Foot soldiers of the health system: It’s election time which means men and women in party regalia take to the streets, podiums, loudhailers and stadiums. Invariably they tell people about all the good and wonderful things they have done or plan to do in the health system. SECTION27’s Nomatter Ndebele and photojournalist Thom Pierce travelled the roads of South Africa in search of the foot soldiers of the health system, the men and women who quietly get on with doing the job and saving lives, often without any acknowledgement.
Umsebenzi wama CHW. (The work of CHW’s) – Bringing hope and life to the community of Sweetwaters
Three years ago Doris Ntuli and her fellow Community Healthcare Workers (CHWs) Nhlanhla Makhaya and Sindi Zondi took Spotlight from house to house on a tour of Sweetwaters in KwaZulu-Natal where the trio worked for a paltry R1 800 per month, caring for extremely ill people in their homes. They had no resources, which means they had no gloves, no soap, no bandages, and no support from those in power. At the time Spotlight published an iconic photograph of CHWs using old bread bags as gloves as they washed patients at home. Last week Spotlight returned to Sweetwaters and found the trio.
The last time we saw 78-year-old Gogo Tholana in July 2016, she was living alone in a bare rondavel in the hills of Sweetwaters. She had been ill for two years, suffering from a serious and possibly fatal kidney infection. She was bed ridden, her skin was ashen, she was stick thin and was wearing nappies. When she spoke she was almost inaudible, and was barely able to sit up. Day in and day out, she lay on a thin mattress in her rondavel, a few meters away from a fire place. Her only source of heat in the rondavel. She would have to wait until Doris Ntuli or another CHW came to check on her, to ask them to light a fire for her.
This time, almost three years to the day we met Gogo Tholana, we are led a little bit further down the hill, her rondavel is still there, but there is a gold latch dangling on the door. A few hundred meters from the rondavel is a big four-roomed house, and in bedroom number two (all the doors are numbered) we hear a loud voice saying “ Ah, you’re here”. We wait while the CHWs enter the room 2, and now there are sounds of laughter and excitement emanating from it.
The trio of CHWs file out of the room, with a sparkle in their eyes and finally a large ever present woman, dressed in a baby blue gown stands up straight in the doorway.
The person standing in the door way is a healthy weight, her skin is bright and she has a wide cheeky smile on her face. It is almost unbelievable, that this was the helpless woman lying in a bare rondavel, whose only access to healthcare was through three dedicated CHWs who never missed a single day in attending to her, feeding her, bathing her, clothing her, washing her sheets, washing her clothes and telling her silly jokes to keep her spirits up.
The woman who stands in front of us now, clearly cheated death.
“Umsebenzi wa Labantwana ongivusileyo (It is the work of these kids that bought me back),” says Gogo while she points at the three CHWs. My skin was black, I couldn’t move, I tried my best to shuffle across the room to try and relieve myself, but I could not move to urinate, so I had no choice but to urinate on the mattress I was lying on,” she recalls.
From this single example it is clear how Doris Ntuli and her team of CHWs have impacted on lives in the community. However, on the flipside, sadly very little has changed for the CHWs themselves. Other than a salary increase implemented earlier this year, shiny name tags, and branded backpacks from the department of health, not much else has changed.
The backpacks cling limply to their backs, as the women make their rounds by foot, visiting the 60 households they look after. There is nothing in the bags to assist them in doing their work. The CHW’s still don’t have the resources they need, they do not have a transport subsidy, not an airtime subsidy, there are no masks to prevent them from contracting communicable diseases, and often times, they still don’t have gloves to wear. This while they care for patients the public health system no longer cares for in any other way.
“A few months ago, we did a TB program, we walked up and down these hills collecting sputum, with no masks or gloves. We then had to walk a long way to the central point where we had to deliver these (sputum) bottles. So many of our colleagues have died, and many more continue to die from contracting TB and other diseases, as we have no means for infection control,” says Nhlanhla .
In meetings and workshops in roundtables, politicians and health department workers will speak of war rooms and the importance of CHWs, but ask these CHWs and they will tell you that when they report their challenges to the “war room” the only ones who respond is the Department of Agriculture. The departments of health and social development are mostly no shows. Many of the issues the CHWs encounter require the assistance of social workers in order to assist the community in attaining ID documents, grants and food parcels. As it was three years ago, Doris and the team still take food from their own homes to feed their patients.
“The patients will hold their medication in their hands and say, I have no food- How can I take this medication,” says Sindi.
From their salary of R3 500, they must look after their own families, as well as all their patients. “By the time we get paid, the money Is already gone,” said Sindi
“When we arrive at a household, if there are ten people living there, we attend to every single person. We check the elderly for chronic diseases, we ensure that babies in the household have been immunized, we check their growth, and after all the health aspects, we deal with the social issues- some are being abused, most are unemployed, others have no means of accessing a grant- and all of that is on us,” says Sindi .
As they walk along the streets, community members wave, shouting greetings at them, “Hello Nurse, Hello social worker!”
“That’s what they call us, but our actual titles are just CHW’s,” says Nonhlanhla. The community has so much faith in the trio, that sometimes the terms of endearment weigh heavily on them, particularly when they are unable to provide the assistance people need. Never due to a lack of effort on their own part, but rather because the system they are made to work in, provides them with no support. The situation begs the question, why do they bother?
Each of the CHW’s are bound to their work by this inherent need to help. The idea of community and care is one they hold in high regard, “You cannot see trouble next door and just look away,” says Nhlanhla.
For Sindi though, it was the death of her cousin who died from AIDS that lead her to caring for the community. “My cousin was so ill, he bled from everywhere possible, his ears, nose, mouth, he bled from every opening in his body, he never told us what was wrong, he died from the disease, but it was also the way he was treated that killed him. He started to notice that he was being served with the same dish and spoon everyday- we didn’t know better then. But when he died, I vowed to myself that I was never going to let another person die like that, not under my watch”
And so she joined Doris and Nonhlanhla in taking care of the community of Sweetwaters. The trio is unstoppable, there isn’t a hill they won’t climb, not a story they won’t listen to and not a single house they will pass. Unknown to the high ranking officials of the Department of Health, these three woman live and breathe the principals of Batho Pele.
With what little they have, they ensure that the community comes first in every way. And while the country prepares to mark a change with an (x) these foot soldiers are committed to bringing change and hope that is far more tangible, than that of a ballot box.