#FootSoldiers: Do the work that nobody wants to do
Dr Marlisa Van Rensburg keeps a meticulous register of every tuberculosis (TB) patient she has ever seen. To date, she has seen 5 050 patients at Tshepong Hospital in Klerksdorp in the North West province. She has the names of each and every patient. “It helps me track if patients are coming back,” she says nonchalantly, but from the way she speaks about her work, one can tell these are more than just numbers to her.
At the start of the nineties, very few doctors were willing to take up the fight against TB. Faced with the option of Oncology or TB, Van Rensburg opted for TB. “I believed that there was hope with TB, it’s curable, with cancer it’s not so easy,” said Van Rensburg. But more than just taking the “easier” path, Van Rensburg chose to follow the words of businessman Anton Rupert who she recalls saying the following soon after the end of apartheid: “Things are changing, and you must accept that change. You must find the work that nobody wants to do, and when you find that job, you must do it well.”
It was those words and the need to spread hope that Van Rensburg took to her work in treating TB patients. Later, she carried the same attitude towards drug resistant TB patients.
In 2000 the Department of health opened a TB unit at the Tshepong Hospital. Since then Van Rensburg has worked alongside her colleague Dr Hannetjie Ferreira. The two doctors and a complement of dedicated nurses and admin staff started to cure patients who arrived at the unit on deaths door. In that first year the clinic saw 56 patients, and now in 2019, the unit sees at least 56 patients in a month. Later, Van Rensburg reveals that her register also contains data on their yearly death and cure rate at the facility. She says that in 2015, the Tshepong XDR TB unit had the best cure rate in the country at 80%.
Although the TB Unit is attached to Tshepong hospital, it is not part of the main hospital building. At the TB unit patients and the unit staff interact as old friends, little children are playing together, and there are patients seated outside in a garden lapa that is surrounded by white roses. The nurses jokingly refer to the facility as “our holiday resort” .
As we walk through the unit, there are very few patients lying in the wards. Those that are in the wards, are there for a simple lie down, not because they feel ill. There are patients milling about the communal cooking space, walking about the corridors and chatting to each other cheerfully. But perhaps the most striking thing about the “resort” is that in both the MDR and XDR sections of the unit- there isn’t a single healthcare provider who walks around in a TB Mask.
Instead, the unit is kitted out with Ultraviolet germicidal light (UVC lights that kill the TB bacteria within a 3 metre radius. There are no curtains in the facility , as a practical measure to ensure that windows are always open. The patients are highly educated about infection control as well as the importance of taking their treatment. Although the patients are referred to as patients, they are not made to feel as though they are just another number. The hospital staff and the patients are a tight knit group who know each other by name and are always stopping during their rounds to enquire about how the patients are doing, not just medically, but also emotionally and socially.
Other than being a TB expert, Van Rensburg also doubles up as a social worker. Often times her patients come from impoverished backgrounds, facing many social ills. Van Rensburg then takes it upon herself to engage the department of social development to ensure that her patients have access to which ever kind of grant that will assist them the most.
“Many of our patients come from the surrounding areas, and we know how difficult things are there for them, so we try to do more than just assist them medically,” explains Van Rensburg.
One such patient who has required extra social support is a little 14-year-old boy called Sam*. Sam has been at the Tshepong TB unit for the past two years. One afternoon, Sam came home from school feeling unwell, with a constant cough. Eventually his father took him to Tshepong hospital to be seen to, but he never came back for him.
Sam has now been at the facility for the past two years, diagnosed with drug-resistant TB. During his initial admission Sam was diagnosed with TB. When he was discharged into the care of his mother, he stopped taking treatment. By the time he made his way back to the facility he had drug-resistant TB.
“Sam is a troubled boy, he comes from a very bad background, we tried to put him in a foster home, but he would always run away to go back to his mother. We’ve decided to keep him at the facility until the end of his course, but I do not know what we’re going to do with him after that,” says Van Rensburg.
Sam’s tiny frame balances delicately on a hospital bed in the ward, he is very small for his age, his forearms are covered in mosquito bites, and he keeps his forefinger to his lips, moving it only to answer questions very quietly. “My mom has never come to see me, not once. And I really miss her. The nurses look after me here, but I do get bored. All I ever do is lie around, watch TV, sometimes I want to play pool, but nobody really wants to play with me,” he says.
Surprisingly, his face lights up when he starts to speak about politics. He is quite assertive in his beliefs “If I could vote, I would vote for Cyril Ramaphosa, I hate Zuma. Actually, Zuma should have died, not Nelson Mandela,” he says.
Under the care of Van Rensburg and the staff at the Tshepong TB unit, Sam is expected to make a full recovery.
“The greatest thing is that when these people come, they are at deaths door, but by the time they leave, they are dancing out of here,” said Van Rensburg
But with the 2018 North West strikes and other chronic problems in the public healthcare system the job is not always easy. Last year Van Rensburg did not receive a salary for a period of three months, due to complications with the renewal of her contract. Despite that, she showed up for work every single day. Her reason?
“Some sucker has got to do it”
*Name has been changed to protect the patients identity as he is a minor.
- 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.