TAC District Blogs Treatment Action Campaign

Mindsets against VMMC are changing, according to the latest radio slot Andile held

About 95% of those calling into Andile Madondile’s show discussing VMMC on Monday showed strong support for his effort to educate the community on the vital health issues surrounding the controversial topic. While VMMC encountered strong opposition when it was first introduced last year, the community seems to be warming up to the idea, and progress can already be seen; the Department of Health reported no VMMC related deaths in the Western Cape last year. Additionally, the process has been further regulated, as young men are required to see a doctor and obtain a certificate stating that they are in good health before beginning the process. Those performing the procedure must also be trained and certified. Those who underwent the process traditionally are being encouraged to visit a doctor and to ensure that the procedure was performed correctly, and more and more men are choosing to do so.

The issue of VMMC encountered strong opposition when it was first introduced due to the cultural importance of the traditions surrounding the circumcision process. Those callers in opposition to VMMC were mostly older men, which may reflect a stronger cultural importance of strict adherence to traditional methods found in older generations. While some may seek to ensure that the procedure is done in a healthy manner, there is still a negative stigma attached to those choosing to go the VMMC route. Madondile stressed the importance of allowing individuals the right to choose their preferred method. He cited one example from Mpumalanga, in which 27 died while in the bush due to health issues. Instances such as this highlight the importance of educating young men on the precautions that should be taken to avoid unnecessary deaths or disease. The education TAC and others have been doing seem to be paying off despite the original hesitation, and the new procedures and precautions are receiving increasing support, particularly in Khayelitsha, an area which was largely against the new initiative only a short year ago.

Madondile’s show on Monday, May 20 addressed the concerns surrounding the issue of VMMC in South Africa, particularly within the Western Cape. The program sought to educate citizens on the dangers surrounding traditional circumcision practices and the opportunities available through VMMC to reduce these risks. It also allowed men in the community to call in and voice their concerns, raise questions, or offer support for the new programs.

Madondile addressed several concerns associated with the traditional method of circumcision; most prominent were the lack of training for some of those performing the procedure, as well as a lack of sterilization of tools between uses. In some cases, tools may be used up to 15 times repeatedly without being sterilized, leading to increased risk of spreading HIV or other STIs. Further risks arise for those already infected with HIV or STIs, as a suppressed immune system renders them more susceptible to opportunistic infections while exposed to conditions such as a lack of water or inadequate nutrition. Finally, some of those on ARV treatment have been prevented from taking their treatment while away, which decreases its effectiveness.

Madondile discussed the precautions that should be taken in order to avoid these health risks. Those preparing to go through the traditional process should be aware of their HIV status, and those testing positive should also be aware of their CD4 count. Those on ARV treatment should ensure that they will be able to maintain their treatment while undergoing the process. Condom use is encouraged to decrease the chance of contracting other STIs as well, and those found to have STIs should avoid beginning the circumcision process before being treated by a doctor. By taking these precautions, men can reduce their risk of contracting HIV as well as their partner's risk of contracting HIV and cervical cancer.

Overall, the new procedures and precautions are receiving increasing support within Khayelitsha and the Western Cape. The positive outlook seen among the community is a huge first step in improving health conditions and lowering the rate of HIV in our community. Treatment Action Campaign continues to educate the community on these crucial issues, and is working to change societal views which negatively impact the health of South Africans in all areas.

In Khayelitsha’s taverns, condom distribution provides the first line of defense

Drinking establishments known as shebeens pose a high risk for the transmission of HIV, research shows. Alcohol use has been associated with a larger number of sexual partners for both men and women, and an increased incidence rate of unprotected vaginal intercourse. The dim lighting and intimate atmosphere in shebeens contributes to a sense of anonymity and closeness that encourages heightened sexual expression amongst patrons. In addition, the limited availability of condoms in these drinking establishments means that those who drink in shebeens rarely have a means of protecting themselves. There is a large need for condom distribution and education in these establishments.

Today, 23 May 2013, the Treatment Action Campaign distributed condoms to shebeens within Khayelitsha and spoke to owners and patrons about their feelings regarding this disbursement. TAC believes that the availability of condoms in drinking establishments is the first line of defense against the transmission of HIV associated with alcohol usage. Khayelitsha community members and tavern owners expressed gratitude regarding the condom distribution program, stating that it has been extremely effective in encouraging protected sex within the community.

