Public Health Programme for Vulnerable Groupings

The Clinic

The Clinic

Kenneth Gardens was first established in the early 1940s as a subsidized housing estate for low income white South Africans. Securing a ‘corporation’ flat in a place like Kenneth Gardens meant getting to the top of an existing (long) list of people wanting to access sub-economic municipal housing. Even in the early days of Kenneth Gardens, people with disabilities and health problems were given first preference when space became available. As the Group Areas Act was repealed, places like Kenneth Gardens became available to people from all race and ethnic groups. While the (means-related) listing system continued for a few years post-1994, this system was completely revised in later years. Over the past ten or so years access to Kenneth Gardens has changed fundamentally. To get into Kenneth Gardens as a ‘fresh’ resident (i.e. not taking over a flat of a relative), you must be referred by a public social welfare worker or a public hospital official to the eThekwini Housing Department. Such referrals are usually based on the fact that someone in a designated family suffers from a mental or physical disability, or even a chronic illness. Such disability or illness must be shown to diminish the earning capacity in the family.  This all means that Kenneth Gardens has a high concentration of people living with disabilities or chronic illness.

In addition to this collective of health needs there are also a number of elderly people living in Kenneth Gardens who are unwell and require medical attention/intervention. Despite the ‘policy’ in regard to tenancy in Kenneth Gardens, there is almost no apparent intervention from government welfare or health agencies within Kenneth Gardens. Individuals and their families are expected to take responsibility for their health and welfare, but many living in the estate are unable to do this. As a result informal networks of home based care providers have been established to try to meet the basic needs of the sick and the elderly living in Kenneth Gardens. These informal (voluntary based) networks are self-funded and individuals providing this service have no access to basic medical equipment or medication. What they have made available to the Kenneth Gardens community is their own capacities, skills and knowledge which they have gained in their working lives as assistant physiotherapists, nurses and lay persons with an interest in home based care. The individuals who provide voluntary home based care within Kenneth Gardens are often the only source of assistance for residents with health-related needs.

From a government point of view, residents of Kenneth Gardens, an estimated 1500 – 1800 people, are expected to access public hospitals to meet their health care needs. While Kenneth Gardens is within close proximity to Kind Edward V hospital, residents are zoned to use Wentworth hospital in the Bluff.  Wentworth Hospital is about 20 kilometers from Kenneth Gardens and there is no direct public transport routes to this hospital, requiring residents to first catch a taxi into town and then out to Wentworth hospital. No transport scheme exists to arrange for those in need to get to the hospital. Residents of Kenneth Gardens, as a result, tend to neglect their own health needs or have to go to very great lengths to access medical assistance/attention and to attain required medication.

It is also important to note that there is no municipal clinic in the ward in which Kenneth Gardens is situated. Kenneth Gardens’ residents have therefore identified the establishment of a community clinic, within the estate, as a priority. Such a clinic would go a long way to improving health support and wellbeing within the Kenneth Gardens community. The proposed clinic would also have the benefit of harnessing and supporting the existing skills and capacities of people already providing informal health care services to residents of Kenneth Gardens.

In establishing such a clinic within the Kenneth Gardens estate, we will make use of existing physical space that has been leased to the Community Development Programme at UKZN for this purpose at a minimal rate (R1,00 per year).

The proposed clinic will operate along the lines of another successful primary health care clinic close to Umbilo. In accordance with this model, retired doctors and health care professionals will volunteer their services on a once weekly basis to the clinic. Those retired doctors who wish to be compensated for the work that they do will be encouraged to register with the Department of Health who currently pay retired doctors R50.00 per person they consult with. The City Health Department is one of the stakeholders of the Kenneth Gardens Intervention Project. This steering committee is convened by the Chief Whip’s office in Durban. The Chief Whip has given his full support to this project, and in doing so has been able to mobilize a number of city officials as participants in the project. This clinic will complement the existing Homeopathic clinic initiative, started in partnership with Durban University of Technology, that currently offers a free service to all residents in Umbilo each Wednesday (see below for more details).

Aside from the provision of primary health care services and medical advice, the proposed clinic will also serve to co-ordinate a formalised home-based care programme to residents of Kenneth Gardens who require additional medical support and care. Those providing home-based care will receive a nominal stipend for the home-based care that they provide. As discussed later in the proposal, there is already an existing home based care NPO in Kenneth Gardens but they require assistance in maintaining their status and in mobilizing equipment, funding and government support. Presently members of this NPO operate purely out of good will and the assistance they provide (such as food) is derived from their own pockets. Members of this NPO are all residents of Kenneth Gardens.

Community Clinic Aims

  • To provide accessible basic medical care, through access to a GP and a registered nurse, to a community in need who live in a low economic bracket;
  • To assist pensioners, people with disabilities and those with chronic illness in accessing medical attention and medical advice;
  • To serve as a collection point for some prescription medication and chronic medication;
  • To provide awareness of and referrals to other specialist health care facilities;
  • To organise special awareness campaigns on specific illness eg: diabetes, TB, HIV/AIDs etc and primary health care.
  • To mobilize existing public health related resources and capacities in the Kenneth Gardens community and the surrounding areas.
  • To create a network of people who can provide transport to Kenneth Gardens’ residents who need to travel to Wentworth Hospital.

