A Dialogue with Mama Dube

by Judith King

Mrs Busisiwe Dube's smile is wide and winsome, and her eyes twinkle through the lenses of her spectacles as she traces her involvement with home-based care initiatives in the uThukela district of KwaZulu-Natal. Known affectionately as "Mama Dube", she is a Senior Registered Nurse who, in 1996, was employed by the Department of Health as a sex education and HIV/AIDS counsellor, giving lectures in schools in and around the Bergville area. During the 12 years that followed, she also worked voluntarily from a youth centre at the nearby Emmaus Hospital, teaching family planning.

When WorldVision SA set up a base in Bergville for its Child Survival Project with Home-Based Care as one of its components, the Department of Health recognised the growing need for this type of intervention and offered the programme a grant of R30 000 and the secondment of Mama Dube to run a training programme for HBC volunteers. The community response to the call for volunteers was remarkable, and an interview process was set up to finalise selection. Using the "Doctors For Life" training manual as a model, and working with Estcourt-based DoH District HIV/AIDS Co-ordinator Zodwa Dladla, Mama Dube trained over 90 volunteers in the months before she retired. "I followed up with them to track their progress," she says, "but only met them formally again in October 2001, when we retrained about 20 volunteers using a newly developed DoH manual."

She was shocked to discover that there are pitifully few volunteers available for the many households requiring help. Her heart goes out to those who, with no funds for transport, are shouldering the massive burden of walking over vast rural areas, often with no food in their own stomachs or soap to present themselves hygienically to their clients, much less to use in their care. "I also see how much they need their own supervisory structure, someone to guide and support them emotionally, because working with the terminally ill is so draining. I try to offer them this support, but it's not easy to do it singlehandedly," she explains. "I don't believe society realises just how great an asset these volunteers are - they're the only ones who'll do the unthinkable."

And many aspects of dispensing home-based care, especially in semi-rural or township settings, are "unthinkable", from a Westernised urban frame of reference. For example, relatively simple nursing tasks, like treating the thrush in patients' mouths and genitalia to relieve pain and enable them to swallow, or keeping the bed-linen clean and fresh, are hardly pleasant for family members, but having to accomplish these without any clean water "on tap" is doubly difficult.

One can at least imagine doing these things for a loved one, but to do them for a stranger is a wholly different matter. Yet this it is the very stigma surrounding the HIV/AIDS epidemic, causing families and neighbours to reject those who succumb to opportunistic diseases, and making the clients themselves afraid to confirm their status through testing or confess their diagnoses to their loved ones, that, ironically, turns home-based caregivers into super-heroes. It is the HBC volunteers who help to break this silence, through their loyal, patient and gentle nurturing of trusting relationships with families and the information they can impart to them.

"The volunteers observe a great deal in the course of their work and are able to advise family members very effectively on issues of health and hygiene, and even legal requirements like having to get a will drawn up or documents for social grant applications," says Mama Dube. "Families don't have to feel ashamed of not having the resources required to set up what's needed in the home. The volunteers are themselves poverty-stricken, so they work empathically with their clients and show them creative solutions. If they don't have gloves to protect themselves, they use plastic packets to cover their hands. Also, they are careful to involve the patient in the process, so that he or she doesn't just lie there, feeling like a burden to everyone."

Mama Dube's "wish-list" for the HBC volunteer programme in her area, which directly reflects those of the volunteers themselves, is humbling in its very humility. "The Wellbeing Centre in Bergville serves as a drop-off point for donations of food and clothing from local farmers and church groups," she says, "but it needs promotion so that more supplies in kind can be made available, like food, clothing, bedding, soap and basic medical supplies like gloves, disinfectant, bandages. Another big problem is lack of access to transport for both clients and volunteers. At some end-point, a small salary would be welcome, but most volunteers say their work enriches them in other ways and that all they want are resources to support their work."

Mama Dube recalls the prime example of one volunteer, who, when asked how much she would like to earn, said that as long as her colleagues were not being paid, she would not ask for anything. "This volunteer proceeded to care for a terminally ill patient until the end. When the patient's friends and family collected R600 and gifts of tablecloths and groceries to present to her in return for her dedication, she felt blessed a hundredfold," she recounts.

Further in-service training in First Aid and counselling is also foremost amongst the needs expressed by volunteers, along with pamphlets containing general information in a variety of languages and plenty of visuals for illiterate clients. They also want information on simple remedies and nutritional support, so that they can offer affordable solutions to their clients.

Mama Dube's community work extends far beyond her HBC training. Using seeds supplied via St Joseph's Catholic Mission in Ladysmith, this incredible woman teaches the elderly and the disabled how to build and plant waist-high vegetable gardens; these are easily reaped and can be sustained for four to five years, providing both a nutritive food supply and a small means of income. Under the auspices of the SA Roman Catholic Bishops' Conference, she is raising funds for and testing an HIV/AIDS board-game as an educational tool for youth and adults, and has translated its instructions into isiZulu. She is also involved in developing the "Mandla Box", a simple but essential kit for Home-Based Caregivers containing an Oral Rehydration Solution (ORS), instructions and ingredients for a Sugar/Salt Solution (SSS), disinfectant and home-available fluids.

"I suppose you could say that I've retired in name only," laughs Mama Dube. Somehow and somewhere in between all these commitments, she works in and for her church, and enjoys family life with her husband (who works in nature conservation at the Cathedral Peak mountain resort), her four daughters and her son! "I also have six grandchildren," she chuckles proudly.

How does one conclude an interview with a woman of this stature? Saying "Thank you" seems barely sufficient, and words shore up, unspoken, behind a wall of admiration for a life of such unselfish service.

Issued by: Judith King - Media and Communications Officer
HIVAN (Centre for HIV/AIDS Networking)
University of Natal, Durban
Tel: (031) 260 2975