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A holistic plan of action helps turn the tide of hopelessness for children

© UNICEF/SouthAfrica/Shelley
Dr Khosi Gxagxisa, Superintendent, Prince Mshiyeni Memorial Hospital in Umlazi, Durban.

It’s early morning and the sprawling grey township of Umlazi, south of Durban in the province of KwaZulu Natal, South Africa, is waking up. Thin wisps of smoke from shack-fires boiling water for porridge curl out holes in corrugated iron roofs and already, long queues of solemn faces on their way to work in the city, are forming at taxi ranks.  Children take the hands of smaller children and walk them to school, leaving them at the gate and then hurrying home to take care of the babies.

Umlazi is a township a stone's throw away from Durban International Airport. It's a settlement of great contrasts -- large brick houses stand imposingly alongside streets of corrugated iron structures -- homes to thousands of the area's poorer residents.

Small blocks made of iron sheeting with bits of thick plastic serving as roofs are homes to families, sometimes forced to sleep on mud floors. The informal housing is mushrooming -- each day more and more shacks (as they are called in South Africa) are built by people desperate for a roof -- even if it's held down by broken bricks -- over their head. Sewerage systems and refuse removal is non-existent and rubbish piles up in huge smelly heaps on street corners. Over-used chemical toilets and long-drops service most of the shacks, contributing to unhealthy living conditions for parents and children alike.

While these conditions pose serious health risks, the security risk is thought to be even greater. With the amount of child-headed households in Umlazi, children living in this insecure environment are forced to fend for themselves against evils like hunger, abuse, rape and spiralling HIV rates.  It’s not a very cheery environment by any stretch of the imagination.  But then Umlazi is an area where people burdened with terrible social ills.

It’s a community that amplifies South Africa’s already-significant HIV rate – Children orphaned by AIDS head almost 10% of the township’s households. It is also estimated that more than 33 per cent of the population of KwaZulu-Natal, South Africa’s largest and poorest province, and the one with the highest numbers of child abuse cases, is HIV positive.
But a devoted team of nurses, doctors, social workers and community volunteers at nearby Prince Mshiyeni Hospital are digging deep to try and turn the tide of hopelessness especially for the area’s children. To look at the building, a faceless brown maze of dark corridors and crowded wards, it’s hard to believe.  But just walk inside and the warm smiles and handshakes of nurses at the Neonatal Unit and Comfort Centre for victims of sexual and domestic abuse, speak for themselves.

UNICEF has helped the hospital put together a holistic plan of action to combat the worryingly high rates of HIV, sexual abuse and teenaged pregnancies. It’s a facility that serves a staggering six million people that come from a catchment area bordering on two neighbouring provinces, KwaZulu Natal and Eastern Cape – in two of the poorest provinces where the Government of South Africa has asked UNICEF to concentrate its work.

A successful Prevention of Mother-to-Child-Transmission (PMTCT) programme is up and running, a crisis centre, known here as a “Comfort Centre”, with an on-site police station is making it easier for women and children to come forward and report abuses, and an HIV/AIDS Resource centre is in the pipeline for township youth.

Hospital Superintendent Dr Khosi Gxagxisa flips her dreadlocked hair over her shoulders and beams brightly when she says things are finally coming together.  ”I’m just getting a security cage made for the computer UNICEF donated for the hospital’s birth registration unit and then that too will be ready.’’ Birth registration is a huge problem in South Africa, a firm necessity if people want to access free education, child grants or disability grants and a vital area of focus for UNICEF in improving the lives of children. It is especially important for those in child-headed households who have little or no access to social services and do not know their rights.  In 2000, 70 per cent of all births went unregistered in sub-Saharan Africa.  In South Africa, that number stands at fifty percent, with only 58 percent of children registered at birth. 

Once ready, the hospital birth registration unit will be able to immediately register all the babies born there - estimated to be about 35 a day although this number rises to 80 depending on the time of year.  “The birth registration unit will also aid us in gathering accurate information on the percentage of patients who are HIV positive.’’ At the moment, senior nurses write down Aids statistics in their notebooks and stick the pages to walls in their offices to monitor the situation.

PMTCT: Women scream with happiness when babies are HIV negative

It’s about 9am and the neonatal unit is already quite full. Pregnant women toddle around in nightgowns, in and out of counselling sessions and examinations. The hospital’s PMTCT programme is just two-years-old but running like clockwork. However, statistics gathered as part of the programme paint an even bleaker picture of the prevalence of HIV in KwaZulu-Natal. Sister Thuli Zwane, who heads up the unit says half (50%) the patients are HIV-positive.

The hospital has been providing Nevirapine to pregnant women since July last year. “It’s been so moving to witness. The women just scream with happiness and run around here, phoning their husbands and families to tell them their babies are HIV negative,’’ Zwane smiles.  In her shiny blue gown, Thobile Cebekhulu (29) sits in line anxiously at the unit. She is one of the fortunate women who escaped the grip of the virus, although she admits luck had a great deal to do with it. “The first time I heard about Aids and what it can do was when I came for counselling at the hospital. I didn’t really know anything about the disease before and I wasn’t even using condoms,’’ she admits shyly.
The PMTCT unit employs three lay counsellors who hold individual and group discussions about HIV, family planning and general health. They educate women about the risks and benefits associated with breastfeeding, condom-use and sustainability of resources like fire-wood and clean water.  “There is still lots of pressure out there with men not wanting to use condoms but we are trying our best to tell women it’s a necessity. We also provide pre- and post-test counselling for HIV and highlight the fact that because we now have Nevirapine, most babies can be saved. Breastfeeding is one of the main thrusts of our counselling,’’ Zwane says. 

