SOUTH AFRICA: Wednesday at Somkhele Clinic

SOUTH AFRICA: Wednesday at Somkhele Clinic

JOHANNESBURG, 6 June (PLUSNEWS) - Situated among the rolling hills and valleys of South Africa's picturesque KwaZulu-Natal province, Somkhele clinic is one of 14 outlying clinics serving the 5,000 km square area of Hlabisa district - a region among those worst hit by HIV/AIDS.

The simple pink building is along a taxi route and is one of the most easily accessible health care facilities in the district. On this Wednesday, however, the open-air waiting area was relatively empty and filled mostly with women.

Wednesdays at Somkhele clinic are set-aside for pregnant mothers' antenatal care.

Clinics in the area are generally well utilised with about 95 percent of pregnant women attending antenatal clinics at least once during their pregnancies. All conditions considered beyond the capacity of the resident nurses are referred to the Hlabisa district hospital, about 25 km away.

Supported by only two staff nurses, a counsellor and clinic assistant employed by the Africa Centre, the sister-in-charge, Sister Elizabeth Msimang, laments the lack of resources.

"Our clinic is one of the poorest, the others have everything. There is no privacy or space in the consulting room and we see a lot of people," she told PlusNews. Sometimes up to 89 women have been counselled in one day.

As a primary health care centre, the clinic is also a partner in the "Mama ne Ngane" (Mother and Child) prevention of mother-to-child HIV/AIDS transmission (PMTCT) project run by the Africa Centre for Health and Population Studies. It also offers voluntary testing and counselling services to pregnant mothers. The Africa Centre has made these services available in six of the clinics, as part of their ongoing research in PMTCT.

The centre, a major scientific research initiative and situated within the Mpukunyoni Tribal Area, conducts research on health problems such as HIV/AIDS in rural communities. The research site helps government and other service providers with planning for the provision of health services for such communities.

On this particular Wednesday, five women sat forlornly on a bench in the consulting room, waiting for their turn. Separated by a green curtain, Msimang had to speak softly to the patient to prevent the others from hearing.

A makeshift plastic tent behind the building is used for individual sessions by another counsellor employed by the Africa Centre.

Educating and properly counselling HIV positive pregnant women about nevirapine and the PMTCT programme before offering them the drug is essential, Nigel Rollins of the Africa Centre told PlusNews. Studies have found that nevirapine can reduce mother-to-child transmission by 50 percent.

But AIDS activists took the South African government to court last year for its delay in rolling-out nevirapine in all public hospitals. The government has repeatedly questioned the toxicity of the drug.

The Africa Centre counsellor said that of the women she had seen that day, one had refused to accept the nevirapine tablet because she had heard that the government was still "not sure" whether the drug could be used.

Many women refuse to take the drug because they are also afraid of the side effects, the counsellor added. The most common are skin rash, fever, nausea, and headaches. It can also cause liver damage.

Controversy over the risk of HIV transmission by HIV positive mothers who breastfeed, has prompted the centre to study "vertical HIV transmission" in women attending the antenatal clinics.

A UNAIDS statement on breastfeeding noted: "When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-positive women is recommended."

For many women in Hlabisa, a lack of basic utilities in the rural area and the stigma surrounding women who formula-feed has made breastfeeding the only option.

By comparing rates of vertical HIV transmission in three groups of HIV infected and uninfected women - those who breastfeed exclusively, those who mix breast-milk with other fluids, and those who use formula exclusively - the study will determine the role of breast-milk in the prevention of HIV transmission from mother to child.

According to Rollins, the project will follow 2,500 women, both HIV infected and uninfected, and their babies until two years after delivery.

Women who choose to breast-feed will be visited at home before and after delivery to support them with breast-feeding. An independent team of monitors will also make weekly home visits to collect information about the way infants have been fed, and on whether they have had any illnesses.

At the clinic, the decision on infant feeding options is kept simple.

"Instead of rattling off about whether to breastfeed or not to breastfeed, we ask them about which method they prefer, then we take into account their circumstances and advise them accordingly," a researcher for the Centre's Breastfeeding project explained.

With a population of about 85,000 in the district, the clinic's work seems to be a drop in the ocean. The area's rapidly increasing HIV prevalence rate is making the clinic staff's work even more difficult.

Despite these and many other obstacles, Msimang is determined to provide the best care possible for people in this resource-poor setting.

The clinic is making plans to extend and improve the facilities. Winter is coming and the patients will need shelter from the rain and cold while they wait. Yet administrative hitches and delays are slowly making Msimang lose hope.

"The way things are going, we don't know when this will happen," she said.

[ENDS]

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