29391874 - Desré Barnard

Note; only some of the photos for Desre's photography practical were taken at the same location on which she wrote her article.

Bophelong Community Hospice, Mamelodi
After a strained shudder in the crisp Monday morning air, the car rattles to life. Poor infrastructure in the squatter camp prohibits the Bophelong Community Hospice home visit staff from driving into the area. After parking in a cul-de-sac, the nurses walking up through the rubbish and mud, along uneven rocky roads, through pools of foul smelling water, comment that Amos’* house is difficult and unsafe to get to.
Bounding up the dirt road, Amos, an illegal immigrant from Maputo, is elated to see the visitors. Inviting them in with a broad smile, he gestures to the wall of his shack. Mamelodi Sundowns and Orlando Pirates posters hang above his bed. He smiles, saying he is excited about the World Cup.
“He was a category three patient when he came to us in 2009,” head of home visit care Viola Mahase said. “Category three patients are bed bound and are in the final stages of terminal illness.” After 6 months of Hospice care, Amos is now a category one patient, one who is in control of their illness. “He was almost dead when he came to us” Matron Nomgqibelo Patricia Nogxina said. “One day he stood up and was better” Mahase added.
Amos’ is one of the numerous households in Mamelodi to which Bophelong Community Hospice provides home visits. As part of their palliative and holistic care programmes, nurses visit out-patients and provide care, bathing, and treatment administration.
The Hospice provides support for the patients of hypertension, diabetes, old age, but primarily cancer and AIDS. When patients are referred to the Hospice, staff asses their financial and family situations to determine whether they are to be admitted.
Hospice Palliative Care Association of South Africa (HPCA) outlines two courses of palliative care for patients. In-patient care, where the patients live on Hospice grounds, is the least favourable option. Alternatively, out-patient care provides patients care in their own homes.
HPCA National Advocacy Officer, Nikiwe Dube, says that more than 97% of Hospice patients receive care in their own homes. She says family members are trained by the Hospice staff to care for patients, including hygiene, nutrition and administration of medication.
According to HPCA, out-patient care is when a Hospice carer visits the patient’s home and provides holistic care. Holistic care, Mahase explains, involves assessment of the entire family, and offers counselling, respite, food parcels and bereavement to the families.
“For the people that don’t have disability funds...we refer them to social workers, then the social worker alliances [sic] with the social welfare fund to uplift the family so they can afford medication” Mahase says. “Social grants are not always awarded because the system does not work.”
Bophelong Hospice offers day care facilities, meals, and social gatherings to out-patients. Weekly support groups are held for people infected with HIV/AIDS. The families of out-patients are invited to use the Hospice services for respite.
Nogxina explains that she believes home-based care is more beneficial for patients and Dube and Mahase agree, saying that the psychological process of death for the patient is alleviated when they are in the presence family members. Nogxina explains by saying that when patients are admitted to Hospice “they feel like they have been thrown away”.
Hospice care is for patients with progressive, incurable diseases. International studies by the World Health Organisation show that 80% of HIV-positive patients experience inadequate pain management. The Bophelong Hospice provides pain management medication and through association with the Stanza Bopape Clinic patients have access to antiretroviral treatment.
Nogxina and the Hospice team believe that patients are capable of recovering and re-entering a normal, functional life. “The Hospice is not just a building. It’s a service we render” Nogxina says. She tells the story of an illegal immigrant from Harare who arrived at Bophelong, skeletal and weak. “After a while, she got up, and she was well enough to go back home”.
The Bophelong Hospice is a part of Bophelong Community Centre in Mamelodi. The centre comprises a trauma and counselling centre, pre-school, primary school, an orphanage, an eye clinic, a dental clinic as well as a clinic providing voluntary HIV and AIDS testing and counselling. Donations and funding from companies such as DaimlerChrysler are the only funding they receive from the private sector. Government grants have been provided in order to pay the nurses, but this quarter’s payment has yet to be released. At the time of print, nurses were still unpaid.
Nogxina and Pastor Titus Sitole together built up Bophelong. “There were just dirty floors and three of us,” she said “and although we haven’t accomplished everything, we are getting there.” Nogxina has recently undertaken the building of a Hospice centre in KwaMhlanga in the Mpumalanga province.
Even in the face of the devastating illnesses and the challenges the staff face daily, they are optimistic about the future of the facility and the health of the patients.
“Amos was almost dead” said Bophelong driver Nkonzo Malgas “and now he is getting married.” Amos smiled and waved goodbye.
*Surnames omitted by request of interviewees