Big silver letters, painstakingly fashioned out of foil by nurses in the unit, announce proudly from the walls that “Breast is Best. Breastfed babies are happy babies.’’ The hospital’s breastfeeding policy is in line with UNICEF recommendations which take into account that non-breastfed babies have a six times greater risk of dying from infectious diseases like acute respiratory infection and diarrhoea in their first few months than breastfed infants. A South African study has also shown that exclusive breastfeeding can protect against transmission, compared with a combination of breast milk and other foods.

Down the corridor at the Kangaroo Care Unit, new mums are watching soapies on a small black and white television at the far end of the room - little whimpering bundles wrapped warmly against their skin. This is the ward for premature babies and the kangaroo method of skin-on-skin nursing is doing wonders for the babies, says Sister Thandazile Radebe. The intimate handling encourages bonding between mums and their babies and is a much cheaper alternative to confining the little ones to incubators.

© UNICEF/SouthAfrica/Shelley
Young burn vistims enjoy the winter sunshine at the hopital's early childhood play garden.

A few toys for playing when a volunteer teacher visits the ward

Leaving the drama of the soapie ward for the Paediatric Surgical Unit, little boy giggles echo down the long passage outside. This is the home of a newly-established early childhood development garden and playground.  Three young burn victims limp gingerly around the garden in the winter sun, looking at the swings and jungle gym longingly. They aren’t allowed to rough it up because of serious burns on their arms and legs and the sister in charge keeps a watchful eye.

The unit has a small playroom adjoining it with plastic chairs and tables stacked high in one corner and children’s paintings decorating the walls. The few toys they have are safely locked away - the children can only play with them when a volunteer teacher visits the ward twice a week so the kids can catch up on reading and writing. A physiotherapist visits once a week to exercise the children, many of whom are forced to spend months on end at the hospital while they recover. Just a few months ago a lack of facilities meant young children were missing out crucial parts of their schooling.

A quick walk away, Dr. Sew Ramlakan is talking in hushed tones to a young woman at the hospital’s Comfort Centre for victims of rape and domestic violence. The centre has made life a lot easier for the many women and children who file through the doors of the hospital in need of urgent medical assistance, counselling and prophylactic treatment like AZT and 3TC. Here they can report the crime, get free psychological counselling including pre and post-test advice and sensitive medical treatment.

Dr. Ramlakan says after begging for counsellors (the province does not provide them for free), Childline and Lifeline, two UNICEF supported national NGOs that focus on child protection, agreed to send a team in twice a week. It’s not really enough to deal with more than 100 women and children who come to the centre every month, but for a traumatized victim of sexual abuse or violence, it’s yards better than an unsympathetic police officer.  At the on-site police station, a shocking average of three women and young girls report rapes and other cases of abuse every day, and statistics show that the perpetrators are increasingly younger.  Shockingly, in many cases, it’s young boys and not grown men that are the culprits. 

“Just last week I treated a little deaf and dumb girl who was raped by her father. She contracted HIV from him as well. Children are so difficult to deal with.’’ The Comfort Centre was established so victims didn’t have to walk long distances to police stations where they risked being attacked again, often by the same person.   
They only have 72 hours to save themselves

Dr. Ramlakan says that many child rape cases occur in the home and mothers are often to afraid of their husbands or partners to report them so often a sibling will bring his or her sister to the centre - much later after the rape has occurred. “By then, after the 72-hour period during which we can administer prophylaxis, it’s too late to prevent them contracting HIV. People arrive here from towns and villages far away, often on foot, so we doctors donate money to pay for bread and tea for women and children who arrive starving and tired. We also try to pay for their transport home.’’ Sister Jabulile Hadebe, who counsels sexual assault victims, says many of them are reluctant to deal with the trauma of going through HIV testing when they arrive.  “I need to explain to them that they only have 72 hours to save themselves.’’

The centre has a bright playroom for children but it’s poorly equipped. A dusty yellow truck with three wheels lays next to an old cash register. There are no other toys for patients. Dr Gxagxisa says the hospital is desperately short of toys and learning materials for child patients.  The situation is a little better at the hospital’s Youth Friendly Corner. Two spanking new computers sit in a corner of the otherwise bare room. Bongani Dube who oversees the corner says he is waiting on book donations for the library and Aids resource centre that is being planned.  “We offer Aids and life-skills counselling for the youth. We want this to be a place where young people can spend their time productively. We hold HIV support groups and try to visit schools in the area to give pep talks and encourage students to get themselves tested for HIV.’’

Dr Gxagxisa is most excited about the young peer counsellors the hospital is training - one of whom is her daughter. “These days the youth can’t be counselled by someone as old as I am. They find it intimidating because they’d see me as a mother and because I don’t understand their language and their fears. I don’t know what’s ‘cool’,’’ she smiles. Eight teenage students from schools around Durban will soon start offering individual youth counselling on weekends at the Youth Friendly Corner.

And the good doctor is not stopping there. She babbles off an ambitious wish-list that centers around making life more pleasant for the area’s elderly, sick and orphaned residents. “I desperately want to establish a home-based care system so we can train community workers to provide services like food provision and cleaning to bed-ridden people in Umlazi. We need to help feed our poor, wash the elderly, help the disabled and take care of our young Aids orphans who are trying to run households on their own.  We also need to set up a mobile clinic service for bed-ridden patients.’’

In addition, Dr Gxagxisa says the area needs a place of safety for victims of rape and domestic violence, especially children who are terrified of returning home after they are discharged from the hospital.  “Another dream of mine is to create what I call a step-down facility, similar to a hospice, for terminally ill patients to die with dignity.’’  It’s an ambitious list but it’s an even more ambitious woman steering the ship.





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