How rural stereotypes are being broken in Bulungula

The duo of Bongezwa Sontundu and Khunjulwa Mbi head up the Bulungula health programme

By Ufrieda Ho

Note: This is part two of our Bulungula special feature. Click here for part 1.

A registered nurse, a social worker and one more carer – these are the people

on the human resource wish list for the Bulungula Incubator health programme in the Eastern Cape.

It’s not asking for the moon, but health programme manager Bongezwa Sontundu says the added capacity would mean the four villages covered by the incubator would each have five nomakhayas dedicated to their communities. The addition of a nurse and social worker would help carers with expert input for cases that get tricky.

“We hear many problems and we see many things,” says Sontundu. Nomakhayas, like so many Community Health Workers (CHWs), often become part of the families they visit because it’s becomes a relationship of deep trust and intimate knowledge of the other.

Community health workers (CHWs) are drawn from their communities. They become the people that villagers lean on for everything from medical advice, to problems with a troubled teen, to organising an ID, sometimes helping with providing a meal or getting a sponge bath. In the villages in this remote part of the Wild Coast, it also includes helping many ill people up and down the hills of the coastal villages to get to the ferry that’s the only way to cross the Xhora River to get to the nearest clinic. In emergencies a taxi can be called but it will set a family back R800 for the trip, says Sontundu. An ambulance service exists but its reliability is always questionable and unreliable.

Nomakhayas are the consistent and reliable presence here and this adds to them being an essential element of achieving primary healthcare goals, especially in rural or remote areas.

Meaningful work

Rejane Woodroffe, the director and founding member of the Bulungula Incubator, says their CHW programme represents a form of meaningful work for low-skilled workers. The majority of those in the BI group don’t have high school qualifications. In turn though, their service to their communities helps many who have the least access to healthcare to stop from falling through the system’s cracks.

“A lot of what the nomakhayas do is about re-inforcing common sense and practical ways to live a healthier lifestyle,” says Woodroffe.

From the outset, the BI’s key focus has been on maternal and child health. Woodroffe says it’s a pragmatic intervention that delivers true “developmental bang for your buck”. BI has to make an annual budget from funders of R7 million really count.

She says: “If you start from day one that a woman finds out she’s pregnant and you ensure that that woman gets the right information and care for her and her baby, that kid will grow up to have the best chance of access to having a flourishing life.”

Low cost interventions

The interventions at pregnancy stage are relatively low cost, Woodroffe adds. It’s making pregnancy tests and multi-vitamins available, making sure the mothers to be have good information on nutrition and healthy living and that they attend scheduled clinic visits and antenatal classes.

It’s the nomakhayas who fulfil these roles and they continue to be instrumental when the child is born, honing in on monitoring everything to ensure that children are meeting their developmental milestones.

“It’s the normal things any mother would do, but with the nomakhayas’ assistance mothers can be encouraged to quit smoking or drinking or to eat better. The nomakhayas also monitor children’s growth, what’s going on in the home and they can alert a nurse if they suspect a medical condition,” says Woodroffe.

The nomakhayas are also at the next step of a child’s development – helping at play groups for toddlers and helping prepare them to join one of five pre-primary schools in the area that are run by BI. They even meet with parents for BI programmes like toy making from recycled objects. BI is also working to introduce appropriate technology like an app-based hearing test for children and has already launched online learning for primary school children.

The returns on investing in a child in utero are immense says Woodroffe. She knows this first hand too. The BI’s office in Nqileni, where she’s based, is a rondavel surrounded by other rondavels that are the pre-primary school for the village. All around Woodroffe, every school day, are children making puzzles in their well-resourced library, learning to write their names or reading with a teacher. It’s a no-fee paying school but parents are required to be on a roster to cook the two meals a day provided for the children. It’s a philosophy of putting value on community responsibility not on the amount of money someone has.

After their meals the children rush down the slope from their classrooms to a

trench where they brush their teeth after eating. There’s no running water here, but it’s no excuse for neglecting good hygiene habits. This too builds a value system that emphasises doing rather than focusing on deficiencies.

There’s laughter and giggles, learning and playing – all proof that the BI’s vision is spot on.

More proof that they’re on the right track came this autumn with the announcement that two girls who came through the BI pre-primary ranks in previous years have been shortlisted to attend the prestigious Oprah Winfrey School in Gauteng.

Hope and opportunity

The Bulungula College, another BI project, is also getting ready to open its doors for its first intake of Grade 10 – 12 school children next year. The nearest high school is about 20km away. Parents often can’t afford boarding fees or taxi fares and many children simply drop out.

“We have to give young people hope and opportunities and together with all our partners and collaborators the opening of the college is now happening and it’s a huge project for us,” Woodroffe says.

The college is a bit of a full-circle moment – closing that loop from the foetus in its mother’s womb to a fully grown high school child, ready to take on the world because many hands have helped to get her to that point.