Rural Doctor of the Year reflects on the rutted road to quality healthcare in Eastern Cape
Describing the rutted gravel road between Butterworth and the Tafalofefe District Hospital in the Eastern Cape, Dr Bukiwe Spondo uses the word ‘terrible’ at least 18 times. Biénne Huisman caught up with Spondo, who was recently named Rural Doctor of the Year, to chat about the many challenges of delivering quality healthcare services in South Africa’s rural areas.
On that gravel road, dipping through the Amatole District, the 55km journey can take several hours. With heavy rain, tractors may be required to dislodge ambulances and often even staff have difficulty getting to work because of the mud.
Since 2007, Spondo and her colleagues have offered a multitude of services at Tafalofefe in the lush but impoverished Centane village. First, she moved the hospital’s ARV clinic from an out-building to inside the premises – reducing stigma – “because if patients went into that building on the outside, automatically everyone knew”.
In 2012, having observed how patients stopped taking treatment because of travel costs, she started driving up to 40km a day, twice weekly to nine clinics in the area, where up to 50 patients would be queuing to see her. To make life easier for patients she started packing medication to take to them at the clinics. Later she opened a CHAMP (Clinical HIV/Aids Management Programme) site at Tafalofefe to see complicated cases referred from the clinics, and a multidrug-resistant TB (MDR-TB) review clinic in conjunction with Butterworth Provincial Hospital.
“As a rural doctor, you become a social worker, a pharmacist, a priest – you do everything,” she says, laughing.
Rural Doctor of the Year
Spondo’s efforts have not gone unnoticed. Last month at the Rural Doctors’ Association of South Africa (RuDASA) annual Rural Health Conference, she received the Rural Doctor of the Year award. RuDASA chairperson Dr Lungile Hobe conferred the award at the event hosted near Chintsa. Spondo is quick to point out that she also won an Amatole District leadership award in 2022.
She tells Spotlight: “So the roads here at Centane are terrible. It becomes a challenge to get ambulances through and the chopper cannot fly either when it’s raining. I mean, the other day a truck was stuck crossing the road so the ambulance couldn’t pass. We had to take a private car from the hospital to go meet the ambulance halfway.”
By the time they have saved up enough money to travel to the hospital, it’s too late.
She adds that residents hoped that roads would be improved after a devastating accident 5km from Tafalofefe in 2020 when an overloaded 65-seater bus plunged into a gorge, causing 25 deaths and 62 injuries. But, she says, the improvements never come.
At Tafalofefe, the two nearest referral hospitals are Cecilia Makiwane and Frere Provincial in East London, which are an additional 110km or 90-minute drive from Butterworth along the N2 highway. Housed in a pale building, Tafalofefe has 160 beds served by 41 professional nurses and seven doctors – including three community service doctors who joined in 2022. The additions have increased capacity – for example, emergency caesareans are now available around the clock.
Taking healthcare to the people
The hospital has three 4×4 bakkies for visiting or transporting patients. It is in one of these that Spondo travels to see patients in remote corners between the Kobonqaba and Kei rivers on Tuesdays and Thursdays.
“Clinics are part of decentralised primary healthcare goals,” she says. “But the problem was that if there were complicated cases – like if a patient is taking ARVs and then develops side-effects, the sisters are not equipped to handle that. For example, if there is a kidney problem, they [cannot] do anything about that.
“And in time, I realised that for these people travelling to the hospital costs too much money. Let’s say, for example, the clinic at Qolora – for a person to travel from Qolora to Tafalofefe is R100. A return ticket is R200. And you know, most people here are unemployed. They can’t afford this. By the time they have saved up enough money to travel to the hospital, it’s too late. Like it would be the end stage of their kidney problem. You could not send this patient for dialysis, nothing could be done to help them. This is why I started my outreach trips.”
