PR and platitudes

By Ufrieda Ho

It’s ‛good governance’ week for the Public Protector’s office at the beginning of October and officials are going through the motions of holding a community meeting in Vosloorus. The meeting is however, already running over an hour behind schedule.

The delay, representatives from the office say, is because a team has been dispatched to do a spot

Crowds gather for a “Good Governance” week hosted by the Public Protector’s Office in Vosloorus. It’s set up to allow the community to air its grievances.
Crowds gather for a “Good Governance” week hosted by the Public Protector’s Office in Vosloorus. It’s set up to allow the community to air its grievances.

inspection of the beleaguered Thelle Mogoerane Hospital (formerly Natalspruit), the regional hospital in the south of Vosloorus.

The crowds that have been gathering in the community hall are patient because they want officials to return to finally validate their complaints, to see for themselves what community members who rely on this facility have been complaining about for years.

Thelle Mogoerane Hospital has been singled out for being in shambles for years due to severe staff shortages, negligence from nurses and doctors and bad attitudes from staff. Complaints also include sick people waiting for four or five hours to be attended to, and patients being left on stretchers in corridors for hours before they are seen by a doctor.

The Treatment Action Campaign’s National Women’s Representative, Portia Serobe, says the TAC’s protests outside the Thelle Mogoerane Hospital at the end of September were successful in putting the problems at the hospital on the radar.

‛We can claim this meeting taking place here in Vosloorus as a victory for TAC, but we still need answers, we still need solutions because every day we hear new cases of patients who are ill-treated, and it’s not just this hospital, it’s across the East Rand,’ says Serobe.

The hospital, though, continues to make headlines for the wrong reasons. The Democratic Alliance early this year reported that there was a staff shortage of 382 members at Thelle Mogoerane. The Department of Health, in answering the opposition’s questions, confirmed that staff had been lost because of being overburdened and because of transport problems getting to and from work.

The TAC continues to report on understaffing, unsanitary conditions, the long delays in providing treatment, and negligence.

According to the numbers provided in March this year from the Gauteng Department of Health, the hospital was down to 1,683 staff members. There were 198 nursing vacancies, 87 vacancies in administration and 46 vacancies for doctors.

The DA also noted the long waiting times for patients to be attended to, even in high priority emergency cases, and a failure from management to plot a turnaround strategy.

Back at the Vosloorus community meeting, the minutes tick by and the crowd (about 200 that have gathered since the morning) is still waiting for the meeting to begin.

Finally, the officials take their spots on the stage. The Public Protector’s office staff are joined by other government officials including those from the Master of the Court and the Department of Health.

Each person has time to give a speech. They say little that’s enlightening or specific to the concerns of this community, little that is not a regurgitated bureaucratic line, or an outline of mandates. The officials give out cellphone numbers and numbers for complaint hotlines and they speak about processes and procedures to have complaints dealt with.

The truth, say TAC activists, is that many calls go unanswered and even when complaints are successfully laid, they are seldom dealt with. More often, they’re simply noted and recorded with a reference number.

Then the officials who have returned from the spot inspection at Thelle Mogoerane say they will not be reporting back that day; they will go away and investigate further. The disappointment in the crowd is tangible.

As the TAC activists point out later, the officials say nothing about committing to a timeframe for a future gathering. They don’t talk about a plan of action or consequences for facilities that keep on failing. They don’t talk about a remedy to anyone’s problems – problems that cost lives.

At the end of the meeting there is, however, opportunity to hear a few public testimonies, and people insist on speaking up. As impotent as raising their concerns may seem, it feels like the closest thing they have to power. Yet, as important as it is to be heard, the more hardened activists seem aware that being heard is, in itself, not enough. In fact, there is a trap in thinking that, just because you told people about your problem, they will do anything about it.

Let the voices by heard

Gloria Mnguni

In July this year, the taxi Gloria Mnguni (49) was travelling in was involved in an accident. She hit

Gloria Mnguni
Gloria Mnguni

her forehead in the crash and suffered injuries to her leg, and was taken to Thelle Mogoerane Hospital.

