A few minutes after midnight, on a Saturday in June this year, the wind was howling around the walls of a mud hut in the Zindindi location in the former Transkei, when Nongezile Sinkala realised "something terrible" was wrong with her grandson, Luphumlo.
She had given the one-year-old a homemade oral rehydration solution – made of water, salt and sugar – for the past few days. The clinic nurse had told her the mixture would replace lost fluids in Luphumlo's body. She said his vomiting and diarrhoea would subside naturally.
But then the boy developed a tight chest. When his sunken eyes started to close, his grandmother began preparing for a journey to the nearest hospital. Sinkala, her grandson and the boy's mother, Nosinthu, live at the bottom of a steep hill, a few kilometres from a rough dirt track that leads to the Wild Coast's Hole in the Wall.
The nearest hospital, Zithulele, is 12 kilometres away, across hilly terrain and thick bush.
As Luphumlo "faded away", said Sinkala, she and her daughter realised they had only R20 between them, meaning they could afford to pay only a part of the transport fee to the hospital. They would have to walk to a taxi rank seven kilometres from their house and take a minibus taxi for the remainder of the journey.
The long walk: Sinkala had to walk for hours across hilly terrain to get help
Sinkala lit a paraffin lamp and took Luphumlo in her arms and checked his nappy. It was full of watery faeces again. Increasingly troubled, she changed him and passed him to his crying mother. "He needs breast milk," she told Nosinthu.
The weather was freezing. Sinkala's hut has no carpets or curtains, only a cement floor and a few blankets. She folded one of these over her daughter and grandson. Holding them tight, she pleaded: "God, make us strong. I beg you, keep Luphumlo alive."
But at 2am it was still far too dark to navigate the arduous journey to the hospital. They had to wait for dawn. As the first rays of the sun appeared, Nosinthu became hysterical, thinking that her son had stopped breathing.
Sinkala decided to "be strong for all our sakes".
The long trekShe put her grandson on her back and, with her weeping daughter next to her, they began the trudge. They approached the first of many hills. A few cows, goats and sheep were eating grass among the huts. She thought of the people fast asleep inside.
There was the house of the 65-year-old woman who believed her husband had infected her with HIV. There was the home of the 14-year-old girl who had dropped out of school because she was pregnant. And there was the home of the alcoholic father who had stopped planting vegetables for his children.
There was the shebeen, with its crooked sign that read: "Best tarven [tavern] — where good frends [sic] meat [sic]." Sinkala said: "There is no money in this area, but there are lots of shebeens. I have asked God how this can be, but I am still waiting for God to answer."
At the top of another hill, Sinkala checked on her grandson. "His mouth was dry and wide open, as if he was crying, but without any sound," she said. "I thought: 'He must be close to death.' Then I just carried on walking and praying."
Nosinthu fell pregnant with Luphumlo's older brother when she was 19 and in grade 11. At the time she had left her impoverished parents' house, which was a four-hour walk away from the local school, and moved in with a relative who lived near the school.
"She was alone there; there was no one telling her: 'No, don't have intercourse'," Sinkala said.
Sinkala walked for hours to save one of her grandchildren's life
"But I was still very shocked when she became pregnant. I really wanted her to be educated and to finish school. I wanted her to have a chance." But as with many teenagers who fall pregnant in the area, Nosinthu abandoned education to care for her child. Three years later she was pregnant again – with Luphumlo.
Her children's father lives in the town of Libode with his parents. "He must stay there until he's found a job and then he can marry my daughter," Sinkala said. "For now he's just her boyfriend. Only when they're married will he move here."
Less than 10% of all adults living in Zindindi are formally employed. Sinkala is one of them. She works for an organisation that has trained her to provide pregnant women and mothers with basic health advice. She earns R1 350 a month – a "fortune" in this part of the Eastern Cape, Sinkala said. Nosinthu also has an income – R 540 a month in the form of child-support grants.
In search of a good SamaritanWith less than R2 000 a month to live on, the family of four's money is often depleted within the first week of each month. Until the end of last year, the family also received a R1 000 disability grant for Sinkala's husband. He had suffered a stroke while working on a mine in Rustenburg. But when he died, the family lost the grant.
After walking for more than an hour, the Sinkalas reached the "big" gravel road. Luphumlo's condition worsened. He started to vomit profusely – right next to the government clinic, which was closed on a Saturday.
Sinkala took the boy off her back, cleaned his mouth and eased him down on the blanket. His mother was shuddering, with tears streaming down her face.
In the black outfit she has worn since her husband's death, Sinkala walked down the road, praying that a "good Samaritan" in a vehicle would drive by. When a white minibus arrived 15 minutes later, she thought her prayers had been answered. But the driver announced: "Lifts are R10 a person to the taxi rank."
