All the fighting and the post mortems of the Ndlovu contract ending are pointless for Michael Mampuru and his wife Colet. Both were clients at Limpopo’s Ndlovu, receiving ARV treatment and care there.
“They are sending me to those other clinics to die,” says Michael. He’s a hulk of a man at 55 but remembers a time when he was almost defeated by HIV. He credits his recovery and his good health today to the care he received at Ndlovu.
“When I came here in 2014, my wife held me up on one side and my sister held me on the other side, I couldn’t stand. I slept here for two weeks, they looked after me, they fed me and I got healthy.
“I don’t know what we will find that side. The government doesn’t care about us; I think we voted for them to kill us,” says Michael in Afrikaans and Sepedi.
He and Colet recount their experiences seated at wooden patio benches and tables. This is the patient overflow waiting area. It is spotless. It is also meant to be functional and patient-friendly. These little things, says Colet and Michael, made all the difference to their care at Ndlovu.
“They check everything nicely here, they do my Pap smear every year even when I forget and they know if you are drinking your pills properly because they talk to you– and we pay nothing,” she says.
Ndlovu does have other noteworthy features like a biometric patient identification system for better data capturing, record keeping and queue management. The facility reports that it’s never run out of medicines because of good stock management, they have private consulting rooms, equipment that works and adequate staffing.
The entire township of Elandsdoorn has an undeniable Ndlovu footprint. Over the years NCG set up a crèche, a children’s choir, a gym, a theatre and attractive accommodation meant to attract doctors and specialists to this remote part of the province.
With the non-renewal of the state contract however, 28 people at Ndlovu were retrenched in July. It’s raised fears about Ndlovu’s immediate viability as an employer and anchor in the area where there are already few jobs.
The Mampurus linger before driving off. They shake hands and hug staff, including Dr Hugo Tempelman, CEO of Ndlovu. Tempelman founded the clinic in 1994. He arrived in the country in 1990 as a young doctor from the Netherlands, intent on improving rural healthcare in Africa. He raised donor funds from Europe and introduced free ARV treatment in 2003 before the government launched its ARV programme a year later. From 2007 till 2014 Ndlovu ran the programme with US government Pepfar funding and since 2014 ran it with funds from Limpopo DoH.
In answering the SAHRC’s concerns, Tempelman says that they have always maintained multiple bank accounts managed by a trust to ensure clear separation of funding streams and to enable proper auditing. He says their contract was worth R10.8-million last year – that covered operational costs. Laboratory costs and medicines were provided by the state. It was not the inflated numbers he says have been bandied about.
“I will not say that we were cheaper, but we gave cost-effective care that’s provided patients with a counsellor, a nurse and a doctor. And it worked because we had at least 93 percent of our patients remaining on first-line treatment without a detectable viral load,” he says.
He adds that their research on HIV prevention and co-morbidity of HIV with other chronic conditions has been undertaken with approval by the Limpopo ethical research committee and they adhere to standard medical research protocols and reporting.
“Instead of the wild accusations, lies and confusion I invite anyone to come to do audits or to see our reports – we welcome it,” he says.
Soon after he started the clinic in 1994 Tempelman realised medicine alone would not be enough, so he started food security and early childhood development programmes. NCG also installed much-needed water harvesting and solar panels throughout the township.
Ndlovu has also developed specialised medical units including one focused on cervical cancer screening, diagnosis and treatment and a programme aimed at preventing hearing loss.
Tempelman admits the transfer process has become highly charged, unnecessarily personal and bitter. He insists too that it’s not a case of Ndlovu wanting to cling onto the contract.
“We would be happy to hand over this programme to government. We did this with our ART programme in Bushbuckridge last year. As an NGO we want to work embedded and in cooperation with government. But here in Limpopo we know there are problems and we know patients will suffer,” he says.
Tempelman has, since the transfer, been the target of racial abuse and being demonised as the white man playing saviour to black patients. He says these slurs are distractions and he insists Ndlovu’s operations will continue because the need in the community remains.
Herbert Boltini is an ARV client and employee at Ndlovu. He’s also one of the three patients who brought the case against the Limpopo Department of Health and his employer (NCG was cited for its involvement in the matter but the applicants did not seek any orders against the organisation).
Boltini says his fears about the state-run clinics are based on first-hand experience. He also works as community liaison officer for Ndlovu, which means he visits surrounding clinics and meets with staff there regularly.
“They will always tell you that they’re understaffed and that people will start waiting at 6am and only leave late,” he says.
His own daughter, he says, was ignored for over two hours when he recently had to rush her to an emergency after her leg was severely cut open. Members of his sister’s family complain about long queues and being sent away without medication for chronic illnesses. The clinics he has fingered are Philadelphia, Kwarrielaagte and Elandsdoorn clinics – all three are catchment clinics for transfer patients.
“Patients were not consulted and this decision by the MEC is pure jealousy of what Ndlovu has achieved. The government cannot brag about me when I am one of those who received ARVs from Ndlovu in 2003 when the government was still talking about garlic, beetroot and olive oil,” says Boltini.
He adds: “We are engaging with our lawyers because the DoH failed to submit their findings with the OHSC input on time. We want the MEC to acknowledge the good job that Ndlovu has done. She can find ways to reduce costs without cutting the Ndlovu programme and treating patients like objects she can just move around,” he says.
It’s now a game of wait and see as legal wrangles and monitoring continues. But for 3774 people, what lies ahead is not a game – it’s a matter of life and death.
- The Limpopo DoH’s communications manager Neil Shikwambana initially agreed to a ‘Spotlight’ interview with MEC Ramathuba but then failed to respond to any subsequent communication. He also failed to respond to questions emailed to him.
- NOTE: While Spotlight is published by SECTION27 and the Treatment Action Campaign, its editors have full editorial independence – independence that the editors guard jealously. Spotlight is a member of the South African Press Council.