Shebeen owners reported to the TAC that their patrons are very willing to take and use the condoms when they are available, and are generally not embarrassed to do so. For those who are shy to be seen taking condoms, owners will encourage their use by placing them in discreet locations such as restrooms where they may be taken more privately. Because of the distribution efforts and education taking place within the community, more individuals understand the importance of using a condom with their sexual partners to protect themselves against the transmission of HIV.

TAC spoke to one woman in Khayelitsha who informed us that because her establishment is known to have condoms, people will go there every single day to get them, even in the mornings. Youths especially are willing to take condoms without embarrassment, and understand the importance of protected sex in reducing the rate of STI transmission. There are still some individuals, particularly men, who believe that using a condom is "not cool", but as awareness and availability within the community increases, the stigma associated with their usage has been dramatically decreasing.

At the boardroom at the new Khayelitscha hospital

Follow up meeting with the CEO Anwar Kharwa of the Khayelitsha hospital.

Khayelitsha met up with the CEO of the Khayelitsha hospital for a report back after TAC brought forward 30 testimonials taken from patients that experienced horrible service from the hospital.  Mr Anwar Kharwa, the CEO of the hospital met with us on Monday to discuss these issues.  He started off by taking us through some of the issues and challenges the hospital deals with on a daily basis.

CEO Kharwa claims that the hospital receives thirty-six stab victims with heart injuries each year and that there are high violence levels in the community especially over the weekends, which are major challenges. The facility is a three-hundred and twenty bed center with acute emergency services and is already one and a third larger than wards in other hospitals in the Western Cape.  He told TAC that twelve new beds have already been added in the emergency unit. The biggest issues in the hospital are HIV/TB, trauma due to violence and injury. It is important to note that when it is necessary for patients based upon their condition and location they may be directed to other hospitals in the region and not to Khayelitsha to receive more rapid emergency service. The CEO also claims that the murder rate in the area has declined since the facility opened last year.

According to Mr. Kharwa the complaints brought to his attention by the TAC have been discussed with the chief director and will be taken to the board of the hospital. When members of the community do have complaints with the facility, he encourages them to use the complaint boxes located in the hospital. There is a procedure that these provincial level complaints must follow involving investigations by different agencies if it cannot be resolved with the client directly. CEO Kharwa told TAC that a help desk will be created at the hospital to provide one to one service for patients especially when they have issues with the services they have received. The thirty testimonials that were presented by TAC will be investigated and feedback will be given to TAC directly upon their resolution. A Quality Assessor Manager will also be looking through the complaints.

The CEO was curious about the types to complaints the community had about the hospital. TAC informed him that they largely focused on a low bed capacity and the issues that this creates. There is currently a plan to commission beds and increase the number of wards by two, but this is a long-term future plan. In the interim Kharwa plans to commission a transit lounge for discharged patients to wait for a caregiver to pick them up. He hopes this will reduce crowding and free up the facility. This short-term plan is pending ninety day approval. TAC is still seeking more immediate short-term solutions in cooperation with the hospital.

CEO Kharwa asked TAC to inform the community that a major challenge for the hospital is the intimidation of staff by patients. This problem is frustrating for staff and the CEO and its’ resolution may contribute to improved hospital services. It is also important to note that TAC was promised that no community members coming forward with complaints about the hospital will be targeted or victimized in any way. Clients are encouraged to continue to give their feedback of Khayelitsha hospital using the tools outlined above.

Eastern Cape educates community members about National Health Insurance (NHI)

Around 200 citizens attended the recent Community Council in the Eastern Cape, which focused on the proposed National Health Insurance policy and its potential effects on the regional and national health care system. Several concerns were raised during the council by those attending, highlighting issues within the community in need of attention.

Perhaps the most prominent issue discussed was the shortage of doctors and nurses within the rural health clinics. This lack of professionally trained health care workers results in a decrease in not only the number of patients being seen, but in the quality of care those patients receive. Few doctors and nurses are expected to see countless patients each day, and are therefore unable to give them the necessary levels of attention.

Related to this problem is the lack of space within the clinics. This problem is seen particularly within the former Transkei region; patients may arrive at 8 in the morning and not be seen until 2 or 3 in the afternoon. As few as 5 rooms may be available in a clinic, while those waiting crowd the halls in hopes of being seen. This leads to a shortage of care, as well as a lack of privacy for those in the clinic, who may be discussing sensitive health issues with doctors and nurses.