‛It was about 7 pm when we got to the Thelle Mogoerane Hospital. At 11 pm I was still waiting. By then my son had come to meet me at the hospital. When he tried to intervene, the doctor came but he all he did was ask me questions like if I had been vomiting, and then he said I didn’t have problem and I would be fine. They didn’t take X-rays or anything, they just gave me some pills and didn’t tell me if they were pain pills, or what,’ she says.

But days later she didn’t feel fine. Her head was throbbing, her neck was stiff, she had severe headaches and her leg was swollen and painful.

Mnguni returned to the hospital but now she was told there was no record of her being at the hospital or the accident ever happening. She had no file, she was told.

‛The nurses don’t wear their name tags so that you can’t complain about them,’ she says.

Mnguni was given injections for the pain and sent home. Two and half months later she still shuffles when she walks, and says her neck still gives her trouble. She starts to cry out of sheer frustrations at having to deal with the pain and the indignity of being treated so dismissively by hospital staff.

‛I’m the breadwinner for my three children, but now I can’t even do my piece job,’ she says through her tears.

Agnes Banda

‛They don’t respect patients, especially the elderly,’ says Agnes Banda (53) of the Thelle Mogoerane Hospital staff.

Banda’s neighbour, Sipho Radebe, was involved in a car accident in the middle of September. The

Agnes Banda
Agnes Banda

Vosloorus man was admitted to the hospital and admitted for a week, she says. He had to bring his own blankets because the hospital didn’t have enough bedding. He also complained about pain in his ribs but was never given a single X-ray, she says.

Radebe was discharged after a week but just days after he returned home, he died. The family still don’t know what he died from. No one from the hospital has spoken to them.

The family has also not been able to get Radebe’s blankets and personal belongings back from the hospital, says Banda.

‛They don’t care about the family of the deceased. They don’t talk nicely to people or try to explain anything. How can it be that the man’s belongings can be stolen from a hospital? How can it be that you don’t know why their family member is dead?

‛The attitude of the nurses at Thelle Mogoerane must change. It’s not good enough,’ she says.

The work of a nurse

By Mary-Jane Matsolo

‛There is a huge difference between a clinic nurse and a government hospital nurse. Clinic nurses usually do referrals, unlike us, we have to deal with it all – drips, oxygen tanks, two to four injections required to treat a patient with meningitis. We do all of it, from documenting how many patients we’ve seen, to arranging medicines to give to the patients, and monitoring and taking their vitals before doctors do their rounds in hospitals. That’s if a patient doesn’t come in that needs serious medical attention, which is also the work of a nurse – to resuscitate the patient, which could take anything from two to three hours,’ explains Sister Elinor Mpulo (name changed) .

A public hospital nurse’s day starts in the early hours, at 7 am, and usually doesn’t end until the late

hours of the evening. A double shift is also required in a 40-hour-week. The functions mentioned above should be completed before the doctors do their rounds at 8 am; whatever hasn’t been completed before has to be done after the doctors have left. Many days, come 12h00, a nurse hasn’t even had a tea break.

‘The conditions we work under strip away a nurse’s calling’

The TAC visited the Far East Rand Hospital in Springs after pictures of substandard conditions were sent in by field workers in the area. The images showed patients sleeping on the floor, beds with patients sleeping in passages, patients sleeping in bathrooms with non-functioning flushing toilets, and visible unprotected electrical wiring coming out of the walls.

We went to the hospital with the intention of questioning the CEO. He was not on the premises, and so we visited the wards to see the conditions for ourselves. What we saw, confirmed the evidence in the pictures.

Hoping to get information from patients about their experiences at the hospital, we found that a majority of them were mental health patients and unable to give us any substantial input. We asked to see to the nurse in charge of the ward who, unlike many in her position who are reluctant to open up about conditions they work under for fear of losing their jobs, or to protect the department, was willing to speak to us.

Sister Mpulo, who began nursing when she was 18 and who will soon retire at the age of 55, has seen it all. She spoke to us from the heart, listing the challenges at the hospital and with the entire system. She explained that the main reason behind the overcrowding at the hospital, resulting in some patients having to sleep on the floor and patient beds being moved into the bathroom area, is due to renovations that have been ongoing since 2014. Many patients that come through casualty are told the wards are full and there is a shortage of beds. They are given an option of being given medication and to go home, or to sleep on mattresses on the floor. If they agree to stay, they are made to sign a consent form, to cover the hospital. Up to 62 patients are squeezed into a ward with the capacity to take 31-46 people. Sometimes, the hospital closes admissions to regulate bed capacity.

