AfricaVox 2007

Return to Mazista: a South African village recovers its health

Zinhle Mapumulo revisits a South African village in desperate need of health services and is pleasantly surprised.

Eight months ago, just before the G8 meeting in Germany, I visited the village of Mazista in the North West Province of South Africa and blogged about the stigma and fear felt there around HIV.

I described how villagers were too scared to disclose their HIV status and how the only easily accessible health service was a mobile clinic that visited twice a month.

A week after returning from Germany I received a call from the North West Department of Health inviting me to an open day in Mazista where they were planning to educate people about HIV and AIDS and voluntary counselling and testing (VCT).

Before I had a chance to accept, their media liaison asked me why I had to air their dirty laundry to the world. His question took me by surprise but made me wonder whether my article had anything to do with their invitation. I was told it was a coincidence.

I couldn’t make it to the open day and in any case I wasn’t sure it was worth travelling 300 km for what I believed to be a publicity stunt for the health department. To my surprise it was not.

The people of Mazista now have a mobile clinic that comes twice a week. Here they have access to testing and counselling for HIV. Some drugs not previously available, such as medication for tuberculosis, are also being delivered.

I learned this after a recent visit to the village, when once again I met Mmabo Lefatshe who had been so open about her HIV status and outspoken about the lack of services. She told me that some people in the village had been angry when they heard from the health authority that their business had been told to the world, but she said they now understood.
Lwandile Sicwetsha, health department spokesman told me Mazista had been identified as one of the priority areas for healthcare services in the province. “Home-based caregivers have been trained and are now working in the village and updating the ministry with information regarding health needs of people in Mazista,” he told me.

“Mobile clinics visit the area twice a week, but this is complemented by health programmes targeting the area with door-to-door campaigns and awareness campaigns on HIV and AIDS, pap smear and mental health.”

Good progress indeed. But even more could be done.

According to villagers the door-to-door visits happen once a month - not enough but better than nothing. However, the problem of access to antiretrovirals is yet to be addressed. Villagers still have to travel miles to get treatment.

And I am worried that people may not be taking advantage of the VCT being offered. The department could not provide me with data showing that people were utilising these services.

Things have definitely improved. But I suspect the final hurdle of overcoming stigma which prevents many from going for testing will take longer to surmount.

Uganda strives for a generation free from HIV

Kakaire Kirunda thinks the only way to stop the spread of HIV among teenagers is to treat them like adults.

Against a soothing instrumental background, a group of female friends discuss the hazards of sugar daddies on a popular Ugandan radio show:

Mary: Let me tell you about this friend of mine. A few months ago she told me mbu [that] she met this nice guy with a lot of money. Yes he was married but he treated her like a queen, took her to all the nice clubs, and bought her a really cool phone. Even the expensive clothes, he bought. Now yesterday she came to me crying, her world is falling a part. She has just found out that she is pregnant.

Kate: And the nice man?

Mary: He is not interested. He is tired of her. But that is not the worst part; she is also infected with HIV.

Kate: Girls! The gifts, the nights out, the cash, can never be worth your life and future. Older men are taking advantage of you and putting you at risk of HIV infection in exchange for these bu [small] things. This practice is called cross-generational sex. Respect yourselves, do what I do. Say no to sugar daddies…

Uganda wants an HIV-free generation and, to help to achieve this, the government has begun an onslaught against so-called cross-generational sex. The practice is defined as young people, especially girls, entering into sexual relationships with people who are more than ten years older.

Catchy as it is, I believe this media campaign is in danger of overlooking an inconvenient truth – young people are not contracting HIV simply because they have sex with older people, they are also at risk of transmitting HIV to one another.

Hard labour: stopping HIV in its tracks

Collins Vumiria discovers why Uganda’s traditional birth attendants are being sidelined in the fight against HIV.

Earlier this month I asked Uganda’s minister of state in charge of primary health care, Dr Emmanuel Otaala, why traditional birth attendants – who deliver tens of thousands of babies each year – seem to play little part in HIV awareness and prevention or in the prevention of mother-to-child transmission of the virus.

It had been on my mind since I met an experienced traditional birth attendant (TBA) who told me she last attended a workshop on HIV counselling in 1992. Hasifa Nalwoga Ssenkayo is 52 years old and with two years of schooling behind her has been working as a birth attendant since 1976.

A mother of ten, Hasifa’s workplace has 14 make-shift beds. She operates in a crude environment where everything is improvised. She knows something about HIV and advises women to go for HIV tests after she delivers their babies. But from her answers to some of my questions it was clear she was confused about how the virus could be diagnosed and would benefit from more training.

In fact Hasifa had asked for just that. She told me she had been to the nearest general hospital looking for collaboration with the medical team to improve her services “but failed to get through”.

