They brought me back from death

Programme involved in row over UN funding takes the load off hospitals by treating HIV-positive people as outpatients.

Malan Mhlongo, like hundreds of desperate HIV/AIDS victims in the Msinga area of northern KwaZulu-Natal, could not be admitted to the local hospital because it was overcrowded, with patients sleeping on the floor.

But, thanks to a care organisation that is at the centre of a war of words between the government and the United Nations, the 45-year-old labourer has recovered from HIV/AIDS-related tuberculosis after being bedridden for months.

The organisation, the Enhancing Care Initiative (ECI) and health workers at the Church of Scotland Hospital in Tugela Ferry have developed a groundbreaking care programme for patients who cannot be admitted to hospital.

It is called Philanjalo (Live Forever) Continuum of Care for AIDS.

Patients with full-blown AIDS are treated at the hospital and at an adjacent hospice, and those who are not yet seriously ill are given home-based care by doctors and volunteers.

This week, Mhlongo is slowly recovering thanks to his TB treatment - he can walk and tend his vegetable garden, as he explains, having "risen from the dead".

The Enhancing Care Initiative's advocacy of a combination of anti-retroviral drugs, care of the dying and HIV/AIDS education and counselling won it R700-million from the United Nations' Global Fund Against Aids, TB and Malaria.

But the Minister of Health, Manto Tshabalala-Msimang, demanded that the money be given to the national authorities for distribution among the provinces. The government is still insisting on this.

In Msinga, a disappointed Dr Tony Moll, the head of the hospital's HIV/AIDS unit, says the programme was developed in 1997 when the hospital was overwhelmed by patients with HIV/AIDS. Moll says: "The government wheels were taking too long to turn and we had to do something drastic."

The hospital discovered alarming rates of HIV/AIDS infection, including 40% in pregnant women, 60% in children admitted to the paediatric ward and 80% in TB patients.

"We developed the Continuum of Care Programme, which includes providing antiretrovirals for health workers, HIV/AIDS education to stem new infections, and home-based care for the ill to ease the overcrowding in the hospital," he says.
"[We also established] an orphanage and hospice."

The R700-million that the Enhancing Care Initiative was awarded by the UN was to be used to extend the programme to other hospitals in the province.

The Initiative's spokesman, Dr Robert Pawinski, says it is convinced that the Continuum of Care model begun at Tugela Ferry is the best way to stem the devastation caused by HIV/AIDS to healthcare in the province.

Moll says that in Msinga it has been possible to turn the HIV/AIDS crisis around by mobilising the community. "We called for volunteers and were overwhelmed by more than 500 energetic young people from the villages of Msinga who volunteered their services," he says.

Some were trained as HIV/AIDS educators and counsellors. A corps of 200 were trained as home-based caregivers to visit HIV/AIDS patients to ensure they were living in acceptable conditions, had nourishing food and took their medicine and vitamins. The rest were trained to take care of orphans and the terminally ill.

The hospital's home-based care unit is run by three elderly women fondly referred to as abogogo ("grandmothers") by staff and patients. Every Tuesday, Phikona Mbongwa, Sibongile Lembethe and Compi Khoza run an HIV/AIDS clinic at their makeshift room in a shipping container at the hospital.

"We see an average of 50 patients every week. After confirming the presence of the virus, we encourage patients to change their lifestyle and eat properly," Khoza says.

"We can only strengthen their immune systems by giving them food hampers and multi-vitamins while arranging for disability grants from government for more ill patients."

Thobile Dlamini, 25, an HIV/AIDS counsellor, was sent on a counselling course in Durban. She is responsible for counselling and testing at least 10 people a day. Of those, at least seven are usually HIV-positive and she has to break the news and help them cope.

Philane Madi, 27, is the youth organiser and runs the Sinozwelo ("we are compassionate") Resource Centre. He has organised the volunteers to provide HIV/AIDS education at schools, churches and community meetings.

"The youth corps are the footsoldiers of the Continuum of Care programme and visit infected and affected households providing support," he says.

The young people spread the HIV/AIDS education message and also help to arrange disability grants for the ill and child-support and foster-care grants for orphans. They take the terminally ill to the hospice.