EPISODE 24 - Community Health Workers

Our public health system is seeing more and more people. The HIV epidemic is a big contributor to the increasing number of people attending our clinics and hospitals. However, the number of health workers has not increased to keep pace with this so there is a big role for community health workers to play in supporting health service delivery.  For many years lay workers have had a very bad deal. Often they are not paid and training is very uneven. Some are very well trained and can do a lot while others receive almost no training, yet they can still play a vital role.

Noluto Tuswa stays in a remote village of Emandlovini some way from Umtata in Eastern Cape. She is a home based care worker.  Many people including those on ARVs have to fetch their medication every month. As the clinic is far from Emandlovini one of the things Noluto does is to fetch medication for people.  Many people in the village say she helps them a lot in this way. She also helps people who are too sick to look after themselves, washing them and helping them at home.  Home based care workers like Noluto could do a lot more if they were helped with proper training. Then they could help prepare people to start on ARVs, monitor for side effects, ensure pregnant women test and get onto to treatment to prevent mother to child transmission and many other things.  They also needed to be paid a proper salary  so they can do this work every day.

In Khayelitsha, Western Cape Xoliswa Mtwetafa is the Programme Co-ordinator at The Caring Network. She does assessment visits to the homes of people referred to them. She is trained to test the blood pressure and give a general assessment of a patient. While we want as many people as possible to get on treatment and get well, there are still unfortunately, those who are bedridden, or those who start late and will need help at home for a couple of months till the ARVs kick in. There are also many who unfortunately start ARVs much too late and don't get better. Once Xoliswa has made her assessment, a home based carer like Mhozisa Mbali takes over. We go with her to visit Mrs. Nomhimha Ben. Nomhimha unfortunately started ARVs much too late. She had developed a serious nerve condition as a result of HIV that has left her partially paralysed. Amazingly, she did get better overall because of the ARVs. But her paralysis has remained, so she really needs help at home.   Mhozisa bathes her client, makes sure there are no bed sores, changes linen, helps with the house. One can only hope that the message gets out, test and start ARVs BEFORE you get sick!

Also in the Western Cape, Nobuhle Qabazi works for Siyayinqoba Beat It! and is based at Langa Clinic.  Nobuhle provides treatment and prevention literacy information to people who come to the clinic. Treatment Literacy means empowering people to understand their own health.  Why should I have an HIV test and a TB test? If I test negative how can I stay negative? If I test positive, how can taking ARVs give me back my health? How should I take ARVs and why is it important to take them every day, for the rest of my life? How to deal with any side effects? How is it possible for a mother and father who may both be HIV positive or perhaps only one partner is positive, to have a health HIV negative baby? How should the baby be fed to make sure it stays HIV negative? Why should someone test for TB at the same time as testing for HIV? How can some infections, like herpes which many people have, be controlled so it doesn't bother one so much? What is a viral load test and a Cd4 count and why should I check them from time to time? What do the results of these tests mean? What is the truth about nutrition and HIV and what can I do to support my immune system? Should I see a traditional healer as well as visiting the clinic? Should I go to the Universal Church and try and be healed by faith alone? All of these and many more are questions Nobuhle and her team are trained to answer. These are the questions which people have.

Without a good understanding of the answers to these questions,  the government's plan to get 1.5 million people on ARVs by 2011 will fail as many people will fail to adhere and problems will emerge. Nobuhle feels that people like her should be part of the health team in the hospitals and clinics and should be employed by government instead of NGOs.