Author: Lungani Ndwandwe, Tulio de Oliveira - 2012-09-13

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We turned our lenses to focus on home-based health care givers in rural South Africa this month of July 2012. As part of the Art in Science project by the Wellcome Trust, we felt that in order to capture a comprehensive picture of health, home based care could not be ignored.

This very important level of health care service is much similar to that of a hospital and other institutional health care settings; however it presents an opportunity for treatment of patients where human resource constraints and inadequate hospital/health facilities exist. Home-based health care working environment is less controllable or predictable, and in most cases less standardized. It again becomes more complicated in rural settings with poor communities. Even though home-based care givers often work under these unfavorable conditions, they have since strived and compassionately offered their services despite.

Zwelethu Mthethwa, an artist in residence and photographer working with the Africa Centre and I were invited by two home-based care givers in order to see them in action and hopefully snap a few photographs. One thing that one readily picked up on the day of the visit, of which is one of the benefits of home-based care is that the sick are surrounded by people they love and are familiar with, which makes the level of care flexible and at times stretched. Patients in this type of care are often very sick and in this rural setting suffer from financial constraints. In this visit we met a woman who had been bedbound for a year; she was paralyzed after a complicated child birth procedure. She cannot move or take care of herself and relies heavily on the assistance from caregivers and family members. Fortunately her now one year old baby boy survived the procedure. Her biggest worry is that she cannot hold, feed, and take care of her baby as his mother. As mentioned above financial constraints have impacted negatively on the situation; the patient has to regularly go to the clinic to take bloods and this often requires her to hire transport to get to the clinic. As there are limited resources at the local clinic, the clinic can offer ambulance transport only in life threatening emergencies. This is one of many examples home-based care givers find themselves in, and on a day to day basis they see 2 to 3 patients with similar cases.

Zooming out and looking at a bigger picture of the entire health system in South Africa, particularly in rural communities a lot has been achieved by the National Department of Health (NDoH) in training and employing home-based care givers. The NDoH is looking into installing a primary health home-based outreach team of volunteers in rural communities. This team of volunteers who will be accompanied by a trained nurse will visit patient's homes and take bloods where necessary. This great initiative will see to it that patients who cannot get to the clinic because of reasons relating to the shortage of money and being bedbound receive good, supervised treatment from the comfort of their beds.

We would like to thank Dr. Kevi Naidu and Sister Dana Chirwa from the Africa Centre's ART program for making provisions for the above mentioned patient to be seen by a nurse and also for making provisions for her to take bloods. At the time of writing this article, she was able to go to the Home Affairs department and apply for a disability grant.

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