Patients, regardless of their illness, and including mental health and TB patients, share wards. Some

A nurse walks down a Gauteng hospital passage way with a child in this file photo.
A nurse walks down a Gauteng hospital passage way with a child in this file photo.

TB patients waiting for test results don’t know their status when admitted, putting other patients and nurses at risk of contracting TB. Even the hospital’s TB wards, Sister Mpulo says, are overcrowded, with little to no ventilation. The only way nurses can protect themselves from being infected with TB is to wear their TB masks, something they are reluctant to do because they usually come in one size, are uncomfortable and, when temperatures are hot, it’s very hard to breath while working with them on.

Furthermore, the wards don’t have enough oxygen points, and there are not enough drip stands. All these conditions make the nurses’ work very difficult, and the people that suffer the most are the patients, says a visibly exhausted Mpulo.

When new doctors are employed, they know nothing about the patients and it’s up to the nurses to bring doctors up to speed on the patients’ records and to ensure that everything runs smoothly so the doctor doesn’t make a mistake.

‛We become burned out and our concentration levels are low. At least, in the last two months, the department has employed some nurses and doctors, which is good. We can only do so much – many nurses take sick leave before they reach a state of burnout. A nurse at a clinic is required to see one to eight patients but at a hospital level we see anything from 12-20 patients a day. The conditions we work under strip away a nurse’s calling,’ she says.


A new coalition for people-centred health care

By Ufrieda Ho

Two specific issues emerged as priorities for Gauteng from the Provincial Health Assembly this year: migration and mental health.

Migration has always been part of human behaviour, moving to and from places for better opportunities or to flee harsh, untenable living conditions. The challenge of managing health care in the context of migration, though, can be complicated. Undocumented individuals who have no medical records, or are suspicious of anything associated with the state, remain highly vulnerable and they are prone to fall through the cracks. There can also be language and cultural barriers and a state of perpetual transience that makes sticking to health-care regimes or follow-up medical checks difficult for patients.

Gauteng is also subjected to xenophobia directed at those who are seen as outsiders taking up scarce resources in the economic heart of South Africa, which makes managing migration a heightened priority for the province.

But it’s mental health issues that have come into sharp focus for the province, brought into the open with news breaking in September that 36 psychiatric patients, who were among 1,300 patients relocated from Life Esidimeni facilities to NGOs, had died. Life Esidimeni, a subsidiary of the Life Healthcare Group, cared for indigent patients, and were part of a public/private partnership that worked under contract to national and provincial health departments.

The patients who were reported dead, died within three months of the MEC for Health’s decision to end her department’s contract with Life Esidimeni. She said that the facilities were too expensive.

SECTION27 has represented The South African Depression and Anxiety Group (SADAG), the South African Society of Psychiatrists, SA Federation for Mental Health, and a number of families since last year, when the decision was taken to relocate the patients. SECTION27 believes the number of reported deaths is an underestimate.

‛Besides not having accurate records of where users are or which users have died, it does not include deaths at home or in other hospitals (SECTION27 is aware of at least one death in each of these categories,’ it was stated in an open letter to the MEC, dated 22 September. The letter is signed by SECTION27, the TAC, SADAG‚ the People’s Health Movement-South Africa‚ the Public Health Association of South Africa and the Junior Public Health Association of South Africa.

The crisis around mental health has spurred the revitalisation of a new coalition seeking to

Brainstorming at the Provincial Health Assembly on mental health and migration.
Brainstorming at the Provincial Health Assembly on mental health and migration.

revitalise the Gauteng People’s Health Movement (PHM). The PHM is a global network that draws together grassroots health activists, civil society organisations and those representing academic institutions. The PHM promotes health care that is guided by the People’s Charter for Health and is meant to present an alternative to health-care models that are not meeting the needs of society’s most vulnerable members.

The approach is to look for horizontal links and collaboration in health-care practices, rather than remaining stuck in a top-down, silo-approach to implementing programmes and plans.