In motivating for Spondo to receive the RuDASA award, Tafalofefe’s CEO, Masizakhe Madlebe, pointed out how her work days start at 7am and only finish once all patients had been seen, whether at the hospital or at one of the local clinics. In addition, he notes how, over the years, Spondo has mentored young people in the area, including children whose parents had succumbed to Aids, and schoolgirls on topics like life goals and contraceptives. He adds that Spondo even reached into her own pocket to pay school fees for children without parents.
These kids, I’ve seen them grow up. Some of them I saw angry – with everyone, with their own deceased parents.
Spondo relays how she noticed girls as young as 12 in their maternity ward, giving birth. “Myself and some nurses we went to two schools in the area to educate them, to discuss goals and contraceptives,” she says. “We started with Grade 12 pupils. No teachers were present. It was just us and them. And I was surprised at how free they were talking. I said to them, education is more important. I said to them, you see me? I am a doctor. One day you can be a doctor too, but you need to be educated. I told them they could come to Tafalofefe any time if they needed to talk, that I could help them apply for tertiary degrees, to college or to university.”
Spondo has kept a close eye on children orphaned by Aids in the area. “I tell them to bring me their June, September and December school reports, so I can see how they’re doing, so I can motivate them,” she says.
“These kids, I’ve seen them grow up. Some of them I saw angry – with everyone, with their own deceased parents. And I explained to them, don’t be angry. It’s not your mother’s fault. It’s not your father’s fault. It was the government’s fault for not giving your parents access to ARVs. But now, take your own ARVs and you will be fine. Some of them have passed high school with distinction, some even now have access to universities.”
Bringing her skills back home
Alongside two brothers, whom she describes as “wonderful”, Spondo grew up in the village of Nqamakwe, on the opposite side of Butterworth. Her parents have died, but she still considers Nqamakwe her home. Here her family’s farming interests include cattle, goats and sheep.
She attended Blythswood Secondary School in Nqamakwe – excelling at biology and physics, even though maths was hard work. “Becoming a doctor was just something I always wanted,” she says, relaying how in her formative years she had been a sickly child who often required medical care. This changed, she says, as she cannot remember ever being sick as an adult.
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Spondo graduated from medical school at the University of KwaZulu-Natal in 2002, completing her internship at Cecilia Makiwane and her community service at Tafalofefe and Frere in 2004.
Speaking with rapid enthusiasm, she says how happy she is to bring her healthcare skills back home to serve the community that shaped her own humanity.
“I mean, I know these people inside out. I was born in front of them, raised in front of them,” she says. “These are our relatives, our aunts, our grannies. It’s giving back to them, to the community that raised you, that has done everything for you. Who supported you through all these years.”
She adds that Tafalofefe’s clinical manager, Sambona Ntamo, grew up near Butterworth too.
“Who would look after these people if we didn’t?” she asks.
Where does she find the resilience that drives her passion to care for sick people, often queuing at the end of long rutted roads?
“Lots of exercise,” she says, smiling.
At Tafalofefe there is a staff gym with a treadmill, a bicycle, weights and Pilates balls.
“I tell the guys after work it’s gym time, it’s gym time, it’s gym time!” she says. “We’ve got a key and everyone knows that even if they want to go to the gym after midnight, they may get the key and go.”
Photographs capture an air of camaraderie at Tafalofefe. Staff sharing a meal of tripe and creamed spinach on Heritage Day, a farewell gathering for a retiring nurse with balloons and huge gifts in silver wrapping, [and] women knitting countless bright beanies for babies delivered in the maternity ward. A picture inside the hospital’s paediatric room shows youngsters on plastic motorbikes and mothers holding toddlers wrapped in blankets.
Spondo and her own eight-year-old son, Lutho – which means “the greatest one” – live in a doctor’s house on the hospital’s premises. They travel to their family home in Nqamakwe over weekends.
For Spondo, being a doctor does not feel like a job. “When you do something you love, it doesn’t feel like a job,” she says. “Being a doctor is something I look forward to every morning. When patients return to me, saying they feel better with a smile on their faces, saying thank you for the treatment – that just makes my day.” DM
This article was published by Spotlight – health journalism in the public interest.