Access to even the most minimal clinics, such as those 'tent clinics' in many rural areas, is made difficult due to a lack of infrastructure. Roads are in disrepair, and many do not have the vehicles necessary to get to the clinics. Many do not have money to pay for public transportation to clinics either, and so are forced to go without.

The prevalence of corruption was also discussed at the council, and is a large concern for many citizens both regionally and nationally. High rates of unemployment persist within the region, and some have taken to selling their free medication for a profit. Due to the shortage of medicine and lack of access to treatment for many, this practice continues to increase, particularly in the Eastern Cape Province. Additionally, many of those within the health department and government structures are taking part in this process. Those selling the medicines tend to have connections to government officials, who supply them with the medicine and fail to regulate these unfair and illegal transactions. Therefore, concerns taken to these provincial government officials are often ineffective.

Finally, the council addressed the need for increased access to education, particularly in the health field, for those coming from poor, rural areas. Most colleges are inaccessible for citizens of these regions, due to lack of funding, lack of transportation, and lack of equitable primary education. The shortage of doctors and nurses within the clinics can only be fixed if more students are given the opportunity to study and succeed in these fields.

The Eastern Cape NHI Community Councils discussed these important issues, and called for cooperation by all those within the community to work for improvement in the health care of the region. Overall, those attending were optimistic about the effects that NHI will have on the rural health care system; they believe that it will help to sort these issues out by expanding the existing clinics, therefore providing additional treatment as well as additional jobs. The council agreed that these issues, while seen particularly within the province, are national issues. All provinces and all branches of TAC must work together to expose the corruption which is rampant within the government, and to bring these issues to the attention of those working on the National Health Insurance policy. Additionally, attention must be given to the areas of infrastructure and education in order to affect lasting improvements in the health care system.

TAC WC Provincial AGM

 TAC WC hosted its Provincial Annual General  meeting in Cape Town on the 25-26 March 2013.  The AGM was attended by 70 delegates, partners, donors, staff and supporters of TAC from across the Western Cape.  The Provincial AGM formally reviewed the work of the organization in the province since the last congress.  Part of the process was to have strategic discussions and debate the new organizational form and elect a new provincial secretariat and propose resolutions on the national, provincial and district campaigns that TAC WC should undertake.  The opening of the AGM was done by Vuyiseka Dubula, National General Secretary of the organization.  The provincial accreditation and credentials was done by Loyiso Mahomba who was followed by Yolande De Monk who did the Chairpersons report and Fredalene Booysen who did the financial report.  The key note address was done by Mark Heywood of Section 27.

Most of the discussions and debates happened inside the commissions that covered: (i) Constitutional amendments, (ii) How to build strong branches and sustain the membership of TAC, (iii) Integration of NHI with TB/HIV and the last commission looked at the (iv) relevant structures, committees and platforms that TAC WC should participate in as well as partners that we should be working with.

After much deliberations and vigorous discussions, the AGM came up with some of the following resolutions.

CONSTITUTIONAL AMENDMENTS

1. The Chairpersons forum must be part of the constitution with clear directions as to what this body will constitute and the purpose and its function
2. Before branches are formed they need to go through an induction process for 6 weeks which includes in house meetings
3. Staff members should not serve as political office bearers
4. Staff should be part of a branch
5. All newly elected office bearers must be inducted before taking office
6. All organograms to be changed into a  provincial organogram as well as the change from district office to provincial office to be reflected
7. For a branch to be constituted it needs to have 15 members and more
8. Sectors (PLWA, youth, women, men and now the LGTBI sector) to be incorporated into the constitution and they should form part of the branches and come out of the branches
9. The provincial coordinator will not automatically be the chairperson of the provincial secretariat but an ex officio member of the secretariat and the council

