why there is no doctor: harsh realities in zonkizizwe (part 1) (10)


(photo: Clinic #1 in Zonkizizwe, serving zones 1-4)

From May to August of 2008, I interned with an organization called Vumundzuku-bya Vana ‘Our Children’s Future’ (VVOCF). The organization is located in Zonkizizwe (Zonke), an informal settlement south of Johannesburg closest to Germiston. The informal settlement is best described as a peri-urban area much like a shantytown with convenience stores. Some live at a lesser degree of poverty than others, but everyone is impacted by HIV/AIDS.

I […] learned more about the extent of HIV/AIDS in Zonke. The intern coordinator reminded us that the statistic of students at MSU that have an STD is 1 in 4. We are only lucky that HIV/AIDS did not enter the mainstream population. Here in Zonke 1 in 4 people is HIV positive. The family at the center is more so affected by HIV/AIDS and now they work to care for children who come the center affected by the virus. There is still a very high stigma and a terribly ineffective ARV program. Many people refuse to get tested or even consider the idea. Each child at the center either has HIV […] has lost parents from AIDS or related illnesses or has not yet been tested to know. There are many who should be tested, but are not. […] It has come to my attention that much of what the government does here looks good on paper and on banners, but there is a huge, massive disconnect in implementation (78).

Zonkizizwe is a snapshot of post-apartheid health care development failures. It was founded when a group of displaced people set up shacks on a farmer’s land so that they could live closer to potential places of work. Many times the South African government tried to remove them, but they kept rebuilding. This is a story different than that of the Black townships or Bantustan “homelands.” Zonkizizwe was an area not meant to be inhabited by anyone, let alone poor Blacks. Understandably the story of health care here is one of an even greater lack of access. Informal settlements had no budgets of their own to even attempt to build their own health infrastructure and even if they did it would likely have been destroyed during forced removals. Under apartheid, health services would have been incredibly difficult to come by.

Everyone waves from their steel-corrugated shacks, children smile and get excited, parents and elders are welcoming – looking out over the shanty town roof tops that extend as far as the eye can see in each direction, you can’t help but wonder that within this poverty and desolation mixed with laughter and happiness – what potential can be harnessed, what community action can be inspired to make South Africa’s future brighter by and for those who live here (79).

My goals as an intern with VVOCF were HIV/AIDS education, HIV/AIDS peer educator training, and assistance with nonprofit organizational development. I was very glad to be able to focus my strengths and interests in the work I did. I also worked to formulate a rough community health assessment based on my interactions with people at the VVOCF center, neighbors, visits to the clinics, and interactions with Zonkizizwe residents.

Now Zonkizizwe has two primary health care clinics to serve its roughly 250,000 people. Health services are all free through government funding, including immunizations and treatments. However, the issue does not become access to treatments, but rather quality of care. The director of VVOCF, Celumusa, said that all the health clinics do is give out painkiller tablets for everything (80). She said she often just goes to the chemist [pharmacist] to tell them what is wrong and get something that will actually help. This appears to be a direct outcome of apartheid health policy. The lack of trained medical professionals, notably doctors, leaves local health workers with no better option than handing out painkillers. Quite possibly the training of these health workers remains inadequate as well. Zonke is an area much in need of the RDP’s action, but all that can be seen here are RDP building supplies for new houses.

“You can see people die, sitting at Natal-spruit.” – Celumusa (81)

The closest hospital to Zonke is in Natal-spruit, about a 30-40 minute taxi ride away. If you live in Zonke, this is the closest place to get ARV medications since the clinics are “not certified” yet to distribute (82). There is another hospital nearby, but the taxi fare is more costly and it takes longer to get there. Residents of Zonke don’t necessarily have the time or money to take a day to travel to the hospital even if it is critical to their health. Those who go to Natal-spruit notice a different level of care. People die waiting, people in great pain are not attended, people in need of good health care cannot access it. At Heidelberg I was told the staff rush to help you and are much more caring (83). The Natal-spruit hospital is set to be closed soon and a new hospital will be built in Extension 6, which is in Sandonga, much closer to Zonke. Maybe with this new hospital the level of care and access to care will increase, especially in regards to ARVs accessibility.

Notes:
78. Hill, Alex B. Journal Entry. 15 May 2008.
79. Ibid, 13 May 2008.
80. Ibid, 6 June 2008.
81. Ibid, 29 May 2008.
82. Ibid, 10 June 2008.
83. Ibid.

Coming next: Harsh Realities in Zonkizizwe (part 2)

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