27 February 2007
Red Cross worker, Ncane Kunene infront of the Sigumbeni Clinic in Swaziland. (James Hall/IRIN)Sigumbeni, Swaziland:
Home-based care in Swaziland is increasingly being relied on to compensate for the inadequacies of a public health system buckling under the weight of the country's HIV/AIDS pandemic.
UNAIDS estimates the national HIV infection rate of people aged 15 to 49 at 33.4 percent, the highest in the world, a demoralising environment that has led to nurses migrating to other countries in search of better salaries and working conditions.
The strain placed on the country's resources by HIV/AIDS has resulted in the public health service failing to care for the elderly, especially in the rural areas, and it is a gap being increasingly filled by volunteers within the home-based care network.
One such initiative, started by the Baphalali Red Cross Society in 1999 and orchestrated from the Sigumbeni Clinic, in rural central Swaziland. It sees community volunteers visiting homestead after homestead to monitor their clients' conditions, ensuring medication regimes are adhered to and, if required, arranging doctors visits to the home and providing transport for the collection of antiretroviral drugs and other prescription drugs. Any medical emergencies are referred to Swaziland's second city, Manzini, a 30km drive on dirt roads.
"Our responsibility is to respond to the health needs of terminally-ill patients. These are people with AIDS, tuberculosis, cancer, people who had strokes, and the bed-ridden elderly. It's all about bringing health services to the home," said Muzi Dhlamini, a male nurse who for the past two and a half years has headed-up Sigumbeni's home-based care programme for the Red Cross.
The majority of their patients are adults in the advanced stages of AIDS-related illnesses, or the elderly, an exception being eight year-old Khanya Dube (not her real name), born HIV-positive and severely weakened by chronic anemia. She has developed multi drug resistant TB, a condition, until recently, that would have been a death sentence, because the costs of taking the child to hospital for medication and hospital checkups would have been unaffordable for the family.
The health care provided by non-governmental organisations, including the Red Cross, has brought Khanya under the wing of the home-based care system, bringing life saving assistance to her and other people in isolated rural areas.
"The test found she had a resistant HIV/AIDS, and on Wednesday we switched her treatment. Generally, she is weak, weak, weak. It's the anemia. She needs transfusions, and we arranged these twice. Once she was unable to get the blood she needed because the hospital didn't have the pints," said Dhlamini, highlighting one of the public health care systems shortcomings. This week, Khanya was taken by ambulance to hospital in Manzini.
Hive of activity
Each day the Sigumbeni Clinic is a hive of activity, with small trucks and ambulances arriving and departing to take volunteer workers to far-flung areas and bringing others to the clinic for prescription drugs. About 88 home-based care patients were assisted this week, Dhlamini said, a sizeable number considering the sparsely-populated area of the widely-dispersed homesteads.
Ncane Kunene, a 26-year-old nurse co-ordinates the Red Cross's food security initiative in the area and was supervising the loading of medical supplies on a truck that will also distribute mattresses and food to patients. "Food is an element of home-based care, especially now when there is little food in this area," Kunene said.
Nomcibelo Dlamini, a 54-year-old Red Cross trained care facilitator, who dispenses aspirin, cough suppressant and similar non-prescription medications, said: "I work from a list of patients, and I must report to the clinic the state of each client. I see that the patient is feeling well. There are some ordinary tasks to perform, like changing the position of a patient in bed who has difficulty moving, to avoid bedsores. Sometimes I will feed patients."
Care facilitators are given about US$15 a month for lunches and bus fare, but their supervisor, Dhlamini, wants the amount raised to US$60 a month. Two-thirds of Swaziland's roughly one million people, ruled by sub-Saharan Africa's last executive monarch, live on US$2 or less per day.
"This will be an appeal to our donors. We face a crisis with care facilitators. They are devoting so much of their time to treating the terminally-ill that they cannot earn income to support themselves and their families. This is becoming a problem, because we need them and we are asking so much of them," he said.
The care facilitators also provide advice to relatives on how to care for the terminally ill, including the use of rubber gloves when bathing and tending AIDS patients and keeping accurate records of medicines taken.
"The families are thankful for this programme. It is scary to have a loved one ill and you don't know what to do. We offer moral support, and that is really an important part of what we do. When this programme started, there were people dying of AIDS without medical assistance. The need for home-based care is not new. But HIV/AIDS has accelerated the response," Dhlamini said.