Bakgethwa Home-based Care

Today I went to go meet with Gloria, Gaobodiwe, Boitshwarelo, and Patricia (as seen in that order in the above picture) at Bakygethwa, a home-based care organization here in my Northern Cape village. They are a full staff of 22 and receive all their funding from PEPFAR (President's Emergency Plan for AIDS Relief) and the Global Fund, the Kgotla (the Chief's office) sometime will give them money, but other than that they get no financial help from the community. But at the same time what would they have to give them – something of course I could help them work on, fundraising. Nonetheless, this is a great group of women who hold in their hands an incredible way to help their community. They are also on their 10th month without pay, still they continue to service their patients.

The target groups for Bakygethwa are "The Sick," orphans, HIV/AIDS, TB, Cancer and any other chronic disease patients. In their files at the office they have easily over 300 patients they see. On a typical day the group will do home visits to 2-3 patients. They work alongside the local hospital here and get referrals from the hospital and vice versa Bakygethwa will bring patients in need of a doctor to the hospital. The majority of these women are not professionally training, there are some retired nurses within the group, but all have basic skills on how to help patients and when to refer to a higher level of attention. Their main task is to monitor patients and make sure that they are taking their medication correctly and regularly. One of the biggest challenges that exist is that many of their patients, who may be doing well on the medication, will decide to move to one of the larger towns, like Upington, in search of work and then disappear from their system and then fall ill since they have defaulted on their treatment.

Bakygethwa's other main priority in the community is the monitoring of the about 150 orphans. They help them with supplying them with clothes and food and provide assistance when they need to apply for the Foster Care grant, which they can receive up to the age of 18. The child (or grandparent taking on the child) may get accompanied with a community based care worker to go to SASSA (South African Social Security Agency) to apply for the governmental grant to walk them through the process. They have a specific doctor that they have established a relationship with who will see the orphans when needed. The women will hold events for the orphans on days like Children's Day, or bring them on field trips to places like the bigger cities nearby, like Kimberley. The women also mentioned that it was often the case that they may help the children apply for other social grants for when they become pregnant with their own children as a teenager.

When I asked about the challenges facing the community, I felt like I opened up the flood gate as a slew of items began to be rattled off from their mouths. They began to go off on the lack of jobs and skills of the community residents and the downfalls of rural life leading people to take to housebreaking and take up risky sexual behavior out of boredom. I was told that girls in middle school and high school will enter into relationships with older men, who they called "Sugar Daddies." "You know these high school-ers, they only want nice things, and these men will provide them with these." The women told me that they see a growing case load of HIV in the community in men and women in the 25-40 year range.
When I asked them about contraceptives, they told me that they only hold male and female condoms on the premises. The Global Fund provides Bakygethwa with 2 huge boxes twice a year; at least they get something useful for the community despite not getting paid by them. I looked over to the box of the condoms popping out of a small box in the corner of the small front room we sat in and wondered when was the last time any of the kids are my school were referred over to the Bakygethwa office as a place to find contraceptives. They did tell me that they start young with their sexual lives here, so I asked if they had a relationship at all with the school with any life skills lessons, and they shook their hands. Why not? The women replied to me, "We were told last time that we were a distraction to the students." I couldn't believe it, I couldn't think of a better way to help the children with life skills lessons and hit the nail on the head about teen pregnancy while pushing the availability of services at their headquarters and expanding their notoriety in the community. Something to look into, I told them I would talk to the principal since even if it was just participating at World AIDS Day in December I think would be a great idea for them to combine forces.

From here we moved onto a darker subject: rape. The women were not scared to share any details of this topic to me, I admire that highly. They told me of 2 recent cases of young girls in elementary school getting violated – how horrifying. I was told that it is in cases like this were the cases are very serious matters where the hospital, police and social workers are all involved. The girls were moved out of the community and assigned a social worker and victim empowerment services. I was told that when rape occurs in the high school age group the cases often go unreported to the police and that even when a case is made, the victim with eventually go back and withdraw the case. I had read and listened to several pieces on NPR about this before I came to South Africa about how the country has one of the highest incidences of rape in the world. I was glad to be talking to people who finally brought this up this with me.

From there we moved on to another taboo topic: rampant alcoholism. I asked about the existence of any type of support groups or services for people suffering from alcoholism or with a family member who is an alcoholic and I was met with all sort of reasons of there not being any. Principally, that "The Sellers" or shabeen and tavern owners would be outraged. Going hand in hand with alcohol abuse is domestic abuse. I was told that there are no support groups for this either and this is something that happens behind closed doors and you stay out of. Cases brought to the police are often dropped and women remain "quiet because they don't want to destroy their marriage."

I sat in the room and talked a little bit longer with the women about the community and how I hope to learn more from them. I got out of my chair and said I needed to make my way back to the school and bid them farewell. They brought me to the door and thanked me for coming and I asked, "you all look so lovely in those shirts can I take your picture?" They said of course and I snapped with my phone camera. "Okay, I'm off," I said, "I will try to get you a copy of this eventually, and keep up the good work! You really are doing great work here!" And that was it, my first step into the world of how community based healthcare works here…wow. I really want to do something that combines my love of public health and helping to empower these students and teachers. So many unknowns, but then again this is just the start, I thought and walked off into the hot African afternoon sun.

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