First published by GroundUp.

Katrina Jacobs grew up on a farm in Varkens Vlei, Philippi, where both her parents worked. She was in her twenties when her father was diagnosed with TB. She saw him coughing up clots of blood.

She says her mother struggled with her “stubborn” father because he didn’t want to take his medication. So she gave up her job to stay home for the duration of his six-month treatment to ensure he ate properly and took his pills daily.

Back then, there were no nearby taxis and as her father walked using a crutch, she would carry him on her back to go to the clinic. “It was a struggle, but I did it,” says Jacobs.

Today, 20 years later, Jacobs is one of thousands of Community Health Workers (CHWs), providing home care across the country. She lives and works in Heinz Park, Mitchells Plain.

From Monday to Friday, on foot, carrying a shoulder bag and wearing a mask, and sometimes a visor, she delivers medication, screens people for Covid-19, gives information and assesses about 10 of her patients a day.

Whether it’s rain or shine, field workers Felicia Davids and Raylene Kotze deliver chronic medicines in the Westridge area. On this particular day, they did 32 deliveries. (Photo: Ashraf Hendricks)

Jacobs was specifically assigned to TB patients, especially those with drug resistant TB.

Due to the risk of contracting Covid-19, Jacobs tries to see her patients outdoors, but confidentiality can be an issue. One of her patients has TB as well as HIV and she decides it’s better to hold the consultation out of sight of the neighbours. She asks him to please put on his mask and asks that the children step outside.

She explains to him that she has been sent to assess him in order for the clinic to supply his medicine. Among the questions she asks, stressing that this is all kept confidential, are: “Do you smoke dagga, do you use condoms, do you consult a traditional healer, who can support you during your treatment and what time do you take your medication?”

She explains it is vital he does not forget to take his medicine on time. “You can get sick again,” she cautions.

When she leaves, she gives him a brochure about Covid-19.

Gaynor Dankers, project manager for Arisen Women, has been with the organisation since its inception 20 years ago. Alongside her at the head office in Mitchells Plain is professional nursing sister Sheila Scoble, who is one of the organisation founders. (Photo: Ashraf Hendricks)

The pandemic has made her job much harder, she says. “Standing outside, we can’t see what’s going on in the house,” says Jacobs. This makes it harder to assess the patients’ living conditions and to judge what else might be necessary to treat and help them.

Some patients can also be difficult. “Many of my clients are on drugs, so it’s a struggle to get them to the clinic,” she says. They have to be continuously reminded to go to the clinic. Others are involved in crime, and are too afraid to go to Samora Machel, where the clinic is located. Sometimes, Jacobs has to travel with her patients. At times, she uses her own money for their taxi fare or to buy them some food while they sit and wait at the clinic.

Building trust is an issue. She has had doors slammed in her face. But she returns the next day with a smile and reminds them her services are free.

Travelling around certain neighbourhoods poses a risk to her. Community healthcare workers complain of being robbed of their phones and money. Jacobs has also been caught up in protests and teargassed. She says that experience was “traumatising” and she was given a day off work. Despite that, she still delivered medicines on that day.

Jacobs works for the non-profit Arisen Women, which is contracted to the Western Cape Department of Health. Project Manager Gaynor Dankers says it started 20 years ago with four staff and now has over 180, including 136 field workers. In Mitchells Plain, in June 2020, they saw 600 patients, from newborn babies to centenarians. The organisation is focused on home care, but also has feeding schemes and offers bereavement support. We do everything from “the womb to the tomb,” she says.

Home visits by nurses used to be unavailable in the Mitchells Plain area, other than expensive private home-care. All their services are free and are funded by the health department.

“Heinz Park is a TB, HIV, Covid-19 and child health hotspot,” says Dankers.

Covid-19 “has had a major impact on how we operate”, she says. Before the pandemic, people would pick up medicines at specific locations like churches and civic centres, but now everything has to be delivered to people’s homes. Field workers have also taken on educating the community about Covid-19.

“When we knock on the doors, the people don’t want us in the houses because of fraud and the people think we are bringing in Covid-19,” she says.

Crime is an issue for the fieldworkers and she pleads with the community “to keep our people safe”.

“Community-based services are vital to our health system,” said Monique Johnstone, spokesperson for the provincial health department. She said fieldworkers have been crucial in managing Covid-19 cases.

“They have assisted with doing home visits to find contact numbers, drop off pamphlets, discharge and work letters, and even food parcels. They have also provided valuable assistance with Covid-19 screening and referring relevant community members to testing sites,” she says.

Arisen Women also operates out of the Stephen Reagan Hall in Westridge, Mitchells Plain. Clinics, social development offices and community driven organisations, such as Arisen Women, have become key delivery and health partners. (Photo: Ashraf Hendricks)

In the Mitchells Plain area, there are 10 organisations and over 750 CHWs providing care.

Johnstone said that CHWs are not medical practitioners and can only refer patients requiring urgent medical attention. “They operate in volatile and vulnerable communities, and we request that the community assist by keeping them safe so that they can deliver an effective and supportive healthcare service,” she said.

Regardless of the risks, Jacobs says that she has no fears or concerns. The lord gave her “a spirit of love and a sound mind”, she says. DM