South Africa: the HIV waiting game

In South Africa HIV patients continue to feel the effects of a chronic shortage of health workers. Zinhle Mapumulo looks at a problem that refuses to go away.

The Tshepang Clinic in Pretoria is fully booked. The 26 people who enrolled here in November for HIV treatment will have to wait until March for the first of three counselling sessions. Completing these sessions is mandatory for anyone who wants antiretroviral drugs.

The clinic’s manager William Matereke has a huge patient backlog, few staff and plenty of stress. “Over a thousand people are on a waiting list at this clinic currently,” he says. “The list changes every day - some people die while others enrol. It is hard to say how many have died because our data collection system is not up-to-date.”

One doctor and two nurses work at the clinic, based at the Dr George Mukhari Hospital. William Matereke has sympathy for the patients on the waiting list but there is nothing he can do. “At times we utilise volunteers in conducting counselling sessions. But we cannot rely on them – we need permanent staff on board if we intend to run a proper ART clinic," he says.

To qualify for antiretroviral (ARV) treatment in South Africa your CD4 count, which measures the white blood cells that control immunity, must be less than 200. Even if you are critically sick and your CD4 count has dropped drastically you still have to follow the procedure of registering for treatment and attending three ARV adherence counselling sessions.

After the sessions the doctor reviews your cell count and viral load. If the CD4 count is still below 200 and you meet all the necessary requirements you can begin treatment.

Zibuyile Mahlangu [not her real name] lives in Soshanguve and is waiting to start treatment at the clinic. The frail 27-year-old is scheduled to come back in March next year for her second counselling session.

Africa’s brain drain here to stay

Tigist Kassa

Underpaid, overworked and disillusioned: doctors and nurses are leaving Africa in droves. But the G8’s response today offers nothing that will prevent further migration of Africa’s healthcare workers.

International NGOs say that despite the announcements of funds for HIV and AIDS and other diseases, the G8 has not got back on track to meet the promises they made in 2005.

Aditi Sharma, head of ActionAid’s HIV and AIDS campaign, says the G8 leaders had recognised the problems but not offered any concrete action. “The shortage of health workers was on the summit agenda, but the G8 hasn’t made any specific commitments: no specific funds, timelines or targets,” she says.

A report by the Ethiopian National HIV/AIDS Prevention and Control Office in 2005 stated that there are just 2,115 doctors for a population of over 77 million people – and newly trained doctors all too often migrate, for better earnings to support their extended families. 

And it’s not just a problem in Ethiopia. Collins Magalasi, director of Action Aid in Southern Africa, told me that “over 70 per cent of the doctors and nurses trained in Malawi have emigrated. The G8 countries are utilising them. We can’t stop doctors leaving”.

Malagasi thinks the G8 countries should fund training institutions and provide earnings for healthcare workers that will make it more attractive to stay in Africa. The solution is in the hands of the developed countries.

This isn’t a new story: despite all the talk of funding drugs and clinics for HIV, the fact is that a continued critical shortage of doctors and nurses means people are dying in Ethiopia and elsewhere in Africa.

The G8 has committed to spending $60 billion to fight infectious diseases over the next five years, but civil society groups are worried that not enough funds will be available to retain doctors and nurses in developing countries.

It’s depressing for me to watch what’s happening here at the G8. It looks like I’ll be going home to the same problems as before.

Fear and stigma in rural South Africa

The G8 has pledged extra funds for infectious diseases including HIV and AIDS. But a shortage of money is not the only barrier to HIV treatment. Fear, stigma and poverty are rife – and still claiming lives. Before coming to Germany, Zinhle Mapumulo visited one of many villages in South Africa where few are willing to discover their HIV status.

Mmabo Lefatshe looks petite, but in her village of Mazista - in South Africa’s North West Province - she is a well-respected and strong woman. I’ve visited a number of the country’s rural areas, but none compares to Mazista; the affluence you find in some parts simply hasn’t touched this corner of the country.

"Look at me today, I am alive and kicking..." Mmabo Lefatshe

The first thing I see when I enter the village is a cluster of about a hundred shacks squashed into a site suitable for ten or so houses. A few metres away a squatter camp doubles as a dumping ground for rubbish. Deeper into the village is Lefatshe’s house which belongs to the mining company she works for.

Lefatshe (39), Steve Modise (27), and Catherine Moya (51), were the first three people to disclose their HIV status in Mazista when the virus dared not speak its name. Many villagers called for them to be expelled, saying they had shamed the community by bringing this 'curse'.

Today the same people who were calling for Lefatshe and her counterparts to be banned are seeking advice from her on how to live with the HIV virus.

The value of protest

Francisco Xerinda

The last four days here in Germany have been dominated by the anti-globalisation protests. The roads are constantly blocked and the police keep telling us to take a different route. 

