Accessing healthcare services is a daily struggle in one of the Eastern Cape's rural towns. Residents of Ngquthu near Dutywa, 148km north of East London say they are risking their lives travelling more than 15km to seek medical help on roads that are terrible and littered with criminals.
This situation prompted villagers to take their health matters into their own hands.
Dutywa is one of the economic hubs of rural former Transkei. Despite the glaring poverty and high unemployment rate plaguing Ngquthu, villagers pulled together their resources to refurbish what was once a preschool into a community clinic.
A once-off contribution of R100 from every household helped kickstart their dream of their own health facility.
Getting to health facilities is not safe
The community pulled together after incidents of rapes and muggings reported by people on their way to and from the nearest clinic. Residents have to wake up as early as 5am to walk about 15km to Nqabara Clinic, which is the nearest health facility.
According to community members, four women were raped on their way to the clinic last year. Fed up with the surge in criminal activity mostly targeted at women and children, community members called an emergency meeting with the police, social workers, ward committees and their local councillor in February this year.
Resident Noviwe Dyubhele, who is the secretary of the committee that facilitated the building of the clinic, tells Spotlight they were angry at what she called "government's inaction towards bringing to them a health facility to their door steps".
"We decided to act after a teenage girl on her way to the clinic was accosted by panga-wielding men who raped her towards the end of 2019. We could not just sit back and watch while our children were being targeted by criminals who hide in nearby bushes between our village and the clinic," Dyubhele says.
Dyubhele says this unfortunate situation has interrupted treatment of some patients because they fear for their safety and others cannot endure the gruelling long distance to the clinic.
"There is a mobile clinic that comes once a month, but there are times when it fails to pitch for several months, much to the anger of patients who depend on it like the elderly, pregnant women and chronic patients. The mobile clinic used to operate from one of the houses in the village, but the house owner recently moved back into the house. We have to stand under a tree while waiting for [the] mobile clinic [and] we don't know whether it will arrive. That is why we want to build a one-stop clinic for all our needs," she explains.
Daily struggles and selling 'pipe dreams'
Another community member, Sivuyile Guzu, says he is passionate about the initiative he too has suffered walking the long distance to the Nqabara Clinic. Guzu says he braved rain and cold weather, adding that he was always afraid of criminals.
"Accessing health services in our village is a daily struggle for the sick and those battling with chronic diseases. Those who can afford to pay transport fares do so at high cost ranging from R180 to R240 per single trip to Nqabara Clinic, Dutywa Clinic or Butterworth Hospital. The free healthcare that our government has been promising us is a pipe dream because there is no shred of development in that regard. We have to get money for transport from loan sharks because the government is doing nothing while we are sinking in debt."
"The journey to Nqabara Clinic is not easy as patients who can't afford private transport face the daunting task of navigating the Nqabara river as well as dealing with the bushes that are on the way. This has resulted in patients dying at their homes because they can't afford to hire public transport, and ambulances also take a long time to respond. More often than not, young children miss their immunisation treatment owing to their mothers failing to cross the flooded Nqabara river, especially when it is raining," says Guzu.
Chairperson of the health facility that is still under construction, Sydney Class blamed the Eastern Cape government for failing to act despite having engaged them on numerous occasions.
"For many years we have been begging the Eastern Cape Health Department for a clinic, but our pleas have fallen on deaf ears. Every time we voice our need for a clinic, our government is not listening as they sing the same tune for the past 15 years, telling us that there is no money to build a clinic for us," says Class.
"Villagers agreed that each household would donate R100 to buy building material. We approached a local carpenter to build stud walls and partition them in order to create rooms, and everything was done up to par. So far we spent nearly R15 000 for material and labour rectifying and transforming the old preschool to make life easy for us," he says.
"The project is known to the department, although we had not entered into a written contract with them," he says. "Officials from the departments of health and those of public works gave our building a thumbs-up but ordered us to halt construction, telling us they would provide their resources to finish what we had started. We were optimistic that by the end of this year the project would be completed and ready for use by patients in December. However, we have been anxiously waiting for them to arrive since August."
Meeting the community half way
Class says the community hopes the department won't abandon them now that they've decided to come on board.
"At least this poor community has shown the government that as a poor community we are able to meet government half-way by building our own future. It was not easy to fundraise for the project, given that most families depend on old age and child support grants," he explains. "If this project fails to materialise, it is tantamount to having our dreams for a better life being robbed from under our noses."
The residents are sceptical after a similar project in Mankosi in Ngqeleni, also in rural Transkei was allegedly dumped after the government failed to provide staff and the necessary equipment for the Mankosi Clinic. This followed after Mankosi residents in 2010 raised R250 000 from their own pockets to build the clinic. Unfortunately, ten years after completion, the clinic turned out to be a white elephant forcing villagers to still walk 17km to Philani Clinic in Ntshilini village.
Meanwhile, the Ngquthu facility has a secure fence, a reception area, three consulting rooms, and a dispensary room. Once completed, it will cater for eight villages in and around Ngquthu.
"Health spot" not a "clinic"
The district director of health in the Amathole region, Sindiswa Gede, however, rubbished claims that the community is building their own "clinic".
"We have a clinic in that area. The provincial department of health and that of public works took over the project of renovating the old preschool to operate as a health spot, but not as a clinic," Gede says. "We normally ask chiefs to provide land where mobile clinics can be stationed. If that point is difficult to be reached by all community members due to long distances, we open either a satellite clinic or a health post. [The] health post is not a clinic, but ensures that people have improved and frequent access to primary healthcare."
Gede referred Spotlight to the departmental spokesperson, Siyanda Manana after we pressed her about when the health facility will be opened, the number of health staff to be posted there, what services they will offer and why the mobile clinic that used to visit the area had suddenly stopped the service.
But Manana said the department of health and that of public works are still finalising the memorandum of understanding on taking over the renovations and the procurement processes. "The public works department is due to draw up the scope [of work] for the project and once renovations were done, we are going to have our staff that is going to manage the facility and the medical equipment would be moved in," he said.
"The mobile clinic was discontinued due to low numbers in that area. The success of that health post will depend on the numbers of people using it. As the numbers/ turn-out increase, we are going to make a way forward," he said.
But community member Mbulelo Twani is concerned over the time it is taking for the facility to open given the amount of money and effort they had invested in the project.
"We are in the same province, but the health service in our area is worlds apart from that provided in the city. It's appalling to see the government turn a blind eye when it comes to rural healthcare services. In this province, rural areas are totally forgotten. Even though we were meant to have a mobile clinic at least every month, this service is often unavailable. Community members have been trying to get answers from [the] Amathole Health District on why the mobile clinic no longer visits the village. They will only say that either there is no driver for the mobile clinic or it is broken," Twani tells Spotlight.
"It seems that the department of health doesn't have interest in us because none of their services are reliable. People used to get assistance from Dutywa Clinic but recently they stopped and referred all people from Ngquthu to Nqabara Clinic to get chronic medication. It is not safe to cross the river. If it happens that it rained while you on that side of the river, you will get stuck and you have to seek shelter from friends or relatives," he said.
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