It was this new coalition that called for a meeting with the Gauteng Health MEC, Qedani Mahlangu, in October 2016, demanding clearer answers for the families of the 36 mentally ill patients who had died. It also sought to open up channels for dialogue, communication with the Department of Health, and to hold the authorities to account.

‛What we are saying is, we want to work together with the Department but we also believe that the truth has been lost somewhere, and we are still looking for answers for the families of the patients.

‛Going forward, we want to be equal partners with the Department of Health in deciding how the treatment of high-level-needs patients can be met,’ says Shehnaz Munsi, an occupational therapist, part of the PHM and a master’s student at Wits University.

At the meeting, the MEC stated that the high costs of care, which she said had a similar price tag to intensive-care treatment at a private hospital, was what swayed the decision to relocate the patients.

Mahlangu also claimed that family members of some the patients had been ‛coached and coerced’ into slamming the Department of Health in the media. She added that other patients had been happy with the department, and had phoned her privately to express their thanks.

Mahlangu, who has come under intense scrutiny since the news broke and who been fighting off calls for her sacking, acknowledged the new coalition and committed to more regular meetings. She invited members of the coalition to accompany her and her team for unannounced inspections of the mental health facilities in the province.

The coalition has called for the current investigation into the deaths to be given terms of reference wide enough to establish the immediate and root causes of the decision to discharge patients. They have also called for an audit of the NGOs that are taking care of patients and a list of the other former Life Esidimeni patients who are being housed, with an update on their treatment plans and current health status.

The coalition is still in its infancy but Professor Laurel Baldwin-Ragavan of Wits University’s Family Medicine department, who is also part of the coalition, says the umbrella body is ‛about galvanising many people across sectors of society to apply their minds to solve complex health and social issues.’

By strengthening networks within networks, we can present a powerful force to shift the inequalities that exist in health care today, and to work on alternatives for improved models of health care that are responsive and relevant for the urgent health needs of a modern world.

Getting the system to work

By Ufrieda Ho

Staff shortages remain a massive challenge for the public health service.

The Gauteng Department of Health earlier this year released information in response to questions

Patients are left in hospital corridors for long periods.
Patients are left in hospital corridors for long periods.

from the Democratic Alliance. The Department reported that state hospitals need 1,151 Grade 1 medical officers, 110 medical registrars, 78 community service medical officers, 160 Grade 1 medical specialists, and 58 intern medical officers. There are 17 clinical unit and department head vacancies and a dire shortage of nurses. The report noted 1,184 vacancies for Grade 1 nursing assistants, 1,340 Grade 1 professional nurses, 141 speciality nurses and 88 primary health clinical nurses.


The pressure of getting doctors and nurses into the system is complicated by the lure of private

sector salaries and employment conditions. This year, the system has come under additional significant strain as student protests rock the higher education institutions. If interns and qualified doctors are prevented from entering the system it will severely compromise the service offered at the province’s academic teaching hospitals.

In October, however, the Gauteng Department of Health announced that it had seen a ‛net gain of 2,227 nurses by the end of August, and 1029 medical professionals’. Earlier in the year, the Department also announced that 25 Cuban doctors would start working in the province. The Cuban doctors will focus on maternal, infant and child care. Infant mortality and maternal deaths remain a priority even in the country’s economically dominant province. Meanwhile, currently, there are 400 South African medical students being trained in Cuba as part of government’s initiative to plug the gap of doctors in South African public health care.

In June, the MEC for Health, Qedani Mahlangu, said a new double-storey paediatric unit at Chris Hani Baragwanath hospital should be completed next year. The unit will cater for children under the age of 10 and the target is to treat 3,000 inpatients and 2,000 outpatients a month at this facility.

The Gauteng Department for Emergency Medical Services budget has increased to R1,2 billion for

No sign of improving, a sign flippantly tells patients that their long waiting times means “they’re not dying”
No sign of improving, a sign flippantly tells patients that their long waiting times means “they’re not dying”

the current financial year. This amount will go towards the procurement of an additional 150 ambulances, 25 primary response vehicles, 11 rescue vehicles and five mobile emergency communications and command vehicles.

The provincial government has shown some positive initiatives, though the long term test lies in ensuring that good projects and recruitment drives are sustainable, adaptive and have the commitment of properly trained staff, to make them effective.

