We Have a Long Way to Go

By: Deborah Bender, PhD, MPH

I met Mirriam Goa at National Heritage Day. She heard from a mutual friend at the gathering that I was a public health person and, immediately, she introduced herself to me. She told me that she was a public health nurse and that I must come to visit her program, Ilinge Lokuphila, in the Guguletu Township.

Yesterday, I went to visit Mirriam. The Township lies 20 minutes outside of Cape Town, on the N2 highway, just south of the Cape Town International Airport. It is the second oldest township in the Province. I listened, intrigued, as Miriam told me about the home visiting program she and other women in the community have created together. Mirriam worked as a staff nurse in a Home for the Elderly in Cape Town for many years. Though she is retired now, she is not about to slow down! She and the 18 others – all volunteers -- regularly make home visits to elderly residents in the Township. They help out with bathing and feeding and ensuring that each resident is taking medicines according to doctor’s prescription. When necessary, they make referrals to the social worker or to hospital.

Mirriam stops mid-sentence to add – these problems, --the isolation of the elderly -- they are caused by people, by these people’s own children not coming to care for their parents. This is to say, that in African culture not caring for one’s parents is almost unimaginable. But, today, despite Mirriam’s sense of disbelief, this is happening.

When Miriam or one of the volunteers makes a home visit, they sometimes uncover other unexpected problems. Sometimes a daughter has left her children with her elderly mother to go to work. Other times, it is more difficult; the children may live permanently with the elderly relative because have been orphaned by AIDS, which has taken a parent’s or parents’ lives. The hardest for Mirriam to accept is that some of her elderly, themselves, have contracted HIV/AIDS through being unaware of protective precautions necessary when caring for an infected adult daughter or son.

It is hard to talk about AIDS, she tells me, because there is still a lot of stigma associated with the disease. People infected with the disease are often forced to leave their homes and shunned by friends. So, no one talks about the disease, and the disease is left to spread silently through the community.

The home visiting program is vital to the community, but Mirriam wants more. She would like a larger space where community members could meet and share a noon-day meal. She would like to use the same space to create a support group, to help people infected with HIV/AIDS and their families. “Now,” she explained, “If a daughter discloses, she’ll tell her mother first above all. But, often her mother will deny what her daughter has told her. It is just too hard to accept.” Mirriam believes that people need a place where they can learn about the disease, and where they can learn how to talk to one another about AIDS. “The way to take apart the stigma is to talk about it – to talk about it directly, “she added parenthetically.

Mirriam says that TB is also a problem in the community. Again, sometimes people do not take their medicines. But, in this case, Mirriam thinks that it is the doctors who prescribe the medicines who do not understand the community well enough. One of the volunteers made a follow-up visit to the home of a man who did not return to the clinic for his TB meds. The volunteer asked him why he did not come. He answered, simply, “The doctor told me to come back for my medicine after I had eaten. I haven’t eaten. That’s why I didn’t come.”

Mirriam and the other women of Guguletu, the volunteer home visitors, are busy. They work from 9 to 5, and sometimes evenings, too. Still, there are more homes they would like to be able to visit; meeting space to be negotiated with the City of Cape Town; and, additional services to be offered. A garden promotion program would help in providing improved nutrition and needed micronutrients for community members. She also imagines creating a park with swings for the children to play in. A crèche for the very young children right next to it would be ideal. "We have a long way to go," Mirriam concludes as other volunteers in the room nod in agreement.