South Africa: Towards dignity and social inclusion, JRS’s healthcare services
05 April 2019

In the middle of the picture, Claudine, an asylum seeker from the DRC living in Johannesburg, walks assisted by Marceline Sangara, head of JRS's health department ,and a volunteer at JRS / Image Irene Galera
Marceline Sangara: “ JRS is like a family member now for the people who are sick,”

Midday, somewhere on the road to Melville. “Time is not on our side,” mumbles Floyd Maphetha, driver at the Jesuit Refugee Service South Africa (JRS). Marceline Sangara, the head nurse of JRS health team’s Home Based Care programme, makes a phone call from the back seat of the car, checking that Didi*, the first patient of the day, is available. “How many minutes do you think you will spend with this “mama”?” asks Floyd. “Just ten minutes, today I won’t stay much as she just wants me to see the girl because the boy is at school, they close today,” Marceline answers, “We start with “mama” Didi because she is on the road.” This is a usual scene during JRS’s home visits –intended to respond to the basic needs of asylum seekers and refugees living in Johannesburg and Pretoria.  

Documentation, language barriers, fees and institutional discrimination often exclude asylum seekers and refugees from access to South African healthcare facilities. Many of JRS’s beneficiaries have been waiting as asylum seekers to be granted refugee or residential status in SA for over a decade. As they are not fully recognized citizens, they therefore are not eligible for certain types of medication and major operations within the public system. Asylum seekers and refugees are also subjected to higher health fees than South African nationals and not all can afford them–as they experience difficulty finding jobs and affording the housing, school fees, food and other essentials.

JRS is aware that access to health is a step towards dignity and social inclusion for those who had been forced to leave their country behind. “Democracy is in the health department,” Marceline feels. With eight workers and three volunteers under the supervision of Marceline and the social worker in charge of the health department, JRS’s health team provides assistance to over 1000 refugees and asylum seekers through home care based services, counseling, as well as funding support.

“From Monday to Thursday they [JRS’s health team] go house by house to respond to the basic needs of the patients,” Marceline explains, “For those who are very ill, JRS can even accompany them to the hospital, collect the medication for them, do the cleaning, bathing, cooking and making sure that they take the medication properly.” Every Monday and Tuesday, Marceline also provides health counseling at JRS’s office in Belgravia “For people who has an appointment at the hospital but not the money to go there or for those who don’t understand their disease,” she states. Some patients can request JRS funding for healthcare consultation fees and transport to healthcare facilities. More than 140 beneficiaries receive about R 1000 (61 EUR) for rent and R 500 (30 EUR) for food.

After four or five hours of consulting, Marceline usually gets into the car and goes to the field. She can attend to more than 20 people per day at in the office (mostly from the Great Lakes region, but also Eritrea, Somalia, Uganda, South Sudan and Bangladesh). And an additional 40 patients within the home based care program. Shifts are long and intense. There is no time to lose. “Once you start, you don’t stop,” Marceline admits. “I am strong to deal with them. I can even go on Sunday to take care of the ones I didn’t have time to visit,” she expands.

Eventually, JRS’s health team offers routine health checks (blood pressure, sugar testing and HIV testing) and workshops in different areas around Johannesburg. Marceline explains how they even go to different neighborhoods, knock at people’s houses, shops and ask the people on the street to refer asylum seekers, refugees or undocumented migrants in need of attendance and advice to JRS.

Accompaniment and information are crucial among the asylum seekers and refugees communities. In fact, some of the main challenges that JRS addresses in SA are witchcraft, as well as the stigma and lack of information regarding some illnesses. “They [the patients] don’t know you can live with what we call a chronic disease forever, but you have to know how to manage it. When we do workshops South Africans can say: I am living with cancer, with epilepsy, with HIV and now I am back to life with my medication,” states Marceline, “But a Congolese person will never accept that they have them, they will continue pretending that they are ok. You can’t deny to be sick. Sickness is part of our life.”

A part of our life

A quick visit to Didi at her modest roadside stall helps Marceline to ensure that both women and Didi’s younger son are ok. As a single mother from the Democratic Republic of Congo, Didi tries make ends meet selling avocados, candies, peanuts and other consumables. Her daughter, seventeen, hugs Marceline as soon as the nurse gets out from the car. All three family members are HIV positive since Didi and her daughter were sexually abused in their country over eight years ago. Alone and lost as a foreigner in South Africa, Didi was unable to take the pre-exposure prophylaxis pill to avoid infecting her son, of whom she was pregnant with at that moment. Since 2008, JRS addresses their needs and help the children to learn and understand about their illness.

Back to the car, Floyd and Marceline head to Ivette Mbayo’s home. Not much has changed for her since JRS’s visit last week. Ivette still struggles to get her medicine for her renal, diabetes and hypertension problem. Dialysis or a transplant are not provided by public hospitals. “Mama, I am dying,” tells Ivette to Marceline. As Ivette, Assumani Matondo Nibizi is one of JRS’s patients residing in Johannesburg with kidney failure in need of dialysis and an organ transplant. In addition, this young man from the DRC risked ending up homeless as the shelter where he stayed, accommodation covered by JRS, decided to close the hospice for chronic patients in need of palliative care –as Assumani himself. Sitting on the porch besides the quiet Congolese, Marceline listens to her patient while tries to figure out a new place for him. “This is South Africa, even ill people can end up on the streets,” Marceline regrets. A few days after this meeting, JRS already could accommodate Assumani in a private residence.

“JRS’s health service is important because most of the time, when you are in a chronical condition or if you have any kind of disease, you find yourself alone. And no one is on your side,” states Marceline regarding cases as Assumani and Ivette’s. “We [JRS] are like a family member now for the people who are sick,” she expands, “if you are on the last stage of your life, we can go with you, the day you die we go to identify your body and give you a burial.”

For Marceline, it is crucial to work closely with the patient. “When they [the public healthcare staff] deny to treat or give medication to someone because he is undocumented is when we go there, talk to the manager of the hospital to provide him the medication. By overcharging them they don’t have enough to respond to their basic needs so it means they will end not taking the medication.”

Apparently, time seems not to be on refugees and asylum seekers’ side when it comes to health. Perhaps because receiving assistance takes too long, if it even comes. “Last time how many steps did you give me? Four. Today will give me ten steps, mama!” Marceline encourages a scared Claudine, “I will help you on your way forward, but on your way back you will come alone.” An asylum seeker from DRC, Claudine came to JRS’s health office in seek of attendance three years ago. She was not able to walk after her not looked after hypertension problem led to epilepsy and a stroke that prevented her from walking since November 2018. “One day all JRS decided to visit her, we were shocked, she was so sick,” explains Marceline. Claudine can’t help but scream while Marceline and the JRS volunteer helping today massage her slim legs. It feels like the nerve-endings are burning for Claudine. Exhausted after the session but with Marceline assistance, she is nevertheless able to take a few small steps across the room –in the space left between the fridge, TV, bed and wheelchair.

Today’s visits are finished. Tomorrow Marceline will again open the door of the office, new faces will be gathering at the JRS office to get consultancy or a monetary stipend, Floyd will hurry everyone up from behind the wheel and, hopefully, this time, time will be on everyone’s side.

*Didi is a fake name intended to preserve the privacy of the JRS’s beneficiary in question.


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Mr. Tim Smith
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