According to Mahlangu’s 2016-17 budget speech, recent successes include the Stock Visibility System (SVS). This is a phone app-driven system that allows nurses and staff to scan medicine barcodes to track stock levels of ARVs, TB medicines and vaccines, to be entered into a stock levels database. By the middle of this year 110 clinic should have been connected to the SVS system, with a roll out to all primary health clinics to be completed by the last quarter of this year, the Department reported.

The Gauteng provincial government’s own scorecard of its districts, meanwhile, identifies Tshwane as the best performing district in the country this year, with Laudium and Calcot Dhlephu clinics rated as Gauteng’s top clinics.

Furthermore, the Department said some of their facilities improved their national core standards rating, with Steve Biko Academic Hospital scoring 96 percent, Kalafong Hospital 81 percent and Mamelodi Hospital 73 percent. Declines in performance were noted at Charlotte Maxeke and George Mukhari Hospitals.

Rich province, poor health care

By Ufrieda Ho

In money terms, Gauteng’s health budget looks plump and healthy at R37,4 billion for the 2016-2017 financial year – R2.07 billion more than the previous financial year. It represents a sizeable portion of the province’s overall budget. On the surface, this is money that could make a significant contribution to improving the health outcomes for the province’s patients.

But, even though it’s South Africa’s richest province, Gauteng is under pressure from a growing metropolis and is not future-proofing fast enough for its evolving needs. There are challenges of rapid urbanisation, with high migrant numbers and community members who are transient and difficult to track medically. The province also has to plan for accelerated environmental degradation, overcrowding, job shortages, limited resources and the yawning gap between the haves and have-nots.

The divisions are evident in data from Stats SA’s General Household Survey of 2015, which was released in June this year. For example, Gauteng is home to the highest percentage of medical aid members in the country at 27.7 percent, but this still leaves 70 percent of the population reliant on that R37,4 billion to be spend wisely and effectively.

The Gauteng Department of Health has its own hurdles to overcome, including proving that it is fit to govern. After being placed under administration in 2013, the department finally achieved an unqualified audit from the Auditor General for its financial management this year.

But the health issues continue to be a challenge in the province. On-going staff shortages, overworked staff, unreliable ambulance services, staff who don’t treat patients with dignity, and a disconnect between policy and plans and the reality on the ground. Increasingly, bureaucracy replaces communication, and there are more reference numbers and records of complaint than actual solutions or firm plans on how problems can be rectified.

In addition, a tangled web of social failings impact on the health-care challenges. There’s high unemployment and competition for scarce resources. Public works shortfalls mean infrastructure in hospitals and clinics is not upgraded or maintained. And the high cost of commuting, or lack of proper roads in new developments, represent very real barriers to accessing health care for many patients. The protracted drought in southern Africa has also made food security a great cause for concern among the most vulnerable people in the province.

It is a most distressing trend that already weak health-care standards are slipping further and that there are clear losses in areas where gains had previously been achieved. For Gauteng TAC leaders Portia Serote and Sibongile Tshabalala, these include noticeable deterioration in the way TB is being managed in many of the province’s clinics and hospitals.

Serote, who works mainly in the East Rand districts, says many basic good care and oversight practices are simply not adhered to.

‛We can walk into clinics and see people not using masks. Patients are all mixed up in the same small facilities – so you can see XDR and MDR patients with TB patients. There is no infection control, or the UV lights (that help limit the spread of infection) are not working,’ says Serote.

She says the TAC has had to step up its own outreach programmes after discovering in a spot sampling exercise recently, that out of 60 people, 10 had TB and three had MDR-TB.

Another growing concern, says Tshabalala, is the high number of ARV defaulters that they are noticing. Tshabalala says the target of getting patients to undetectable viral loads is slipping.

‛We did a workshop and survey in Orange Farm earlier this year and found that people default because they can’t afford the taxi fare to get to a clinic, and it’s too far to walk. They also have to wake up by 4 am to get to a clinic or hospital if they want to get help that day. There is a benchmark for waiting of 180 minutes, which is just too long,’ says Tshabalala.

