Motaung (not his real name) was in his final school year when his mother, Nthabiseng, suffered a stroke. His father had passed away when he was younger and it was left to him to take care of both his ill mother and his older brother, who is mentally unwell.
In the beginning, the neighbours were willing to help Sabelo by taking care of his mother while he was away at school. But as her health deteriorated and the situation got worse, people stopped coming to help. Sabelo struggled to balance his studies with caring for his mother. Overwhelmed, he went to the local clinic to ask for assistance.
“I told them my mother was sick and that I needed help, but they told me that they couldn’t do anything unless she came to the clinic herself,” he says.

The local clinics do not allow anybody else other than patients to collect their medication. CHWs were the only people who were allowed to collect their patients’ medication on their behalf and, when they were dismissed, many people stopped taking their medication because they were unable to make it to the clinic. Those who try often return home empty handed, having not made it to the front of the queue by the end of the day.
After being turned away from the clinic, Sabelo went home and did what he could for his mother, but on his own after the dismissal of CHWs there was not much he could do. His neighbours then insisted he call Mma Mokoena. Despite having lost her job, Mma Mokoena didn’t hesitate to help Sabelo. “I will never forget what I saw at that house,” says Mma Mokoena.

When she arrived at the house, she found Nthabiseng lying in a cockroach-infested bed, with bottles of various medication by her bedside table. Nthabiseng had soiled herself and someone had removed her underwear and wrapped her lower body in plastic in an attempt to prevent her from soiling her sheets even further. “The first thing I did was undress her so that I could wash her, and as I started to wash her I found maggots coming out of her lower body,” said Mma Mokoena.
Nthabiseng was taken to the hospital, but they sent her back home, saying there wasn’t anything more they could do for her. She died a few days later. “It hurts me that people have to die, when we are here to help people. Why must people die?” Although his mother did not live, Sabelo says that her last days were a relief to him.

“When Mma Mokoena came, she did everything for my mother, she treated her like a baby even though she was older than her,” he says. He believes that Mma Mokeona may have been able to save his mother’s life, if she had gotten to them sooner.

“I just wish that whoever employs her can give her her job back because she is doing such important work. For those of us who have no one, she is everything,” he says.

An opportunity for human contact
Mma Mokoena still attends to five of her most critical patients every day. One of these patients is Mpho Dihlopo. Mpho (51) has been ill since 2001. He was diagnosed with a heart disease and HIV. When his family heard that he had HIV they disowned him and left him to live alone in a two-roomed windowless house. Sick, alone and dying, in a desperate attempt to get help, Mpho got out of bed and crawled along the streets holding onto fences and anything that could support him. That is how he arrived at Mma Mokoena’s house.

“She let me in and I just said, ‘Mma Mokoena, I am suffering and I am hungry’,” he says.
Mma Mokoena did not ask him any questions. She went straight to the kitchen and began to cook for him. At the time, Mpho was very weak and had no appetite.
“She started feeding me soft porridge to drink, and she would make me eat so that I could get a little stronger,” he says. For the 14 years since that day, Mma Mokoena arrives at Mpho’s house every morning to check on him. For Mpho, these morning visits are more than just a check in, they are an opportunity for human contact. “It helps me so much when I just sit and chat to her, when I have someone to talk to even for a few minutes each day, my heart feels much lighter,” he says.
On days when Mpho feels a little bit stronger he is able to walk to Mma Mokoena’s house for his evening meal. He attributes what little strength he has to her care. “If it wasn’t for her, I wouldn’t be here.”

An invaluable asset
The battle is to get the CHWs reinstated. The issue is more than just ensuring the CHWs have money to put food on the table, it is about making sure that the public health-care system in South Africa works for those on the periphery. CHWs are an invaluable asset to the country’s health-care system. Other than providing support to people who are in the system, they also play an important role in identifying people who have fallen on the wayside, and those in rooms with no windows. They are able to track people who have defaulted on their treatment and ensure that they are monitored.

Zone 14 is just one example of a community that is suffering without the assistance of CHWs. All over the country, there are hundreds of patients who are losing hope of ever getting better, patients who are dying just because they cannot get their medication and are patients who are dying every day, betrayed by the very health-care system that promises them life.