March 20, 2007
By Emily van Rijswijck
GOOD healthcare starts at home. This may well be the motto of Region F's biggest and busiest clinic, Rosettenville Clinic.
It is making headway in educating and promoting sound health habits with the appointment of a male community health promoter and communications facilitator.
Eddie Shongwe joined the clinic in 2006 as the first male health promoter and facilitator, running community outreach projects aimed at educating residents from the male-only Denver Hostel about healthcare. Previously a high school teacher, Shongwe is not lacking experience in dealing with touchy issues. And he knows instinctively that a gentle approach yields the best results.
Link between clinic and community
Commenting on his work at the Denver Hostel, Shongwe says he has really fallen in love with the project and the place. "You must show you want to help them, not just push the scorecard." A sure ticket to failure is to impose your own ideas on people, forcing them to do it your way.
A recent prostate cancer campaign run by the clinic illustrated the importance of Shongwe's facilitating work. The clinic staff realised that this was a difficult and sensitive subject to broach with traditional black men, but one that nonetheless needed to be brought to the community's attention.
Shongwe, as clinic representative, approached the health sub-committee of the Denver ward to support the drive and the resultant response to the campaign surprised everyone. Over 100 men were tested during the campaign, of which 12 percent needed further intervention, confirms Pretty Kgoadi, the operational manager for Rosettenville and South Hills clinics.
"It helped that it was a male talking to males," she says.
Health sub-committees are appointed by the community and consist of representatives from different interest groups in the community – male, female, traditional healers, church leaders, youth and so forth.
Shongwe works with the committee and the different indunas to help communication and co-operation. "The community must define its own needs," he emphasises. "I just facilitate the process. Health issues are discussed at the committee, after which they take it to the community."
Although prostate cancer is not the most prevalent cancer among black men – oesophageal cancer is more common, according to the Cancer Association of South Africa – Kgoadi points out that the campaign has resulted in a snowball effect regarding awareness of other health risks.
She says the campaign has resulted in better understanding and awareness of other health issues, such as sexually transmitted diseases (STDs) and HIV/Aids testing, which is often then relayed to the rest of the family. There is a greater general awareness about health issues and where to get help and testing because of this campaign.
The Rosettenville Clinic prides itself on a 74 percent cure rate of tuberculosis. This success is partly attributed to its pro-active approach in dealing with the illness, with the emphasis strongly on education and information.
HIV/Aids running riot
Sexually transmitted diseases and HIV/Aids are, however, still running rampant, according to Kgoadi and colleague, Vicky Manzini, the operational manager for Malvern and Glenanda clinics. "And it is [affecting] very young people, between 20 and 35 years old. Three quarters of people we test end up being positive," Manzini says.
She feels that the patriarchal system that is still in place in South Africa, can take much of the blame for the continued apparent laid-back attitude towards the disease. "You can do the education," she says, "but be realistic. When she [the patient] goes home and the man says, 'No, I am not using a condom', she has no option but to consent. As long as women are disempowered at home this attitude will continue."
This is where Shongwe's work becomes so important – educating black males on these and other health issues. But Shongwe warns that it is not an overnight process. Even though he is a black, adult male it took time to establish the working relationship he has with the Denver community.
"You ask them to come up with their own solutions. They must understand why they have to do it."
Though it is still early days, he feels certain that through constant education and involvement there will be an improved health system. "It needs passion, dedication and a vision. In the end you want these people to be self-reliant, making good decisions about their health themselves."
Sarah Dass, the assistant director of primary healthcare, says the City's Health Department is trying to appoint more male health facilitators at clinics in areas where there is a strong traditional patriarchal system.
Clinic mirrors Joburg diversity
The Rosettenville Clinic reflects the diversity of Johannesburg in general. As with many other clinics in Johannesburg, it serves a large number of patients from outside the country.
As well as from across South Africa, the people in the suburb hail from all over the continent. Ghana, Democratic Republic of Congo, Zimbabwe – the united colours of Africa can be seen in the colourful garb and traditional attire of patients in the clinic's waiting room.
They may come from foreign countries, but like all Joburg residents, they are in need of basic health services; they are ordinary people, with run-of-the-mill health needs - from antenatal and blood pressure check-ups to all kinds of common ailments.
This has resulted in a unique challenge faced by many of Johannesburg's clinics in the more cosmopolitan areas of the city, such as the CBD. These foreigners often speak very little English and French and Portuguese translators are regularly required.
The clinic usually requests that the patient bring an English-speaking family member to help with language difficulties, Manzini says.
Staff challenges
However, the biggest challenge faced by most clinics is a shortage of staff. Considering that more than 200 people move through the Rosettenville Clinic every day, or almost 6 000 a month, this is no small challenge. And the recent announcement by Executive Mayor Amos Masondo that all clinics and primary healthcare facilities will extend their operating hours will add to the load.
The assistant director of primary health care, Sarah Dass, with operation managers Pretty Kgoadi and Vicky Manzini
Some relief will come in the form of four additional staff members for Johannesburg South clinics. Additional staff is also earmarked for this financial year for the other regions in Johannesburg, says Dass.
In addition, Johannesburg South, including the Rosettenville Clinic, has done away with satellite clinics, with all eight clinics now open five days a week, from 8am to 4pm. Region F has a total of 17 clinics.
An annual customer satisfaction survey is compiled throughout the regions to monitor the services of all Johannesburg clinics. The complaint most often made by the public is the long waiting times to see a medical professional. In 2006 the Health Department looked at 42 measures that could be changed to improve service at the clinics without incurring financial costs or making any structural changes.
"It is often the simple things that make a big difference, like clean toilets and having drinking water available," says Dass, who has also looked at improved structural and time management systems at the clinics to cut waiting times and increase customer satisfaction.
"We now require that regional managers visit clinics [in their area] every month and quality assurance procedures rating the services of the clinic are in place."
These include a short questionnaire and a suggestion box.
Rosettenville Clinic is on the corner of Rose and Mabel Streets, in Rosettenville, Johannesburg South. Joburg clinics will run a polio and measles education and immunisation campaign from 7 May to 11 May.
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