The facilities that people rely on have no privacy, are often cramped and have not been properly maintained. Serote says she’s visited clinics where nurses have brought curtains from their homes so patients can have some privacy and dignity during their consultations.

And, Serote says, mental health patients are falling through the cracks in the province. The TAC has seen an increase in the number of patients who simply walk out of hospitals in hospital pyjamas, completely unnoticed, sometimes for days.

‛The nurses were just unaware in Pholosong in Tsakane, when a man who was mentally ill just got up from his hospital bed and left. He was living in really terrible conditions and that’s where we found him, still in his hospital clothes, but the nurses didn’t know anything,’ she says.

Both Serote and Tshabalala acknowledge the nurses are under immense pressure themselves. ‛Nurses are not just nurses; they are counsellors, they’re cleaners – they are expected to do everything. The Department of Health thinks that a benchmark of one nurse to every 40 patients is not being overworked, and very often the nurses see even more people than that,’ says Serote.

Even for a thriving economic hub like Gauteng, prosperity is shared by only a few. Money can buy many things, it seems, but clearly it can’t buy solutions that are inclusive, innovative or impactful for a health-care system that needs just these.

Where all that glitters is not gold

By Ufrieda Ho

Mineral-rich, prosperous, the glitter of gold – that’s supposed to be the promise of the towns the sit atop the ore-rich western fringe of Gauteng.

But while mining giants may have cashed in for generations, many more labourers have been casualties of a long legacy of exploitation and shocking workplace practices.

There isn’t a clear sustainability plan for this sunset industry, leaving people who have flocked here in the hope of work and a better life with uncertain futures. Their present realities are still about competing for scarce jobs with few opportunities. They struggle to make ends meet in homes and communities that are underdeveloped, stuttering along with poor infrastructure, from a lack of basic services like piped water, electricity and proper sanitation, to clinics that are overcrowded and understaffed, and hospitals where maintenance and upgrading have not taken place in years.

People before profits

HIV positive and unemployed, Richard Moloko was fired from his job on the local West Rand mines when his ARV treatment started to make him ill. It’s discrimination and unfair labour practice he hasn’t been able to fight.

Richard Moloko (43) knows first-hand about the tough life on mines. In 2008 he was working for one of Carltonville’s big gold mines as a machine operator. That year, he was also diagnosed with HIV. It was a shock he says, but what was worse was that starting treatment that year took its toll on his body.

‛I would get dizzy and nauseous sometimes. Because I was working with flammable things on the mines they said I shouldn’t do my job anymore. After some time I was fired,’ says Moloko.

Initially, he thought that he would be offered another job, something that wouldn’t have comprised his or anyone else’s safety. Instead, he was sent home and now, eight years later, Moloko is still unemployed. He lives with his brother in Khutsong, a settlement outside Carltonville.

Moloko is on ARV treatment and gets his medicines from the local clinic, about 4 km from his home. The Welverdiend Clinic is small and cramped and sometimes he waits for hours.  But generally there are no problems with stockouts, and that’s a relief, says Moloko. Still, he’s not completely well and he rolls up his sleeves to show a skin condition that won’t heal. He hasn’t been able to see a specialist, nor has the clinic referred his case to other hospitals in the municipality where he could find help.

Moloko’s health issues, though, concern him less than his lack of employment. He’s never been able to challenge his employers for firing him and now, eight years later, the company has changed ownership several times. He doesn’t know where to begin to take on the fight and he doesn’t have the resources to do so.

‛It does make me cross that this happened and that I can’t do anything about it. I accepted my HIV status, my employers should have too. I feel I was discriminated against. I am still discriminated against when I go look for work. But even so, I don’t hide that I am HIV positive. I always disclose, I’m not ashamed,’ he says.

Quiet and desperate on the western front

There’s an odd stillness for a mid-week morning in Extension 5 in Khutsong on the western rim of Gauteng. The blustery spring day has driven people indoors, but even so there are few signs of people stirring among the rows and rows of new RDP houses, as you’d expect in a sprawling location

Most people are away in town about 10 km away, looking for jobs, locals say. Many of the houses stand empty – curtains are drawn and everything is shut and locked. Locals says that the RDP houses are uninhabited because people can’t afford to live so far away from the centre of town, Nor can they maintain the upkeep of their homes, or pay for utilities like electricity bills in the sections of the settlement that has been electrified. People also can’t count on water to run from taps, even in those houses that have piped water.

