Bukhosi Mdletshe, operational manager of the Ensingweni Clinic in KwaZulu-Natal, is standing high up on a rise on the side of a dusty road. “These are all our people,” he says.
He makes a sweeping gesture across a landscape of hills and valleys dotted with the small homes that characterise this very rural countryside between Gingindlovu and Empangeni, located approximately 60km apart. The small clinic, located in the north-eastern region of KwaZulu-Natal, serves around 12,000 people, many scattered across the surrounding countryside.
“See there,” he says, pointing at a circular house, made of concrete bricks, “an old woman lives in that house. She won’t leave because her husband and forefathers are buried there. She lives far from the clinic and has no way to get there. So, we visit her.”
Mdletshe points to another home: “That’s a child-headed household. We need to check that they are going to school.”
Showing us another home down in the valley, he tells us an elderly woman living there is defaulting on her medication. “We need to check on her,” he says.
While HIV rates are very high, as in much of the province, most people here with HIV are taking treatment, and Mdletshe says 96% of those on treatment have the virus suppressed in their bodies. “We also have quite high rates of hypertension and diabetes in older people,” he says.
“A major problem around here is that patients default on treatment and this is largely because of the distances they have to travel for healthcare. It can be a simple case of not having bus fare to get treatment or fetch medication,” he says.
The clinic is in an old building with fittings reminiscent of the 1980s. It is a busy, bustling place, with patients ranging from mothers with tiny babies to the very elderly waiting in orderly queues. It operates on weekdays and includes an emergency section for acute cases. Twice a week, a medical doctor attends to patients requiring advanced assessments or adjustments to their treatment plans.
Indira Govender, an NHI-contracted GP who visits the clinic once a week, says: “There’s a good team spirit among staff, including cleaners and security guards. People get along and although there are days when the number of people to attend to is overwhelming, they manage, and care for each other.”
Mdletshe says he insists that clinic staff go beyond merely “dishing out tablets” and consider the wider impact of their work. “It’s about asking if a person is well − psychologically, mentally, and physically. It’s about asking, ‘do you have something to eat at home?’”
Mdletshe says in a rural setting like this, the distance to Ensingweni clinic and Catherine Booth Hospital is a major barrier to accessing healthcare services. “Ambulances take a long time to come, and the hospital is not nearly as accessible as it might be in a city … The people who don’t have money must walk to the clinic,” he says.
This is why, from Monday to Thursday, 12 community healthcare workers employed by the clinic head out on foot to at least 60 households. “Sometimes it’s more like 150 households. We have a shortage of health workers,” says Mdletshe.
“We visit pregnant women and young mothers with new babies to see how they are coping and to help them with breastfeeding,” says Nombuso Nzuza, one of these 12 community healthcare workers.
It’s a Friday afternoon, and Spotlight is joining Mdletshe and Nzuza on home visits. Nzuza, known to all as MaDlamini, is a familiar face in the area, having been part of the government initiated home-based care programme since it started more than a decade ago.
For Mdletshe, one-handedly steering the vehicle along winding gravel roads, it’s also a tour of his home. He’s lived here since he was a child and knows its landscape, history, and people. Besides managing the clinic, he’s a pastor in the Apostolic Church of South Africa.
After a long drive we arrive at the home of a family who Nzuza came across during her home visits. Until recently, the family of seven were living in a single-roomed shack.
“When MaDlamini brought me here, we found the whole family was cooking and sleeping in here − mom, dad and four kids … After that visit, I couldn’t sleep well, especially thinking of what happens when it rains,” he says.
Mdletshe says he took up the matter with his church board who resolved to build the family an extra room. “Church members donated money and materials, and a team of builders organised by the church spent two weeks building,” he says.
We drive past a group of young men sitting under a tree. It’s a pastoral scene. Except, says Mdletshe: “They’re drinking.”
There is also a drug problem. “We have not escaped this whoonga thing,” he says. “It affects a lot of our youth. They break into houses and steal from their neighbours and their own families to buy drugs.”
Mdletshe is also the secretary of an NPO called Imbumba Yamadoda, a men’s forum that he says brings men together to confront and discuss challenges affecting them. “I’m not just serving a community. I’m serving my people,” he concludes, his face breaking into a smile. - Spotlight
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