Indymedia

But for me the practical irritation is worth it; such protests really do matter to me. I saw the impact they had two years ago when pressure from civil society at Gleneagles led to debt relief for my country, Mozambique.

One of the sessions at the Alternative G8 Summit drew attention to how AIDS is affecting young people. It brought together young people aged 18 to 25 from different parts of the world.

My older sister lives with HIV. My family and I contribute money for her anti-retroviral drugs and as a result she is well and can work. It used to be very difficult for us, but following the Gleneagles summit the price of the drugs has dropped.

Of course, it makes it easier that I have a large family and many of us are in employment. Of the 1.5 million people living with HIV in Mozambique, only about one in ten has access to anti-retroviral drug treatment. My sister is one of the lucky ones. 

Two young AIDS activists spoke at the meeting, one from India and another from South Africa.

I was struck by the grim picture painted by the Indian activist. Of the 5.7 million people affected in his country the majority are young, and the epidemic is moving fast, out of the cities and into the countryside. Children in India are particularly vulnerable, and access to information and services very limited.

The South African told of the huge increase in TB in connection with AIDS, and the importance of education in tackling the epidemic. Both spoke of the need for more funding for drugs from G8 countries. 

So when we’re travelling along the country roads here in Germany, and our bus is forced to turn round at a street blockade, you don’t find me objecting.

The sick priorities of the G8

This afternoon the G8 leaders announced their communiqué on climate change – but healthcare funding is still proving to be a sticking point. Walter Otis Tapfumaneyi of the Panos Global AIDS Programme is not surprised.

It never rains but it pours for Africa, and the light at the end of the tunnel always seems to get dimmer because the world’s richest countries insist on making the tunnel even longer.

As if slavery and colonialism were not enough, Africa today is still being looted in the name of unfair trade, brain drain, conflict and corruption. And it even has to pay for crimes it has not committed.

Take climate change, for example, which today the G8 made a series of announcements about. The G8 countries represent 13 per cent of the world’s population but emit 40 per cent of its greenhouse gases.

Africa has hardly contributed to global warming but, according to this year’s IPCC report, Africa is the continent most vulnerable to climate change.

By 2020, yields from rain-fed agriculture in some countries could decrease by as much as 50 per cent, exacerbating malnutrition and food insecurity, while a three degree temperature increase could leave up to 1.8 billion more people facing uncertainty over their water sources.

Climate change, however, isn’t grabbing the headlines because of its potential to harm people in Africa, but because it also affects rich countries. HIV and AIDS, on the other hand, are slipping down the agenda. The number one enemy of the African continent is barely of any concern to the G8 countries, it seems.

AIDS prevention paying the price of the G8 donor circus

Kaikare Kirunda

G8 negotiators have spent much of the week in disagreement over a range of issues – including the commitment made two years ago at Gleneagles to increasing aid to Africa. As the Summit opened today, the prospects for Africa weren’t looking bright.

Perhaps that’s unsurprising. It’s well known that aid has actually gone down in real terms, once debt relief is taken out of the equation. In fact aid agency Oxfam says, going by the present trends, the G8 could miss its 2010 target by $30 billion.

As the rows continue at the Summit, Germany too has been accused of only being interested in pushing its own model of social health insurance while apparently ignoring Africa’s own health strategy.

That all this is happening when some of the G8 countries – especially the US and Germany – made important aid increment announcements prior to the Summit is mind-boggling.

But what's happening here reflects the confusion these countries exhibit in their aid programmes for Africa and the rest of the developing world. More importantly these conflicts have damaging consequences on the ground.

The G8’s $17 million security fence scandal

Kakaire Kirunda

When I arrived in Germany on Sunday I learned from a report in the local press that the security fence around the venue of this year’s three-day G8 Summit cost close to $17 million.

Dissent Network

I promptly sent a text message to tell Michael, my colleague back home. He was not amused: “Couldn’t those people take their summit to another venue where they wouldn’t need to construct a new barricade? Did they have to waste that money?”

I asked why he was concerned – after all, it wasn’t his government spending that money. His response was humbling:

“I lost my uncle to AIDS because he couldn’t get started on the life-saving drugs due to the bureaucracy... They should have donated that money to one of the countries most affected by this pandemic.”
 
While organisers of the G8 found it right to spend millions of dollars on a fence, in Africa the same amount would have helped prolong the lives of over 100,000 AIDS patients by providing them with a year’s supply of anti-retroviral drugs (ARVs).

According to the World Health Organisation sub-Saharan Africa has the greatest number of people on treatment and the second-highest rate of treatment coverage among those who need it. But the region still accounts for 70 per cent of the world’s unmet need for treatment.