Community health care serves the people

The HIV/AIDS pandemic in KwaZulu-Natal is overwhelming some public hospitals' capacity to provide adequate care for patients living with HIV/AIDS. The solution to this lies in community-driven health-care projects, local health workers told PlusNews.

Hlabisa District Hospital is situated in the north of the province, about 200 km from Durban and serves about 85,000 people. A report by the South African Medical Journal last year estimated that at least 20,000 people in the hospital district were HIV positive. According to a hospital doctor who asked not to be named, the hospital is equipped with 350 beds but most of the time, the hospital will have twice as many patients. "We're always busy, but right now we're medium busy," he told PlusNews.

The fine weather has brought many of the patients outdoors and the green lawns are dotted with people dressed in blue hospital pyjamas, sitting in the shade. Inside the overcrowded male ward, maize meal and beans and pumpkin are being served for lunch. "We are quite lucky because we have the equipment but our main problem is that we don't have enough staff that are trained to handle all the equipment," the doctor added.

HIV/AIDS tests are sent to Empangeni - a town about an hour away from the hospital. This presents a problem for the counsellors who conduct pre- and post-test counselling, as many patients don't return for their results. Some refuse to take the tests, as the two-week waiting period is considered too long.

Malaria and the recent cholera outbreaks in the province have pushed hospital resources to the limit and bed occupancies have increased by 200 percent during outbreaks over the last two years. A special section in the hospital is reserved for treating tuberculosis (TB) patients. TB, malaria and cholera are endemic in the region and this has aggravated the AIDS situation in the province.

Projects like Ethembeni Care Centre are the answer to the hospitals' increasing incapacity to care for HIV/AIDS patients, Ethembeni manager, Lana Oatway, said. "Hospitals around here are chock-a-block, they can't give people the amount of attention they deserve because they just don't have the space for that," she added.

Nursing staff at local government clinics were antagonistic and allegedly offered nothing but moral judgement to people living with HIV/AIDS. In a climate where people were reluctant to seek help because of the stigma attached to the epidemic, this attitude was unproductive, Oatway said. Ethembeni ("a place of hope") is an affordable community-based medical centre, which serves as a bridge between clinics, hospitals and the community. The centre is located within the Mondi forest, on the outskirts of the industrial town of Richard's Bay.

Trained staff offer HIV testing with pre- and post-test counselling, lifestyle management workshops and medical consultations. The 30-bed facility offers intensive medical attention and is staffed with nurses and doctors. Oatway is negotiating with Indian drug firms to provide generic antiretrovirals, as the cost of triple therapy (US $84 per month) is still too expensive for many of the patients.

"The greatest challenge for us is educating them about complying with the drugs regimen," she said. Before the patients are placed on the treatment, they attend a workshop to educate them about the drugs. A problem in rural communities is the "potent combination" of Zulu traditional medicine and antiretrovirals. "There's nothing wrong with the plants and herbs in Zulu muti [medicine] but the dosages and strengths of the stuff, when taken with ART, are questionable," Oatway said.

Half of the patients at Ethembeni are not on antiretroviral therapy because they cannot afford the drugs. They practise the "Ethembeni Regime", a holistic wellness programme. The patients are taught how to grow a variety of vegetables on a small plot of land as well as simple herbal remedies like using chilli pepper to raise the body temperature and garlic as a natural anti-biotic. "With power and clean water, they can do this easily when they go back to their communities," said Oatway.

Initially, surrounding communities were hostile and rejected the centre because of the stigma still attached to HIV/AIDS. The tribal authorities (the amakhosi) were approached and received AIDS education. The amakhosi then selected health educators from the communities to care for patients once they had returned from hospitals. These educators also provide training workshops in schools and churches.

When PlusNews visited, one man was sitting in the shade of the leafy garden at the centre. He was waiting for a van to take him home, as he'd recovered enough to leave the centre. He kept shaking his head, murmuring, "I can't believe it, I am so happy".

For Oatway, this is the most gratifying part of her work.

[This item is delivered to the English Service of the UN's IRIN humanitarian information unit, but may not necessarily reflect the views of the United Nations.]