Session 1: Bushbuckridge Sub-District Office Visit
We met with Phyllis Marule, the local area manager who oversees the
implementation of all the programs and services within Marite Local Area.
The Sub-district, population +- 800 000, used to be part of
Limpopo, but is now under Mpumalanga. This was triggered “political unrest” and
the hope that management under a different province would bring about
improvement to improvement.
Mpumalanga is divided into 3 districts. Bushbuckridge forms part of
the Ehlanzeni District and is located in the far north east of the province. It
has 38 health facilities plus 3 hospitals. The primary health care services are
divided into 7 clusters.
Ehlanzeni is one of the 18 national priority districts in the
country, because of the poor socio-economic status. Some people have to travel
40km to get to an ATM and there are very few tarred roads.
The director of PHC is also the sub-district manager. Most services
are still facility based but the sub-district is strengthening the PHC teams
(Community-based).
The sub-district budget is divided into three categories:
Administration, Community Health Centre and Clinics. Facilities have their own
cost-points and need to manage their budget themselves, including all financial
transactions. Human Resource related delegations are located at the
Sub-district level, but decisions are strongly influenced by facility managers.
The main challenges in the sub-district include: infrastructure
maintenance, limited budget, old GG vehicles, drug stock-outs, lack of water in
most facilities.
When hospitals run out of water - they need to refer patients to
facilities with water. The surrounding communities also don't have water until
the municipality brings supply tanks.
Referrals are not easy due to staffing resources and far proximity
of services. While the package of care may have been defined for a health care
facility, the services may not be available due to multiple systems issues.
Phyllis finds the role of a PHC supervisor to be very broad and
goes far beyond supervising staff. She has to link up with other sectors,
governance structures and business. She links it to being like a CEO. She finds
that the poor transport is the biggest obstacle for rendering and accessing
health services. She's ready to be a leader and would like to move up and out.
Session 2: Peer Education Programme: RADAR
The group was met by Realise at the Tintswalo Hospital (Mercy
Hospital)
The programme had been around for 12 years under the umbrella of Wits
University.
It was started in response to research findings that focused on
reasons access to care. There seemed to be reluctance to access HIV testing and
treatment services largely due to the stigma associated with the disease. People
used their co-morbidities to explain their HIV symptoms (e.g. DM, HPT) they
would first try all community options (traditional, clinics EC) before
accessing hospital services. Generally, they are afraid to talk about HIV and
TB. TB is regarded as a manifestation of HIV.
The main programme intervention includes education for in-patients
at Tintswalo hospital: one-on-one or group work. The educators have a matric qualification
and are trained by Realise. Some programme activities are rendered outside the hospital
setting: Health promotion in schools that focus on bullying and disclosure;
children's rights
One of the hardest challenges for Realise is to deal with
"Cleansing rituals" that involve unsafe sexual practices in the
community. These entail arranged unprotected sexual encounters for widows and
children who are coming out of mourning
The programme also gives input at community meetings and
municipally driven events. They support other organizations with their HIV
education programmes.
Session 3: Traditional Healer Visit
After lunch, we visited a traditional healer who practices
relatively close to Tintswalo Hospital.
On arrival we were required to remove our shoes before entering her
consulting room. Ma Jane welcomed us, via translator, and explained the scope
of her practice. She was called to traditional healing in her early twenties
when her ancestors made both her legs weak. When she heeded the call (ukutwasa)
and started an apprenticeship in traditional healing, her affliction was
lifted. In-spite of never learning to read and write, Ma Jane knows all the
medicines that she needs and is guided by her ancestors. When she dispenses her
remedies, she tastes the powders or tinctures in front of her client to verify
the contents and to demonstrate that it is not toxic.
She also gained certification in health promotion, which, besides
learning about health-related messages, also empowered her to refer patients in
need of allopathic medicine. She seems to have a good rapport with health
authorities.
Interestingly, the reason why she does not ask the ancestors for
remedies for HIV and hypertension is quite simple: There is no traditional name
for those diseases for her to communicate the need to the ancestors. Therefore
she cannot elicit their guidance.
One of Ma Jane’s biggest challenges is dealing with the
misconceptions of traditional healing that were largely brought about by
individuals not aligned to the traditional healer’s council / authority. She
does not use “muthi” and does not believe in selling remedies on the side of
the road. On the other hand, she finds the work very rewarding as it gives her
a great sense of purpose and livelihood. It is a gift handed down by the
ancestors through her family and has gained her the respect of her community
and broader circles.
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