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.
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.
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.
Khayelitsha hospital, the pride of Khayelitsha, has been dubbed the new Jooster hospital by the community of Khayelitsha. Patients say that they wait throughout the night and sleep in the cold hard chairs before being attended to in the morning by a nurse or a doctor
TAC Khayelitsha collected 30 testimonials from patients documenting their experiences at the hospital. Complaints range from long waiting periods, sleeping for days on the waiting area chairs before being attended to by a doctor or a nurse to a doctor being on a social media site while attending to a patient and not communicating with the patient while not wearing a medical glove throughout the consultation.
TAC Khayelitsha took these testimonials and forwarded them to the hospital management on Wednesday 14 May 2013 and met with Khulile Dyamare, the hospitals' liaising officer. The delegation consisted of Mandla Majola (district head), Lumkile Sizila (Provincial Organiser), Mary-Jane Matsolo (Communications officer) and Simo Sthandathu (TAC volunteer). We handed the testimonials and requested an investigation before our next meeting scheduled on Monday the 20 May with the hospital's CEO.
We had initially requested a meeting with the CEO of the hospital, but he could not attend the meeting due to interviews and ended up with the patients liaising officer. With regards to the bed shortage issue that result in a lot of patients sleeping in chairs, Mr Dyamare justified it and said that the planning of the hospital was done in the early 2000 and since then the population in Khayelitsha has increased which led to the bed capacity not being enough. He further explained that they are tackling this issue by introducing recliner chairs.
Of which TAC dismissed that justification claiming that it was a poor excuse and showed that the planning of the hospital was poor and that the department should have anticipated this and made the necessary adjustments.
TAC demanded that the hospital provide us with a plan to address these issues for our next meeting and emphasized that these issues should be addressed and resolved. The delegation emphasized and made it clear that TAC would take further steps should these issues not be addressed.
The next meeting with the hospital’s CEO is scheduled to take place on Monday 20 May at 13h00.
Today on the 10th September 2012 we the concerned health care workers, community members and civil society organizations have come together to voice our concern over the plan to decommission GF Jooste for 3 years. This initiation was initiated by SAMA in conjunction with TAC, MCHF, PHM, DENOSA, NEHAWU, Klipfontein sub district and other community groups and concerned parties like MSF. We feel that the community will be adversely affected by this closure therefore we want to address what is widely seen to be a crisis unfolding. A new hospital to replace GF Jooste is welcomed by all , with paediatric and obstetric services, which at present are not provided locally.
While details of plans to demolish and rebuild GF Jooste is unclear, or at least are not in the public domain, the following has been communicated by the provincial department of health, in a piecemeal manner: GF Jooste will close next year for 3 years, It will be rebuilt on the same site, In the interim patients will be moved to Mitchells Plain and Groot Schuur hospital depending on disease complexity, Certain elements of care currently offered at GF Jooste will cease such as High care unit the infectious Disease Unit and the CT Scanner, A potential emergency stand-alone centre may be set up somewhere within Klipfontein corridor.
GF Jooste currently services a population of over 1 million Capetonians. It is positioned strategically within a community who have a very high burden of disease.
It should be noted that there is a fundamental difference between consultation and information. To date there has been no formal consultation, there has merely been information. There has been no written communication to the health care workers based at the hospital and community structures it serves despite some verbal interaction with DOH officials.
A month ago we as the coalition send a memorandum to the MEC for Health, Premiere's office and the ANC Western Cape but to date we still need to get a response from these officials. The purpose of today's picket was to publicly draw attention to our concerns since we are being ignored by our provincial government. We as the Concerned Coalition call for an urgent response to our concerns, a meeting with the MEC of health to clarify these and several related matters, and an immediate moratorium on the plan to close GF Jooste until the issues that we have raised have been adequately addressed. We are picketing again on the 27th September 2012 at GF Jooste hospital and we have again extended a invitation to the MEC for Health's office.
Dudley Lee spent nearly five years in Pollsmoor prison from 1999 to 2004 before being acquitted. He became ill with TB in prison. Now he is suing the Department of Correctional Services for compensation. The Cape High Court found in his favour, but this judgment was overturned on appeal by the Supreme Court. Dudley Lee has appealed and his case was heard in the Constitutional Court on 28 August.