HOW TO BUILD STRONG BRANCHES AND SUSTAIN THE MEMBERSHIP

• This commission first identified the challenges that have made TAC weak and why branches were not functioning, for example: No proper lines of communication, information does not flow, no resources, Lack of support, No commitment from both members and staff, TAC overview not done properly, certain individuals want to own TAC, No Treatment literacy education , People feel that they are not welcome because of attitude, Personal Problems with community members, People are tired with the way we give out the information, Inductions are not done!
• How to build strong branches and sustain the membership:
  1. Prevention and Treatment Literacy education to all branches every time we have branch meetings
  2. All the big meetings should include all the branches leaders
  3. Branches must support each other and each others activities
  4. Involvement, Networking and partnership with CBOs and participating in all the local structures in your areas
  5. Members  need to do research
  6. Change the way of recruitment and the behavior as well
  7. Old members have a role to play
  8. CMs are not fit enough, this needs to be unpacked
  9. Leadership Training- soft skills (chairing meeting, writing minutes, public speaking, listening, communicating, treatment literacy) also education on Socialism, Globalization, Privatization
  10. We need provincial organizer to travel around the province
  11. New ideas to make TAC exciting- we can use educational documentaries, social dialogues on rape, xenophobia, unemployment,  and readings of papers
  12. We need to Mobilize and make sure the following people are part of our branches and membership:  Males, Females, PWAs, Nurses, Teachers, Doctors, Police, Library Staff, LGTBIs, etc.
  13. Membership:  10 Rand Membership Fee, ongoing training for members, should get a HIV positive T-shirts, trainings for members should be accredited , membership should begin at the age group 13

INTEGRATION OF NHI WITH TB/HIV

1. Develop strong partnerships with HIV/TB organizations within the province and represent TAC on the relevant HIV/TB structures within the province (like TB/HIV Care, Sonke Gender Justice, Desmond Tutu, MSF, ARASA, PAC, MSATs, SO4, HAST, DHC, local health committees and forums and Polls Moor)
2. An person that will coordinate TB within the province, starting in Khayelitsha, this position will fall under CMs
3. Have an internal TB task team that will work closely with health facilities and the community at large
4.  Intensify community outreach activities which will include the PLWA sector activities on TB/HIV, early initiation and others
5. Integration of PLWA sector into this campaign
6. Monitor the GeneXpert at facilities

NHI

1. Continue the work with the provincial NHI coalition
2. Intensify Internal and External education, community workshops and awareness on NHI, TB/HIV
3. TAC to work closely with the Eden NHI task team that’s already in existence around the monitoring at the Pilot site and all health facilities across EDEN district
4. Set up meetings with the provincial and local health officials that is responsible for the NHI
5. TAC members to sit in all the relevant TB/HIV structures within EDEN district
6. Work closely with HIV/TB organizations within EDEN district
7. Work on the resolutions from the NHI summit in Eden that took place in August 2012
8. Set a meeting with MEC for health on both HIV/TB and NHI

RELEVANT STRUCTURES, COMMITTEES AND PLATFORMS THAT TAC WC SHOULD PARTICIPATE IN AS WELL AS PARTNERS WE SHOULD WORK WITH

1. General meeting will be called to take stock of who is representing the organization on the different platforms and if they are still relevant or if we need to make changes, at the same time they will give feed-back on platforms they have been representing the organization so that we can determine if this messages that we giving out on the different structures and platforms is still in line with the provincial strategy
2. Inductions must be given to all the TAC members that will be representing TAC in any platform, committee or structure, locally and provincially
3. Monthly and Quarterly meetings will be held with these representatives for them to give feed backs as well as get a mandate from the organization
4. Appropriate forms for reporting needs to be filled in or developed
5. Structures and platforms we will sit on: clinic committees, MSATs, PAC, SO4, COC HIV/TB coordinating committee, DHC, HAST, ward committees, etc.
6. Organizations TAC will work with and sign MOUs with: MSF, NACOSA, SJC, Philani (PTL sessions, social securities, referrals), Ubuntu (education, PTL referrals), Caring Network (bedridden), PHM (NHI), COSATU, SANGOCO, Khayenet (social media), Workers World media, Mosaic/Simelela, Radio Zibolene, Grassroots soccer and Sonke

The WC newly elected provincial secretariat include the following people:

THE END!

Let us work together toward zero infection, deaths, stigma and discrimination from HIV and TB!!

While we commemorated World TB day, we need to take stock of the progress we have made in fighting the disease. TB remains the number one cause of death in South Africa with approximately 500,000 new cases of TB disease per year. A further 13,000 new cases of drug resistant TB are projected for 2013. South Africa continues to carry one of the highest TB burdens in the world.  The Western Cape is reported to have one of the highest incidences for all smear positive cases of TB in South Africa.  The HIV epidemic has led to an enormous increase in the number of TB cases.