If Sinkala paid the fee, they would have no money for the rest of the trip from the taxi rank to the hospital. The minibus drove away. "Those people just left, even though they knew I had a sick child," Sinkala said. "They didn't even ask me why I didn't get in."
She, Luphumlo and Nosinthu continued walking. "It's the way we live here," she said. "It's just how it is."
In much of the former Transkei people have to walk long distances to access healthcare. Renting a driver and a private vehicle to take a woman in labour to hospital costs up to R500 – money the poor and jobless can only dream of.
Sinkala recalled how her 27-year-old niece, Nobembende, had given birth. When the woman's water broke at 11pm one night she and her husband had to walk to the hospital.
Nobembende gave birth on a rock at the bottom of a hill. "Her husband wrapped the baby in his jacket. It took them another four hours to get to the hospital so the baby and mother could be assessed."
Because of the great distances involved, the lack of affordable transport and poor roads, the people of the Eastern Cape often do not access healthcare.
Sinkala helps mothers to register their children at clinics, so the babies can be immunised. Often though, she said, her efforts are in vain because the clinics regularly run out of stock. "Just the other day I managed to get an HIV-infected mother with seven children – none of whom had been vaccinated – to agree to take her baby to the clinic for polio and TB vaccines," Sinkala said. "But when we got there, they did not have the TB vaccine."
With the help of her supervisor, Sinkala took the woman from clinic to clinic in search of the TB shot – known as BCG. "The nurses just shook their heads and said we must come back next week. But that woman never went back because she does not have the money for transport," said Sinkala. "No wonder TB is so rife here."
'Beacon of hope'After walking for more than four hours, the Sinkalas reached the taxi rank. They had to wait another hour for a minibus to fill up before the driver would leave for the hospital. All the time, said Sinkala, Luphumlo was vomiting and suffering intense diarrhoea.
They arrived at the Zithulele hospital just after noon. With its dedicated but small team of doctors, the facility is a beacon of hope in the district. But its resources are strained to the limit.
Sinkala carried Luphumlo to a nurse and pleaded for help. The sister immediately inserted a drip into his small arm, to replace the fluids he had lost. But the Sinkalas had to wait for another two hours to see a doctor. "I understand; there were many sick people that day. We weren't the only ones with a serious problem," said Sinkala.
There are never enough beds at Zithulele, said Dr Ben Gaunt. Many people waiting to be admitted, or those who have not been helped on that specific day sleep on benches overnight.
One-year-old Luphumlo's mother and grandmother walked for 7km to the nearest taxi rank to get him medical help
Luphumlo was diagnosed with acute gastroenteritis – inflammation of the intestines – and admitted. "He was very lucky there was a bed in the children's ward," said Sinkala. She remembered how "exhausted, but grateful" she was at the time. "I cried a lot, from relief of all the worry I had experienced. I just acted so strong to keep my daughter strong," she said.
She recalled how she had stared at her grandson's "tiny, worn-out" body in the hospital cot and how she had put her arms around her daughter and desperately whispered: "He won't die — He just can't."
Luphumlo and his mother stayed at Zithulele for the next 10 days before the boy was well again. But Sinkala had to make her way home "straight away". She borrowed R10 from a health worker and took a taxi back to the rank. From there she retraced the steps she had begun early that Saturday morning; she walked back over the same hills that seemed like mountains, back through the same bush that scratched her arms and legs.
She arrived home well after 9pm. Sinkala fetched her sleeping grandson from the neighbours and placed him on her bed. "I was finished," she said. "But I still had to get water to wash all the sweat and dust off my body. I don't know how I did this; I was so tired." When she finally settled down to sleep, all the elderly woman could think about was the next challenge.
"I thought I must plant spinach in our garden, tomorrow," said Sinakala. "I thought, spinach is now too expensive at the shop. Spinach is good food; it prevents people from getting ill."
The long and winding roadThe 2010 Statistics South Africa household survey indicated that almost half of all South Africans walk to health facilities. Of those, around one out of 10 journey between 30 minutes and an hour and a half to a clinic or hospital.
Around 60% of South Africans use the public health system. But around 10% of sampled individuals do not bother using the nearest state health facility as the medicine they need is mostly unavailable. An additional 10% believe lengthy waiting periods that have to be endured do not justify the effort to visit the closest clinic or hospital.
Ncedisa Paul is the co-ordinator of Mentor Mothers Zithulele, a project that gives pregnant women and mothers advice about healthcare. She said people living in the rural former Transkei can walk for five hours and more to get to their nearest hospital or clinic. "It can take them the entire day to get there and back and, if they arrive too late, they have to sleep over on a hospital bench or outside to see a doctor the next day. People simply do not have the money for transport back home and walking takes too long."
Such patients are often sick and weak, but they still have to travel with small children strapped to their backs.
[Note this article was originally published on 11 November 2011]
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