World away
For example, it experiences shortage of medicines and some months it doesn’t come.”
Access to healthcare in the Gert Sibande district is a serious problem, according to the Treatment Action Campaign. The group’s chairperson in Mpumalanga, Belinda Setshogelo, says that even condoms aren’t widely available because the clinics are so far away. “Young people have to spend money to catch a taxi just to go and get free condoms.”
The 2015 District Health Barometer lists HIV infection as one of the leading causes of death in the district, and Mpumalanga is one of two provinces where the rate of teenage pregnancy did not decrease in 2014-2015.
A 2012 national health department survey of pregnant women attending government clinics for the first time found that “the only two districts out of the 52 that have recorded HIV prevalence rates of more than 40% in South Africa are uMgungundlovu (40.7%) in KwaZulu-Natal and Gert Sibande (40.5%)”.
Both these districts are National Health Insurance ( NHI) pilot districts.
In eMahlabathini, a village about 10km from the Oshoek-Swaziland border, a little boy squeals as his friend roars after him. Nomvula Ngwenya laughs as she tries to stop them from running in the room.
“If I find someone who is very ill, I will bathe them, change their dia- pers, feed and give them their medication. I do this three times a day,” she says.
Ngwenya’s sitting in her neighbour’s one-room house along with some of the patients she takes care of. She is a home-based care-worker with a local organisation and has seen first-hand the struggles people in remote towns and villages have with access to care.
“The closest clinic is in Amsterdam [10km from the village]. It costs R10 to go there, but a lot of my patients cannot afford that. I often use my own money to go to Amsterdam to collect their medication.”
Ngwenya, who lives with her hus- band and three-year-old son, earns only R1 000 a month.
“Some of my patients are young people who are suffering from these common diseases. Some have tuberculosis, others have HIV. They delay initiating treatment and many end up dying, because they only start antiretroviral [ARV] medication when they are terminally ill.”
According to the District Health Barometer, HIV accounts for 40.7% of deaths of women between the ages of 15 and 24 in Gert Sibande district. The comparative figure for males is about 16%.
“There is a mobile clinic that comes once a month, but it doesn’t have ARVs. Most of its service is based on immunisation for the children. Those on ARVs have to go to Amsterdam,” Ngwenya explains.
Zodwa Zulu*, 24, lives with her mother and son. She is one of the residents who cannot afford the R10 transport costs to the clinic. She borrows money every time she has to fetch her four-year-old son’s medicine from the clinic.
“My child is on antiretroviral treatment, but sometimes I don’t have money to go to town to fetch the medication,” she says, looking over her shoulder at the boys.
Zulu and her son don’t have identity documents, so she cannot find a job or even apply for a government childcare grant. “We live with my mom and she does everything for my son, because his father wants nothing to do with him.”
Khanyisile Khumalo and her fiveyear-old child are both HIV positive. “I don’t work. I rely on this lady,” she says, pointing at Ngwenya. “She fetches treatment for me and my child from the clinic. I only go to the clinic when they tell her that we have to be there. Then she has to try and give me money to go.” Khumalo fights back the tears. “Aunty [Ngwenya] even shares her food with me and my daughter,” she says softly. “I also don’t have an ID and my child doesn’t have a birth certificate. But Aunty is working very hard to solve my problems.”