'What bothered me the most was when a sick person got into the taxi and you saw how the people around them would discriminate against them. They didn't like sitting next to a sick person," Zamani Dlamini recalls. "And when a nurse got into my taxi I would get really excited and ask them about the work they do."
Nine years ago, Dlamini was a taxi driver. Five years later he graduated as a professional nurse and realised his dream of working to end the discrimination against people like those he used to pick up as passengers.
Dlamini's interest in nursing stems from when he was still a teenager. In 1999, when he was in grade 11, his grandmother fell ill with diabetes.
"I realised that I could have helped my grandmother if I knew more about how to care for a person with diabetes," says Dlamini. "But I didn't have the skills. That is how I developed a fascination with nursing because I saw that, in my area [Hlabisa in rural northern KwaZulu-Natal], there were no nurses. At that point my aunt was the only nurse around. I saw that people in my village were sick and they needed help."
It would take nearly a decade for his dreams to become even a possibility. Dlamini had no way of paying for a nursing education. In 2006, he heard about a bursary opportunity offered by the Friends of Mosvold scholarship scheme – now the uMthombo Youth Development Foundation, which offers financial support to young people from rural areas to help them become "qualified healthcare professionals in rural hospitals" in northern KwaZulu-Natal and the Eastern Cape.
In 2007, Dlamini received a bursary and started his studies at the University of Zululand's campus in Ungoye. In 2011 he completed his studies with distinction.
After graduating he worked at Hlabisa hospital. In June 2015 he moved to Pietermaritzburg to join Jhpiego, a nongovernmental health organisation affiliated to Johns Hopkins University in the United States. The organisation is currently conducting research on the importance of nurses in the care of patients with multidrug-resistant tuberculosis (MDR-TB). Dlamini is based at the Doris Goodwin hospital in Edendale, KwaZulu-Natal – a specialist MDR-TB hospital.
Homesick"But I won't stay here [in Pietermaritzburg] because the people of Hlabisa need me more," says Dlamini. "When you work for the people in your community, people you understand, they are honest with you because you understand their beliefs and their problems.
"So there is this bond that develops between you and the community. Even if somebody has a question, they know you're from the community, so it's easy for them to approach and ask you.
"The people in Hlabisa believe strongly in traditional medicine. So people would often present late at the hospital after they've been to different healers and sangomas. You find that they bring the person to hospital at a late stage and then people say that the hospital is ineffective. They think that if a person goes to hospital they go there to die.
"So, as the TB co-ordinator, I got the chance to visit the 21 clinics served by the hospital and preach this gospel that people must go to the hospital early so that they can get treatment at an early stage before their illness advances."
Dlamini believes that being from the area made it easier for him to raise awareness about the disease and for people to trust him. His beliefs are supported by research.
Driven: Zamani Dlamini wishes to share his passion for TB care and management with other nurses.
A 2011 study published in the South African Medical Journal found that rural health workers "felt significantly more accountable to the community that they served" than their urban counterparts.
The study, which surveyed 174 public health practitioners in rural areas and 142 in urban areas, also states that rural medical professionals "were more than twice as likely as the urban group to have been exposed to rural situations during their undergraduate training, and were also five times more likely than urban respondents to state that exposure to rural practice as an undergraduate had influenced their choice of where they practice."
These findings are supported by a 2013 study in the African Journal of Health Professions Education, which looked at the career and practice intentions of health science students at three South African health science faculties.
According to the study, "rural preference was strongest for respondents of rural origin – consistent with evidence that a rural background is the single factor most strongly associated with rural practice".
For the 31-year-old Dlamini, this is only the beginning of an already stellar career. In 2014 he was recognised as one of 200 Young South Africans, a flagship project of the Mail & Guardian that celebrates the achievements of notable up-and-coming South Africans under the age of 35.
This year, he received a Leading Lights Award, an initiative of the International Council of Nurses to reward individuals making an "outstanding contribution to tuberculosis prevention, care and management in their local facility and/or community".
"I'm most interested in nursing education," Dlamini says as he waves a greeting to a group of patients sitting on the concrete lawn furniture between the red-brick buildings of the hospital. "Maybe one day I might be a nursing tutor or lecturer."
"It is quite ironic that we wear masks eight hours a day while we're on duty, but when we go home we don't have those masks," says Zamani Dlamini, a nurse with Jhpiego, a nongovernmental health organisation affiliated to Johns Hopkins University in the United States. "When I leave work and get into a taxi I may end up sitting next to the same person I was protecting myself from in the ward.
"The people who are in a tuberculosis ward or clinic are actually less infectious because they are on treatment. But you may end up in the same bus or taxi as someone who has defaulted on their treatment, and get infected that way."
Thinking back to the days when he was a taxi driver, Dlamini shakes his head and laughs: "You know sometimes people would refuse to open the window in the taxi because they didn't want to mess up their hairstyles, as if that is more important than your health."
Before becoming a nurse, Dlamini spent four years driving minibus taxis in the village of Hlabisa in rural northern KwaZulu-Natal where he grew up. He also ferried passengers between his hometown and Johannesburg.
After graduating as a nurse in 2011 he started working at Hlabisa hospital, where he quickly developed a special interest in tuberculosis.
"When I was at Hlabisa I was confronted with a lot of TB cases – but I was not prepared for the scale of the problem. To deal with this disease we need to educate not just the community but also nurses on issues such as infection control."
KwaZulu-Natal has the highest HIV prevalence rate in the country. A report last year by the Human Sciences Research Council estimates that nearly 17% of the province's population is HIV positive.
The provincial Aids council says KwaZulu-Natal has the most tuberculosis infections in the country and that tuberculosis is the leading cause of death in the province.
In the uMkhanyakude district, where Hlabisa is situated, nearly 40% of pregnant women at government clinics tested HIV positive in 2012, the fifth-highest prevalence rate in the country, according to the District Health Barometer, which also says that more than 71% of people with tuberculosis in the district are HIV positive. The tuberculosis cure rate in the district is 75.7%, below the national target of 80% according to the publication.
Dlamini conducts regular training for patients on treatment for multidrug-resistant tuberculosis to help them stay on their medication. He has also trained injection and tracer teams, which provide treatment to patients in their homes, and provides support to nurses working in tuberculosis programmes in the Hlabisa area.
When Dlamini joined Hlabisa's tuberculosis programme as the co-ordinator in 2013 the cure rate was between 60% and 70% – by mid-2015 this had gone up to 83%.
But he is not complacent: "People still don't realise TB is a killer disease. We need more education about it so people can understand how it's spread and how to protect themselves – that way we can avoid many deaths." – Ina Skosana
[This story was originally published on 16 October 2015]
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Bhekisisa means "to scrutinise" in Zulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.