The blue angels

2010-02-16 00:00

IT’S dim in the room where Zinhle (not her real name) sits exhausted on the bed after her laborious morning wash. It’s one of the hottest days of the year and she painstakingly scratches at her skin, mosquitoes an ever-present menace.

Zinhle looks up as we walk to her open front door. She is home alone. She probably heard us chatting as we approached from the yellow daisy and pumpkin-lined path that wends its way around her neighbours’ homes at Machibisa in Edendale.

Permission is sought for me to enter her home and that granted, I do.

On Friday last week, I accompanied Hospice-registered nurse, Sister Vicky Sikhosana, on her rounds to see how Zinhle is faring. She is just one of some 450 patients — most of them HIV-positive and half of them children — who are seen by the Msunduzi Hospice in the greater Edendale area. Zinhle needs its help because she is desperately ill, having been diagnosed HIV-positive. I assume by her appearance she is in her late fifties or early sixties but I am startled to hear that she was born in 1967, making her 43.

Her two sons, aged 14 and 11, look after her the best they can. Her elder daughter has disappeared and all Zinhle knows is that she is living on “the other side of Joburg”. She yearns for her daughter’s return and assistance.

Zinhle relies on an irregular disability grant to feed her family of three. Last year when she became very ill with tuberculosis­ and meningitis, she was hospitalised for four months. Her boys borrowed money from neighbours to buy food, but as soon as she was discharged, the neighbours demanded their money back. Her home was also set on fire by one irate man to whom they owed money. So the money from Zinhle’s most recent grant payment went to pay these debts and she is now destitute.

When Zinhle was well, she did washing for other families, but she is too weak now. Sikhosana also suspects that her mental state has been affected by her last bout of illness.

Zinhle’s bedroom also serves as the kitchen and precariously connected electricity wires zigzag across the ceiling. It’s all unofficially connected, but there is little option for Zinhle as she cannot afford gas or paraffin.

Zinhle has had nothing to eat so Sikhosana­ sets about making some instant mabela for her, chatting and laughing to her patient­ as she does so.

Zinhle responds slowly and quietly as if all her energy is being used up just by speaking. I ask if Zinhle currently has a partner and, although I can’t understand her muted response, I get the bitter tone loud and clear. She is through with men. She was abandoned for a girl from a better family by one partner, went through the agony of having an alcoholic as a partner who “spoke a lot of nonsense” and lost the man she was engaged to in 1987 when he died.

“It’s a pathetic story,” says a compassionate Sikhosana. “I am afraid she’ll die alone.”

Sikhosana finds Zinhle’s medicines. She must take her antiretrovirals with her food, so once she has had a few spoons of mabela — all she can manage for now — Sikhosana­ counts out the pills and fetches water. She discovers that Zinhle has taken a sleeping pill by mistake. Maybe she will sleep through the extreme heat of the day. Sikhosana straightens up the room and we prepare to leave. There are others whom Sikhosana needs to call on. As we say our goodbyes to Zinhle, she murmurs something and Sikhosana laughs. “She said I must­n’t be a stranger.” It’s plain why she wants the caring and ebullient Sikhosana around, the only person, other than her young boys, who cares for her.

In the car on the way back, Sikhosana relates how she has tried to convince Zinhle, who hails from rural Msinga, to go back home to get the help and care she so badly needs. But Zinhle refuses, saying that there is no one there for her. Sikhosana disagrees. “If you are an African­, there will always be someone willing to help, from your mother’s side or your father’s side.”

As we approach the hospice building, I spot an old man we saw earlier. He is clearly poor and clutches a packet of bread he was given by the Hospice workers. Sikhosana had told me how he stops by every day. They fill a bottle with tea for him and give him food as well. “He now comes for his tea four or five times a day,” she laughs. I bet it’s not so much the tea that attracts him as the company, laughter and kindness the Msunduzi Hospice team provides him.

The heart-wrenching work of Hospice staff

AT the Edendale Hospice buildings, rented for a negligible fee from the Msunduzi Municipality, nursing manager Zo Finca talks about their work.

They have a staff of 11, comprising four nurses, two social workers, two community care workers, two memory workers and a secretary. They also have other volunteer community workers in the field.

But these numbers are not nearly enough. There is an overwhelming amount that needs to be done.

“We are battling poverty. People have no food and their basic needs are not being met. How do you encourage people to live and be positive when the conditions they live in are so bad?” says Finca.

Most of the approximately 200 children on their books are very sick and need medical attention. “Children are supposed to get special attention, but it is difficult to access the services offered by the departments of Health, Social Welfare and Housing. Their workloads are huge too.”

She says that the Hospice staff are also aware that they need to protect themselves against the infections they encounter in their patients, some stricken with multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis. She tells of the sadness that they encounter in their work. “Do you ever cry?” I ask. “A lot,” she says emphatically. “We cry together often.”

She relays the story of a blind child of 13 years old, with an ill HIV-positive mother. “Her mother had become sick and we thought that she was going to die, so we convinced her that we needed to place her daughter somewhere. But the girl refused to go and told us if she leaves, her mother would no longer have access to her child grant and would literally starve. Bravely, she stayed with her mother, who has started treatment and who is now recovering.”

Another incident affected her profoundly. One of their critically ill patients needed to collect her pension. She knew that if she did not get it, her children would be destitute, so she summoned every ounce of her remaining strength and set off. “It’s their bread and butter. No matter how sick you are, you have to collect it.”

When the ailing woman returned by minibus taxi, she climbed out the taxi and immediately collapsed, dying alone on the street where she fell.

Sister Vicky Sikhosana attended the scene and helped to get a hearse to collect her.

Finca speaks of the helplessness she encounters when people come to her with a dire problem. “They expect me to say something to make it better, and often, I simply can’t. And that’s really hard.”

While some patients can and do recover, for others a peaceful pain-free death, surrounded by loved ones, is the invaluable gift the Hospice nurses can offer their patients.


ANYONE who is able to help Zinhle with clothes for her or her sons or food may drop them off with Msunduzi Hospice CEO Warren Oxford-Hugget at Hospice House in Prestbury, with Sister Vicky Sikhosana at Edendale or Stephanie Saville at The Witness office in Willowton.

Palliative Care

PALLIATIVE care, according to the World Health Organisation’s definition, is an approach that improves the quality of life of patients and their families who are facing problems associated with life-threatening illness, through the prevention and relief of suffering, the early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

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