The TAC National Council took a decision in April 2012 to seek to intervene as “amicus curiae” (friend of the court) in this matter. SECTION27 has agreed to be TAC’s legal representatives. The Wits Justice Project and the Centre for Applied Legal Studies are co-applicants along with TAC in this matter. TAC has an interest in this matter because the issue being decided by the Constitutional Court will impact on its ability to realise its core vision and mission. TAC is committed to advocating for the rights of people with TB and for the implementation of an effective and comprehensive TB prevention, diagnosis, treatment, care and support programme. TAC also focuses on TB because people living with HIV are at an especially high risk of contracting TB. The TAC wants to participate in this case as an amicus curiae in order to persuade the Court to develop the law in a way that gives effect to the rights that prisoners hold, specifically those found in section 27 and 35(2)(e) of the Constitution.
On the 28th August 2012 TAC WC, MSF, SJC, EE, Sonke Gender Justice, NACOSA and other partners staged a picket in front of Pollsmoor prison whilst the Dudley Lee case was being heard at the Constitutional Court.
Thembalethu or its English name “Our Hope” is a suburb and it’s a “community “on the outskirts of the city of George. This is a dynamic community made up mostly of Xhosa people but also living there are other black South Africans and people from other African countries. Over the past 15 years this community has grown dramatically and unofficial estimates in (2009) had at least 80,000 people living there. Many people in this community are struggling economically with many people living in shacks although RDP housing is slowly raising the quality of life. Many people who have moved to this community were not lucky enough to have obtained an education and jobs are very scarce.
On the 17 August 2012 the NHI Coalition partners participated in a National Health Insurance rally in Thembalethu community. The main purpose of the rally was to raise awareness and to educate the community on the National Health Insurance. The rally started in Conville Police station, through the main road of George and ended off through the community of Thembalethu. At Thembalethu hall we had a few speakers which included the general secretary of COSATU WC. The Health Care Workers from Thembalethu Day Hospital offered TB and HIV/AIDS testing to the community that attended the rally. More than 48 people were tested with about 12 people that tested HIV positive. Information tables were also available at the rally that offered a range of material on different topics.
Our TACcies moved into Kwanokuthula and did a workshop with community members that included TAC members from the area. This is one of the poorest areas within EDEN district. The workshop was facilitated in a storeroom next to a scrap yard. On the other side of the storeroom was a soup kitchen where old people were queuing in a long line with more than forty people for food. More than 50% of the youth is unemployed and the youth in the area is caught up in the cycle of substance and drug abuse.
A range of topics were covered in the workshop that included a political discussion, Prevention and Treatment Literacy, Budget Monitoring and Expenditure Tracking, Social Security, National Health Insurance, a female condom demonstration and community health mobilization.
On the 14th June 2012, TAC WC went to ATLANTIS to have a community mobilization day of action to raise awareness and education on ARV stock outs and shortages as well as giving information on the challenges around the chronic illness medication dispensing. The team consisted out of one taxi from PAARL, two taxis from Khayelitsha and ATLANTIS branch members. In the rest of the province the PTL programme with support from the provincial secretariat coordinated further research with branch members across districts and follow ups on ARVs stock outs and shortages, especially in those areas where community members indicates to TAC that they have not received their medication. Some of the other activities in ATLANTIS included meeting with stakeholders, meeting with the Dr in charge of the ARV site at WestFleur Hospital and this included the pharmacist. Our two Community Mobilizers did Prevention Treatment Literacy education at two sites in the area whilst other teams continued with the door to door education and condom distribution in Witsand and Sherwood Park areas of ATLANTIS.
On 23 March 2012 Khayelitsha sub-district received an award through the City of Cape Town Health for distributing more condoms than ever before - 14 million male condoms in 2011, equivalent to 103 condoms per male 15 years and older, per year. For 2012 the TAC Khayelitsha district target has a goal of distributing 1 million condoms per month. The district also received the cup for the ARV programme. Distribution of sexual health materials and information is also a relevant part of TAC's campaign. In December 2011 and January 2012, over 2000 educational materials accompanied condom distributions.
What TAC wants to achieve with the condom distribution programme:
• Decrease in the HIV prevalence in the district
• Decrease in the STI infection rate
• Promote on-going education and raise awareness about condoms and prevention in the district
• Break the stigma surrounding condoms
Challenges to the programme:
• Female condom shortages remain a problem
• Condom shortages over the festive season made it very difficult for the condom distribution to take place
Currently the district strategy on condom distribution is still relevant. The district will continue to evaluate and assess whether we need to change what we do and how we do it. Evaluation takes place every quarter and during the mid-term review process.