Local Treatment Action Campaign (TAC) leaders like Tsediso Mokoena and Tshepo Maboe say that, to an outsider, the pastel-coloured RDP houses look like a step in the right direction for development. They acknowledge that efforts to improve the shortage of proper housing is a good thing, but they criticise the authorities for not considering the bigger picture by  providing better planning and infrastructure.

‛They now say that this is a dolomite area and there are problems with the water, so people have to rely on Jojo tanks and water tankers for water, and they have to use portable toilets. They haven’t built proper roads here, so people can’t get in and out to town easily; it’s too expensive for many people. It’s like they, the council, didn’t know what they were doing when they developed here,’ says Mokoena.

At the end of July, a sinkhole in the area led to the collapse of the water pipes feeding water to Khutsong Extensions 4, 5 and the Welverdiend area, where the local clinic is located. The ground is confirmed to be unstable and water services remain interrupted, intermittent at best.

Turning 40 is a bleak turning point for Nonzwakazi Mamane. The Khutsong mother of three can’t find a good enough job to sustain herself, her unemployed husband and her three children.

Unemployment has also hit hard here, making life much tougher for the likes of Nonzwakazi Mamane (39). She was absorbed into a community works programme launched across Gauteng in 2010. The programme is aimed at providing limited employment to the most vulnerable communities. In Khutsong, the project is to clean up the neighbourhood and tend to community vegetable gardens – with food security being one of the priority focus areas for the programme.

Mamane’s stipend is about R600 a month. It’s too little to survive on, she says, but without it she has nothing. The food gardens that are supposed to help supplement her, her husband and her three children’s diets, are failing because there is no piped water to keep the thirsty plants thriving. The community is also expected to buy its own seeds, fertilisers and gardening implements.

‛They say we are in a dolomite area so they stopped pumping water to us for over four months now. You don’t know when the water will come in the taps, it can be two o’clock in the morning and you’re sleeping then you don’t get water,’ says Mamane.

To water the gardens, the people on the project have to carry what they can in watering cans and buckets from a water tank to the gardens. It’s simply too much labour to be sustainable.

Water is top of mind for Mamane in a season of severe drought that has hit large parts of South Africa. Without water it’s not just that the vegetable gardens can’t grow, but hygienic sanitation is compromised and the risk of illness and disease increases. Already, raw sewage runs down the dust alleys that separate the government houses.

Mamane is worried about getting sick, because it means relying on the nearby clinic. Welverdiend Clinic is 4 km away and she has to catch a taxi to get there. ‛You can wait three hours. Last time I was there they told me I was supposed to have a pap smear, but they didn’t have the equipment to do it. It’s a very small clinic and they don’t have proper rooms, the space is just divided up and there’s no privacy for the patients,’ she says.

It’s a collapse of so many things for the likes of Mamane. ‛I’m going to be turning 40, I have to look after my three children and I can’t find a proper job. I don’t know what to do,’ she says, picking up her filled watering cans and heading home.

A friend in need

An old sewing machine whirrs inside an RDP house in Khutsong Extension 5. Florina Mothabeng (74) is hunched over the machine; she pauses only to hear more clearly what her friend Elizabeth Sholo is saying.

The two friends meet like this most days to pass a few hours of the day. Mothabeng is chirpy and chatty. Her house is one of about 18,000 that were part of a massive housing development launched in 2009 in the municipality. The houses were meant to be built on land that was safe for development and the housing project was meant to introduce an integrated rental model for Khutsong locals.

Florina Mothabeng (left) worries for her friend Elizabeth Sholo who has to take care of herself with a hand that’s been rendered useless from severe burn injuries.

Mothabeng lives on her own, as does Sholo. It’s difficult for elderly people to look after themselves on their own. While Mothabeng says she’s fine and has little to complain about, she reveals that she’s on a slew of tablets for hypertension. She says she’s mostly satisfied with the service from the mobile clinic, which she can reach quite easily and where they have her medicines every month, she says.

But then she motions with her eyes and a little head nod that the questions about medical care should really be directed at her friend. She doesn’t want to put Sholo on the spot but she knows Sholo deserves better care and is not getting it.

