From the Project

September 15th, 2009, My Time in Ndawana, by Kathleen Paton

Kathleen with Zanele (left) and Busi (Dec 2005)

I have just returned from my third volunteer nursing experience in Ndawana, and each time it has been the greatest experience of my life.
 
The health care in Ndawana has progressed amazingly over the past four years. During my first experience there in 2005, I was involved more in health teaching and advocating for the people of Ndawana than in clinical nursing. Not only did I learn how the health care system works in South Africa, but I also learned a great deal about HIV/AIDS, including the stigma attached to it. I was also there during the building of the community centre. For me, the best part of volunteering was getting to know the people of Ndawana, to see how strong and resilient they are – especially the women – and to see how well they cope with both the devastation of HIV/AIDS and the poverty in which they live.

I saw some very sick people and felt frustrated that I could not do more to help them. So, along with Busi Duma (who is now the Community Co-ordinator), we decided we would begin transporting the people whom we suspected had HIV and /or TB to the nearest hospital (about two hours from Ndawana), where they could be tested and receive treatment.

This became a weekly event, and we were soon transporting 15 to 18 people at a time. I quickly recognized that transport was probably the biggest issue for the people of Ndawana. During this time, 15 women from the village were trained in home-based care (HBC), and their knowledge of the people and the village became instrumental in reducing the stigma as they quickly developed the trust and respect of the whole village. I was also there for the completion of the community centre and attended the grand opening.

When I returned to volunteer in Ndawana for a second time, I quickly saw that great strides had been made and that stigma seemed less. The HBC workers were trained on volunteer, counselling and testing, or VCT, as well as directly observed therapy (DOT), a program designed to observe people taking their TB drugs. People would drop into the clinic every day for testing, and at that time over a 1,000 people had been tested. Edzimkulu had also just hired a professional nurse, started a down referral site for the distribution of anti-retroviral treatment (ART), and was administering drugs to a group of about 20 people in the village. Dr. Les Pitt began visiting the village monthly to treat the patients and to teach the professional nurse, community health workers, and me about ART. This was such an achievement on Chris and Jim’s part, and this model has now been recognized nationally.

I spent a great deal of time setting up the clinic and developing a filing system for all our clients. What I loved most about being in Ndawana were the home visits. I loved the friendliness of the people, and the appreciation they showed. The extreme poverty in some cases was overwhelming, especially when visiting the “Gogos”(grandmothers), who were looking after orphans on an old age security of R750 monthly  ($100), and also dealing with the ongoing loss of  close family members.

When I returned to Ndawana in February 2009, I saw that even greater strides had been made. The Department of Health was now involved, another nurse had been hired, the HBC workers were now Community Health Workers (CHWs), and a Community Co-ordinator and a Manager were in place. The CHWs had continued their upgrading on HIV/AIDS and TB and were so knowledgeable and organized.  The HIV program had expanded to four groups (40-50 people each group). The VCT program was very busy, and as soon as a person was diagnosed with HIV, blood work was drawn for CD4 count and baselines drawn for initiation of ART if CD4 counts were low.

A TB program was started in January 2009. One of the nurses hired was responsible for this program and already had 50 patients on treatment, with more being diagnosed every day. The personal nurse had been trained on Primary Health Care and was seeing about 1,000 patients per month. In May 2009, an antenatal program was started, where we saw normal pregnancies but focused primarily on women who were HIV positive (also known as Prevention of Mother to Child Transmission). We had 15 women on the program, four of whom were HIV positive.
 
The day the clinic burned down – June 25, 2009 – was devastating for everybody. To stand and watch it burn to the ground, and being unable to do anything about it, was a nightmare. But, as I mentioned, the people of Ndawana are resilient. The very next day, in fact, the community health workers had the orphan house cleaned and painted ready for the next ART clinic. We decided to provide only essential services for the time being (HIV and TB). Fortunately, most of the patient files and ARV drugs for three groups were saved.

This setback will not hinder health care in Ndawana. Not only are the community health workers dedicated to the people and extremely hard workers, but there are also well-established services already in place. All they need now is somewhere from which to distribute them.