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Monday, March 10, 2014
- Every weekday morning, a stylish procession leaves the offices of MaAfrika Tikkun NGO in Delft, Cape Town; bumps and jolts through the gravel entry gates; then hits the tar and scatters into every corner of the township… “Those people, they are mos kwaai jong (now very cool) – they drive a bicycle now…” says an envious onlooker.
In an area portrayed by the press as crime-ridden, bleak and desperate, the MaAfrika Tikkun health workers cruise the streets between shacks and houses without anxiety, on their elegant, black, single-speed Africabikes, their wire baskets and backpacks filled with the accoutrements of home-based care.
“People say it looks like a bike from the past,” says Esmerelda Piers, who’s been working as a home-based carer since 2006. “Everyone wants one. We lock our bikes, but people see it almost like an ‘ambulance’ bike and they won’t take them from us.”
Piers was one of 108 MaAfrika Tikkun healthcare workers who received a bicycle in late 2008, donated by US-based project BikeTown Africa. The project aims to hand over a further 1,000 bicycles to health workers in 2009.
The carers make home-visits, dress wounds and ensure that people with chronic illness (such as TB, diabetes and HIV and AIDS) are taking their medication. They also monitor the growth and wellness of newborn babies.
South Africa’s national government pays home-based carers a stipend to visit a minimum of between four to ten patients a day (depending on the level of care needed). But sometimes carers don’t get to see everyone, says Beryl van den Heever, who manages the MaAfrika Tikkun team. “It can take a long time to wash and listen to just one patient. Sometimes carers were only getting to see five people properly.
“Now, our carers see 8-12 people a day, they spend more time with the patients, and they can respond to emergencies more quickly…”
Community-based health services such as home-based care play a vital role in enhancing public health and alleviating the pressure on health facilities, says Faiza Steyn, director of communications, of the Western Cape provincial department of health.
In the Western Cape alone, there has been an 83 percent increase in the number of NGO-appointed carers over the last year, and they have provided home-based care to more than 24,000 people during this time.
Home-based carers work mostly in three areas: what the department of health calls ‘dehospitalisation’, patients who have been discharged from hospital but still need care; adherence support, particularly for chronic and TB, diabetes, hypertension and psychiatric illnesses; and health education campaigns.
Charles Rosant, in his third month as a home-based carer, tells of how he visited a patient who had no food in his home. “How can I ask him to take his medicines with no food?”
“It is being able to help like that that makes be stand up every morning,” says Rosant – who got on his bicycle and sped to the nearest shop to buy bread for his patient. “With walking, I would have only gone back to him the next day.”
On another occasion, the Delft team were able to rally additional carers when they needed to create a ‘makeshift ambulance’ to carry a patient to hospital. “We would never have got so many people together so quickly otherwise,” says Piers.
But they don’t move so quickly that they’re no longer able to stop, chat and remain part of the community. ‘We ride slow enough to people to come out of their houses and ask us questions,’ says Piers. ‘We can still give advice “on the move”.’
In terms of energy expended over distance, a casual rider can travel four times the distance by bicycle as on foot, says Bradley Schroeder of BikeTown Africa, and carry up to five times more goods. And in terms of speed, it takes about as much effort to walk at four km an hour as it does to ride at 16 km an hour. Bicycles also have lowest operating costs of all transport modes.
Sixteen kilometres is the average distance Trudy Makerman travels each day, to complete her rounds as a carer – from home, from patient-to-patient, and back home again.
Makerman is a healthcare worker in the fruit farming district of Robertson, Western Cape. Together with Stoffel Klein and Nicolene Regue of Robertson’s Rural Development Association, she travels long distances – 10-20 km – on steep gravel roads to visit babies and people with chronic illnesses.
In November 2008, the Association received a delivery of bicycles from national government programme Shova Kalula. Since then, the team has been able to visit between 500 and 550 patients a month (and spend more time with each of them – as they don’t have to rush off on foot to the next farm), compared to the 100 to 200 patients they saw when they walked.
“Walking there was not the big problem,” says Makerman. “It was the eindpad [the walking back], once the day was hot. (Their working days start at 8 am and end at 12.30.) We were tired by then, from the work. I would want to rest before visiting the next patient, I did not always have the energy for them.”
Her bicycle also enables her to leave home later in the morning, and get back home earlier, giving her more time with her family (and herself).
“My bicycle is just right for me,’ says Makerman. ‘People can shout that I am too old [she is 43] and why don’t I get a car. But for me, my bicycle takes me away from my stress. It is good for me and good for my patients. All health workers should have one!”
Piers also finds personal benefit in her bicycle. ‘I go to see friends and cousins in Belhar, in Bellville, I go shopping, I visit my cousins… each time, I save at least 30 rand ($3.50) in taxi fare.’
And she takes her children with her, but only on her older bicycle – “My nine-year-old and my six-year-old, they both fit on the bike, but I won’t use my work bicycle for this!”
“But you know, it is not about the bicycle,” says Piers – unaware that she is echoing the title of that famous autobiography. “Some people want to become carers because they will get a bicycle, but for us, the bicycle is just the cherry on the top. When someone thanks me for a job well done, I know why I am doing this. And the bicycle helps me do it better.”