Although we welcome many efforts by the NDOH in scaling up its campaign for HIV/TB screening and furthermore making the GeneXpert available across the country (GeneXpert drastically reduces the time to diagnose active TB disease and especially drug-resistant TB (DR-TB).  However, the GeneXpert can only make a difference if it leads to faster initiation on treatment. For this to happen, we need uninterrupted cartridge supply and capacity to manage DR-TB at primary care as soon as the patient is diagnosed, this includes adequate resource allocation, training of staff, continuous supply of TB and DR-TB drugs and adequate supervision capacity. Medicine stock-outs, as we saw in 2012, increase the risk of developing drug resistance and endanger the lives of many of South Africa’s people.

We welcome the department’s policy framework on decentralised and deinstitutionalised management of DR-TB for South Africa in 2011. However, we have had to witness with sadness that two years later the policy framework has hardly been implemented. The provincial operational plans for decentralisation of MDR-TB care have not been drafted, nor have readiness assessments been conducted of all proposed decentralised MDR-TB units, satellite units and PHC facilities, nor have doctors and nurses been trained.

New drugs are being developed and tested. Bedaquiline is one example, and we welcome the open label trial to provide expanded access to Bedaquiline. However, we need to increase the number of primary care based sites which are able to manage DR-TB adequately throughout South Africa to ensure our brothers and sisters elsewhere can access this potentially life-saving drug.

We also welcomed the recent cooperation between the Department of Health and the Department of Correctional Services to jointly prioritize and combat TB in prisons and the development of the "Guidelines for the Management of TB, HIV and STIs in Correctional Centers" that have been announced.  However, we warn that: Whilst DCS and DOH should work together to improve health in prisons, the DCS remains legally responsible for the work and must be held accountable for it.  Whilst the guidelines are a necessary step, the DCS and DOH must remember that detailed set of Standard Orders already exists and controls health care services in prisons.  These must be enforced.  We must remind the DCS and DoH that guidelines and policy only bear fruit when enabled by budgets and implementation plans.  We therefore call for a budget and implementation plan for an effective comprehensive HIV and TB prevention, diagnosis, treatment, cares and support programme in prisons.

For the month of March 2013 the Western Cape province was chosen by the National Department of Health as the province where they will focus on due to our high incidences of TB.  TAC and MSF participated in a range of TB activities during TB month, some included having door to door activities in areas like Nkanini in Khayelitsha, pamflateering and  education in health facilities.  We also participated in a TB march that was co organized by TAC and TB/HIV Care, we participated in a TB picket in Kuyasa area in Khayelitsha as well as a TB picket at Polls Moor prison.

Free Gender & TAC marches against Hate Crimes, Rape and Gender Based Violence in our communities!

On the 15 March 2013 TAC WC and Free Gender marched against "Hate Crimes" in Khayelitsha from Nkanini to Harare where a memorandum was handed over to the MEC for Safety and Security.

In the past months the LGBTI community of South Africa has witnessed and experienced immense trauma and pain due to the on-going attacks against and the murder of LGBTI people.  Free Gender and its allies are angry that there is no statistics that can be produced on the number of hate crimes committed against LGBTI persons.  Hate crimes is on the increase and the reporting of hate crimes is increasing.

Up until now we are not clear what the plan of action or the response from our provincial and our local government is towards “Hate Crimes” in the Western Cape.

In the interim and until the ‘Hate Crimes’ Bill is promulgated, we asked for the following measures to be taken to protect the rights and interests of LGBTI persons:

1. The Western Cape Province to Name and Shame the perpetrators of violence against women and children
2. That the National Prosecuting Authority keep statistics of the number of alleged hate crime cases that they decline to prosecute, the number of hate crime cases that are withdrawn by complainants and the number of convictions of perpetrators of hate crime.
3. A clear strategy to combat homophobia and hate crime in the Western Cape province
4. LGBTI organizations to be invited to participate in the activities organized by the Western Cape province
5. One Joint provincial event in partnership with LGBTI organizations to end homophobia in the province.
6. Police to be sensitized to barriers faced by women and LGTBI community reporting cases as well as for the training of police officers in this regard

The memorandum was accepted from a representative on behalf of the MEC for Safety and Security, Mr Dan Plato and a representative from SAPS Khayelitsha.

