Day one - 2 October 2006

Bela Bela township

The township of Bela Bela is located 2km from the main town. Set up in the 1950s, it was built to separate blacks from whites during Apartheid. The symbolic and physical division is the railway line which we cross over each day we go to work.

The township is a busy place. It is vibrant and noisy. There are 'tuck shops’ everywhere selling sweets, drinks, fruit and vegetables. Also present are shipping containers with mobile phones inside for the community to use. Every couple of hundred metres there are taverns (or shebeens are they are known) selling alcohol. Some are more formal than others, but you find people there at all times of the day. Mostly hang outs for men, they range from tin shacks to rendered earth buildings with shady areas for drinking out of the sun.

Day one – 2 October 2006

Meet the staff

My first day at the Bela Bela HIV and AIDS Prevention Group began with introductions to all the staff. There are 52 people working here and 36 are living with HIV. Bela Bela works with those living in the township, whose population is 45,000.

Cecile is the Director and co-ordinates the Antiretroviral treatment rollout (the drugs that help those with HIV prolong their lives). Billy co-ordinates the awareness and prevention work which includes schools education, daily clinic awareness training, monthly door-to-door campaigns, and work with government and small business. The focus is on behaviour change and reduction in stigma and discrimination.

Mmapula is the Home-based Care Co-ordinator and her work includes daily visits to patients' homes to administer treatment, dressings, and antiretrovirals (ARVs). Bela Bela has 14 carers looking after about 350 families.

Bertha co-ordinates the orphans and vulnerable children program. This includes home visits to orphans living with extended families, as well as ten child-headed households. There are 491 orphans in the program that are provided with psycho social support, school fees and uniforms, and food parcels. There is also a drop-in centre where they can go for breakfast, lunch and supper, as well as homework support, and other activities.

Jonas co-ordinates the voluntary counselling and testing program and has 14 counsellors to undertake counselling with those who come for advice on HIV and taking the test. And finally, Lydia manages all staff and looks after admininstration and finance. Her task is huge but she manages it very well.

Day one – 2 October 2006

Home visits

My first foray into the township is with Fisu, a nurse who volunteers with Bela Bela in the times that she is not working at the hospital. The first home we visit is in the informal settlement 'Zuma View'. It is the home of Martha and her grandchild Poppy. Poppy is an orphan, her mother passing away some years before from an AIDS-related illness. Now her grandmother is the primary carer. Poppy is seven and is living with HIV. She also has tuberculosis. She is blind in one eye and has a distended stomach from past malnutrition.

Their house is a tin shack with one room and earthen floors. There is no electricity or water, and the toilet is a hole in the ground. There is no shade and it is very hot here. There are two others who share their home; Poppy’s uncle and an older brother. No-one has jobs and the only income is the old-age support grant that Martha receives, which at less than $100 per month is not much to survive on.

Day two – 3 October 2006

Awareness training

Every morning at the clinic from 9.30am–10am, while people wait to be seen by the nurses or to pick up prescriptions, Bela Bela staff conduct an awareness session on HIV and AIDS. They explain to those waiting what HIV is and how you contract it. They explain that you can’t tell if a person has HIV. They reinforce that everyone is at risk of HIV and debunk some of the misconceptions about how you get HIV. They show with the help of posters, the stages of HIV and AIDS and detail how to care for a person who is sick. Questions are asked and answered. It is interesting to see the reaction of those listening and watching. They are a captive audience, but how much people really take on board what is being said is uncertain. There are about 50 people each morning who hear this talk, most of them women and children, as men don’t visit the clinic as often.

Day three – 4 October 2006

Home-based care by car

Today’s events begin with a visit to a patient in a rural area about 25km from Bela Bela. Rachel, 29 years of age, lives in a rented home on a pig farm. The home is extremely basic with three tiny rooms. The only furniture is the bed she sleeps in and a cupboard in the kitchen with a few bowls and plates. There is no kitchen; only a tap outside for water and open fires for cooking. We are told that about 200 people live in the houses here and that there is a school. It looks empty though. There is also a hostel for casual workers with three-by-two metre cells to sleep in. Residents pay $15 per month to the farmer to live here.

Rachel is very sick. Her CD4 count is 70; she is unable to walk, has Candida in her throat and chronic diarrhea. She has TB, night sweats and has lost a lot of weight. At a guess she weighs no more than 30kg. She needs to go on ARVs but she is currently too weak to take them.

We take some blood from her left arm but this is difficult. We cannot get enough and try the other arm. This is unsuccessful, even after four attempts. We move her into the bedroom to take blood from her groin. She is too weak to walk so I help her to bed. Despite trying again, we still don’t get anymore blood. She is severely dehydrated. To make matters worse she is a person without an identification card, which means that in the eyes of the law she doesn’t exist. She doesn’t have a birth certificate either. In order for her to receive a social grant or food parcels she needs this document. Applying for this will take about three months. By then she may have passed away.

Day five – 6 October 2006

Door-to-door in Bela Bela

Once a month, all the staff at Bela Bela conduct door-to-door campaigns within targeted areas of the township. Today’s area was Extension 5 with homes no bigger than five-by-three metres. For 30 minutes, 20 of us walked to our destination as a group in the hot sun. Shade is rare in a dusty and parched environment. When we arrived, after much discussion over who was to go where, we embarked on our trip in pairs.

I, with Elizabeth [pictured above], visited over 15 houses in the three hours we walked from home to home, and street to street. Most if not all the families were aware of HIV and AIDS and weren’t very interested in hearing more about the disease. What they were interested in was the clinic and the services it provided. Apart from educating about HIV and AIDS, we also filled in provincial government forms to identify orphans and vulnerable children and granny-, sibling-, and child-headed households.

Of the homes we visited, we identified three that required assistance, either in the form of grants, school fees, uniforms or food parcels.

Day six – 7 October 2006

Reflections

After five days work at Bela Bela I am exhausted! It is impossible to write about everything I have done, but hopefully some of the pictures will help with this. Today is a rest day, although Cecile is at the clinic – she never stops! After I have written up the blogs for the week I will feel happy. A week of wonder recorded – quite an achievement.