Sholo obliges by lifting up a bandaged hand. She removes the wad of gauze and bandage to reveal a hand that’s badly deformed and scarred. This is an old injury from 2009, when Sholo was caught in a shack fire. They hand is all by useless. It still hurts, says Sholo.

At the time of the fire she was treated at the Leratong Hospital in Mogale City but her burns turned septic. Still, Sholo was sent home and had to learn to adjust to living with a damaged hand that still causes her pain.

At home, Sholo has to look after herself. The adult child she used to live with was killed in a car accident some years ago. Both grannies live alone and Mothabeng jokes that her children only visit to borrow the Tupperware she has in neat stacked tiers on her kitchen cabinet. She quips that if she had DStv then her grandchildren would also come visit her.

Jokes aside Mothabeng worries for her friend, who can’t remember exactly how old she is and also has failing eyesight. Sholo seems resigned to this existence and just asks for some help to wind the length of bandage back around her hand.

‛My heart is sore to see her like this,’ says Mothabeng.


A step too far

It’s been more than 18 months since Sibongile Kratshi (40) has been to a clinic or hospital. She’s HIV positive and is on ARVs. Kratshi knows she needs to have a blood test and to see a doctor, but it’s too painful to walk, to make the journey.

Kratshi was diagnosed with HIV in 2009. Since then, she’s suffered a stroke that has affected her speech and her movement. Her feet are constantly swollen and it hurts for her to shuffle to open a door that’s just a few paces from the sofa where Kratshi spends most of her day. She says she can hardly leave the house, her disability has become so bad. A small radio plays all day to keep her company.

Kratshi has previously been told she needs to see a physiotherapist to help improve her mobility. Such help could help her to get crutches or a wheelchair and the necessary medical approval to apply for a disability grant. But she’s physically unable to get anywhere, and only has her 14-year-old son to assist her.

The teenager picks up his mother’s ARVs every month and every time he brings back the same message: that the nurses need her to come in for tests. Neither they nor she know what her current CD4 count is.

It doesn’t help that Kratshi also loathes clinic visits. She says of the local Welverdiend Clinic: ‛I don’t like to go to the clinic; the nurses treat me badly and there is no privacy there.’ Her speech has been affected by the stroke and she dreads coming across an impatient nurse who will be rude and disrespectful as she struggles to make herself understood.

Even though there is a mobile clinic that services greater Khusong area once a month, Kratshi says she will not make it the few hundred metres without considerable pain. Even if she could, the mobile clinic services will not be able to draw blood or give her results.

Instead, she falls back into the sofa, turns up the radio and waits for her son to come home from school.

A message for a better future

The baby Beauty Modise is balancing on her hip won’t stop crying – the 16-month-old wants her mother’s full attention.

Modise is 24 and this is her second child. She was a mother at 19 with her first child. Unmarried and with two children before the age of 25, this wasn’t the future she imagined for herself when she was a West Rand schoolgirl.

‛I wish that I was told good information growing up. People would say things to me like, ‟Don’t go around with boys” but they didn’t say, ‟Unprotected sex can make you pregnant,”’ says Modise, who is now a volunteer with the organisation SRHR (Sexual Reproduction Health Rights).

The organisation is a coalition between the TAC and Youth Friendly Services (YFS). Its primary aim is to raise awareness about sexual health and rights for young people. They speak at schools and also campaign door-to-door.

‛It helps that we are also young people speaking to other young people. For me, the message I want to give them is that they mustn’t make the same mistakes that I made.

‛It’s not easy to be a mother when you are so young. I never went to study because there is no one else to look after my babies and today I am unemployed. The father of my children is 25 and he is also unemployed. We survive only on piece jobs and that is very hard,’ says Modise.

Currently, there are 10 SRHR volunteers for the Leratong municipal district, both men and young women. Modise says having volunteers who are young and are both male and female means they have a better reach and a better chance to reach their target audience.

She says she’s committed to working with the NGO, helping the youth in her community, saying no young person should have the same pressure she has had just as they’re about to start their adult lives.

‛I want to say to school kids, stay in school, work hard for a better education and a better future, don’t be like me,’ she says.