For more information on  this campaign please contact Funeka Soldaat at 076 321 0276 or alternatively you can contact our TAC WC offices at (021) 364 5489

Integrated School Health Programme launched in EDEN NHI pilot project

On Monday the 18 February 2013 TAC WC attended the launch of the NHI pilot project in EDEN.  The event took place in the George Town Hall, York Street, George.  The event was attended by Prof. Craig Househam, Head of Health: Western Cape, Minister Botha, Dr Renette Crous, Chief Director: Rural Districts Health Services, Ms Florence Rhoxo, Director: Department of Education Eden District and many health care workers from the Eden district.  Although the National Minister of Health's name appeared on the programme he was not physically present at the launch.

This project is called the Integrated School Health Programme.  On display were the three mobile clinics that will be used to reach out to selected schools in the Eden health district.   The programme includes health assessments for learners in Grade R and Grade One, which include hearing, eye, gross motor, weight and height and oral health.

There are a total of 163 primary schools and 36 High schools in the Eden health district.  One of the main functions of the NHI is to re-engineer primary health care, and the strengthening of the South African health system.  The NHI pilot project will be rolled out through a focus on schools and promoting health among learners and preventative health care, whilst rendering quality curative and rehabilitative services.

Western Cape Government opposes the centralization of health facilities and all it is currently being undertaken by the Western Cape Government through the support of the NHI pilot project is to strengthen health services in the Eden District and to provide the country with viable models of health care that have worked and will continue to provide quality patient centered health care services.

It was very worrying to see that there was almost no representation from civil society when this programme was launched for the people.  One would have thought that such an important event would have been launched in one of the poor communities of George with as many community members being present.

BM Section, Khayelitsha Fire Disaster – TAC response!

On the 01 January 2013 a fire started that left about 4000 people homeless and those who lost their lives was about 5 people of which two were children . The main reason why the fire was uncontrollable was because the area is highly dense with no streets for the fire fighters to reach homes. Secondly during this time of the year Cape Town is known for are strong winds. Many families were away in the Eastern Cape for the festive season holidays and they will find no homes in Cape Town as they come back this week. Most families are now temporarily housed in the nearby community hall in Oliver Tambo “Mew Way”.

The TAC Khayelitsha office went to visit the area of disaster and we also have a local TAC branch in the area. We also immediately sent text messages to friends of TAC to donate clothes, blankets, food and anything that they can use.
We managed to locate nine of our TAC member families. These families together added up to more than 33 people including children as young as a month old. We also made a list of those in need to their chronic medications and we found 20 mostly at Ubuntu clinic.
We have set up a TAC team to support made up of:
1. Sonia Tombe in charge of distribution
2. Andile Madondile and Sr Mpumi in charge of those who need medication
3. Andile Madondile and Masa Nkawule in-charge of tracing our members and their families                                                                                   4.Mthuthuzeli Dutyulwa, Micheal Hamnca and Vuyiseka in -charge of donations and pick-ups

We received donations of clothes and food from Anso Thom, Nicola Brewer, Vuyiseka Dubula, Lynette Marrian, Peter Benjamin, Carohn Cornell and their families. Thank you for their speedy response. We distributed to all the families that we managed to trace, we also received a donation of R1000 which will go towards buying school uniform of the children.  Jane Letourneau donated R16 700 towards building material for the 12 families we are helping, Deena Bosch R500, Nathan Geffen R500, Dorete R150, Nicola Brewer R1000, MSF coordination office R3010 . 13 people came forward with clothes, shoes and blankets donations. Mrs Bosch will buy stationery and toiletry for 10 kids.

Please continue to support and share this message to your friends. We need more clothes, blankets, children clothes. If you have something to give, please drop off at TAC Khayelitsha office at Sulani Drive, Town one properties and contact Sonia 078 7037 666 or our office (021) 364 5489

If you wish to make a donation towards a child’s school uniform please use the TAC national account below:

• Account Details:     Nedbank, Cape Town
• Account Holder:    Treatment Action Campaign
• Account Number:  1009726269
• Branch Code:            100909
• Reference:                  BM fire or BM relief

Thank you again for your support and we will keep you updated!