Fighting the Terrible Twins. 24/3/11

TB is the leading cause of death among people living with HIV in South Africa.

Health-e

The plump young woman sits on a wooden bench in a room at Hout Bay Clinic. Nothing in her unassuming demeanour offers any clue that many people’s health and ultimately lives depend on her.

Gcobisa Skoti is a 24-year-old Community Health Care Worker (CHW) at the TB/HIV Care Association, which helps TB and HIV patients to improve the management of their diseases.  She is passionate about making a difference in her community of Imizamo Yethu, where she lives with her family.  “I could have gotten a job in town for more money but I love what I do,” she says.

According to Skoti most of her patients are infected with both TB and HIV.  Statistics indicate that as many as 73% of people who have TB are also HIV positive in some parts of South Africa, leading to researchers referring to the co-infection as the “terrible twins”.  TB is the leading cause of death among people living with HIV in South Africa.

Skoti’s morning starts every day with her scanning through a heap of task sheets that reveals who needs counseling, education and any follow-up health care. Soon after, she sets off and purposefully navigates her way through the shacks and houses precariously balanced on a hill overlooking Hout Bay.

“Molweni,” she cheerfully greets residents on street corners.  She is well known here and some refer to her as “the lady from the clinic”.  Today’s tasks include checking that her patients take their medicine, home visits, referring patients back to the clinic, educating anyone and everyone about TB and HIV and doggedly tracing TB contacts (family members or friends who have come in contact with an infectious TB patient) and referrals. 

She reveals that she often uses part of her small monthly stipend to buy airtime to call patients, otherwise she is always available to receive calls and offer advice.  “I enjoy what I do because I believe this is a calling for me,” she says.

Skoti goes about her daily tasks armed only with pamphlets that she hands out to the community. “Stigma is still a big problem here, people don’t want me to come to their houses with a handbag because they are worried that the neighbours are going to think I am coming to give them TB or HIV medicines,” says Skoti. 

Littered streets and the stench of sewerage that confront Skoti don’t deter her determination to reach her clients, “You see, sometimes people just urinate on the streets because there are not enough toilets here, I just walk around it,” she says matter of factly.

She pauses at an elderly, frail woman sitting outside her house and they discuss HIV, but when Skoti refers to TB, the woman interrupts her: “Oh, I had TB, but I am still sick and have been coughing for a while now.”  A concerned Skoti completes a clinic referral form and hands it over, encouraging the woman to immediately visit the Hout Bay clinic nearby. 

The conditions in Imizamo Yethu are cramped and overcrowding is rife. Dilapidated shacks are squashed into tiny spaces leaving very little space for vegetable gardening, something Skoti is encouraging her patient to undertake amid the high rates of unemployment and poverty and despite the space constraints.

Knocking at almost every shack and disappointed that most of her knocks go unanswered, she comments: “Some people are at work, at the shop, or just ignore me.”  She thinks that the presence of a journalist may be playing a role and is confident that when she returns the following day, she will find them. 

“Molo Sisi,” an elderly man greets Skoti as she approaches his house. After an exchange of greetings, Skoti heads straight to the sitting room and without her asking, the man hands over a plastic container filled with pills for her to count.  “You see I am drinking my pills,” he says proudly, flashing a grin.  After meticulous counting and scribbling in her pocket book, a satisfied Skoti offers a couple of health tips before leaving.

Around the next corner Skoti zones in on a group of people and hands out TB/HIV pamphlets explaining the content.  The confident, eloquent young woman is adamant that she be heard and often talks about other health issues as well: “It is difficult to stick to TB and HIV only because there are other health related issues here.” 

After giving a talk to a group of young men sitting on a street corner she walks away, quietly commenting how HIV is rife among teenagers in this community, “There are 15 year olds who take ARVs in this community, and they were not born with it,” she says in a hushed voice.

However, her visits are not always welcome.  She sticks her head into an open door and knocks but the woman inside firmly shrugs her off, “I can’t listen to you I have to go somewhere,” she says without blinking. Skoti politely thanks her and moves on, “I’ll be back again,” she says as she walks off.  According to Skoti, people often don’t take her seriously. While some are rude, she is dogged and enjoys the rewards when someone does opt to listen.

 “People know I work at the clinic and some come to my house to disclose their status, this makes me feel trusted and motivates me to do more,” Skoti says.  She also has clients who take their TB medication at her house.  She giggles that her partner’s complains that he doesn’t have enough time with her because of the busy household.

“It makes me feel good that when I talk to people and they listen because my aim is to bring change to their lives,” says the mother of two with a chuckle.  “Skoti is currently studying towards her Grade 12 at night school and hopes to further her studies afterwards, “My dream is to become a professional nurse and save lives,” she says with a sparkle in her eyes.