International Nurses Day 2020: Case study of the week

International Day for the Eradication of Poverty: “One life at a time” – Improving the health and lives of poor communities in South Africa

Contributor: Patience Shipalane, DENOSA

On 17 October, we celebrated the International Day for the Eradication of Poverty. The World Bank has estimated that the COVID-19 pandemic could push between 71 -100 million people into extreme poverty in 2020. Poverty has immediate impacts on health. There is an obvious correlation to access to food, clothing and shelter, but it also affects a person’s ability to access healthcare services and received the required treatment to return to health. Nurses are at the forefront of caring for and working with those who are most vulnerable and disempowered. Today, we present a case study on a nurse in South Africa who provides primary health care services to the poorest and most vulnerable populations.

Patience Shipalane works for the Department of Health Western Cape Government in the township of Themabalethu, in Western Cape, South Africa: a community confronted with poverty, diarrhoea, crime, poor quality of life and other social and personal challenges such as parental neglect, child abuse and lack of documentation for proper identification.

Due to delayed and missing immunisations, there are lots of diarrhoeal outbreak cases in the community. In order to ensure immunisations are up to date, Patience personally calls the parents of the children, makes appointment for them in the clinics, and follows-up with them after the appointment. In some cases, she does home visits to establish whether the mother and child have attended the clinic and speaks to them about their experience and encourages visits to the nearest clinic. Often on her visits, Patience discovers that there more serious social challenges in these families than just immunisation, such as parental neglect, child abuse, severe and extreme poverty and lack of proper legal documents like birth certificates.

At the clinics where she works, she created an Oral Rehydration Corner where the parents of children could obtain a one litre bottle, salt and sugar to make their own rehydration fluid, which she would teach them to prepare. In order to combat the high prevalence of diarrhoeal disease, she teaches children and teachers in creches and churches proper hygiene and hand washing care.

Patience also decided on a new approach in service delivery, named “Street Community Service”. Patience and other nurses check the status of the children’s “Road to Health” booklets to ensure their immunisations are up to date, and provide Vitamin A and Deworming medicines.

Women’s health is another area that Patience promotes in the community. She encourages women to stay well, gives them information about family planning and motivates them to do cervical screening and a breast examination every month. On average, Patience meets 100 mothers in public meetings, encouraging them to take care of their health and stay well.

She also prioritises HIV screening to help people know their status. She arranged Wellness Days where participants were educated about health matters. On one of these days, 70 out of 120 participants, opted to do an HIV screening. Those that tested positive were referred to the nearest health facility for follow up. The TB screening resulted in 303 new patients starting to take their TB treatment. These outreaches have resulted in a lot of referrals, which has saved many lives. Our monthly family planning programme at South Cape College prevents an average of 30 unplanned pregnancies every month.

As she travels to work on public transportation, Patience talks to the passengers about health issues and has earned massive respect for her approach.

Patience is very appreciated and trusted by the community. She is regularly invited by the community to make presentations at churches, community events, graduations and municipality public events. The people that she encounters everyday feel freer and are more open to ask questions in an informal settings than they would in the formal clinic settings. The community members are so free with her that they report to her most of the cases that the department would never hear about.

Her belief is she may not change the whole community at once, but if she can make a difference in one person’s life a day, she is fulfilled. Her motto is “One life at a time”, if she happens to change two at a time, it is a bonus!