Existing Clinic Services

On the 11th of April 2012, a Homeopathic health care clinic was opened in Kenneth Gardens. The services are provided by the Homeopathy Department based at DUT. At present about 108 residents of Kenneth Gardens are regular clients at the Clinic. The clinic offers access to senior homeopathic students who are supervised by a qualified homeopath Dr Ingrid Couchman.  The clinic offers homeopathic diagnosis and treatment free of charge, as well as basic medical services such as blood pressure and blood sugar testing.  Currently based at the Kenneth Gardens committee room the clinic runs from 09:00am-12:00pm on a Wednesday morning. The clinic is being run with the assistance of an existing Kenneth Gardens’ home based care organization, Senzokuhle (an NPO based in Kenneth Gardens), who assist with administration, translations and wound dressing.  In addition the homeopathic senior students and Senzokuhle members do home visits to residents who are not mobile or struggle to walk down to the committee room.   The clinic has received a very positive response from the community.

A lease agreement with the Municipal Housing Department will be signed in the near future which, funding permitting, will allow for the creation of a fully functioning public health care clinic facility.  A registered community clinic offers access to a doctor and nurse, who can offer basic medical health services as well as immunisations for infants.  In addition a registered doctor is able to collect and distribute chronic medication for pensioners and residents in need.

Extended Clinic Strategy and Modeling

The proposed extension of the Kenneth Gardens clinic will closely follow an existing successful clinic model run at the Frere Road Presbyterian Church in Glenwood. Glenwood is a neighbourhood that is adjacent to Umbilo which is where Kenneth Gardens is situated. This clinic currently serves around 500 pensioners from surrounding areas. In operation for 25 years the clinic is a well-run and has proven to be sustainable. The Frere Road clinic focuses only on pensioners and no longer requires any fundraising; the clinic model operates solely on volunteers, both medical and administrative. Basic running costs are covered by the R20 per annum charge for all patients, and the doctors’ fees are covered by the Department of Health (retired doctors do get a R50 per patient fee paid by the Department of Health for community work).  The clinic operates on a Monday morning from 7:30 till 10am and acts as a collection point for various medications, as well as offering access to a registered doctor and nurse. The clinic also has some specialist volunteers, for example a podiatrist, who offer treatments at specific times at a greatly reduced cost to the pensioners (rarely over R10 for treatment). It is the clinics’ ability to focus on specific needs and the spirit of volunteerism that makes this a successful, sustainable and functioning community clinic for many pensioners in the area.

Sister Thornton who heads up the clinic has already been very kind in sharing both documents and management strategies. She has also assured us that she will provide assistance and advice to the voluntary network that currently exists at Kenneth Gardens as well as to clinic volunteers, administrators and managers, once it is up and running. She has provided important information on what physical, medical and human resources are required for such a clinic to function. She has also invited interested persons who are likely to manage and run the clinic in Kenneth Gardens to spend some time with her at the clinic to see how it runs. Expertise, skills and resources are likely to be shared.

All community clinics are run through NPOs, and in Kenneth Gardens the administrative and financial management of the clinic would be run through an existing home care based NPO, Senzokuhle Community Based Organisation (NPO No: 078-584). This NPO was established by a group of women in Kenneth Gardens who have an interest in, or training in, health care provision.  Financial auditing will take place through the regular auditing of NPOs by the Department of Social Development. Auditing will also be done by the relevant departments at the University of Natal, at least in the first three years of the existence of the clinic. Once the clinic is established, a board will be created to oversee and monitor the Kenneth Gardens community clinic. We anticipate members of this board would include the Ward Councilor and representatives from the City Health Department, Community Development and Medical Programmes at UKZN, the Kenneth Gardens Residents’ Committee, Senzokuhle, and UKZN Foundation.

Following the Frere Road model, the clinic would be run by volunteers, including the doctor, the registered nurse and one or two volunteers from Senzokuhle.  Initially the clinic will operate for one morning a week from 7:30 till 10am. Depending on resources available, the hours of the clinic might be extended.

Residents who wish to access the services of the clinic will pay a nominal R20 a year membership fee to cover basic medical, stationary and cleaning equipment. At the advice of Sister Thornton it will be necessary to charge a small fee such as R5 for some services, for example for diabetic testing lances that are expensive and one use only items. Offering only basic health services, access to a medical doctor and nurse and making collection of medication more accessible ensures a focused a well-run operation that can deliver what it sets out to do.  The clinic will not be able to offer specialized support and treatment for TB, Hiv/Aids and psychological/psychiatric treatment. However clinic volunteers would be the first port of call for referrals and information on other specialist clinics and medical facilitates for these needs. For example UKZN and Senzokuhle have already built a relationship with Dr. Rochelle Adams from the Hope Clinic in Durban who runs a large TB and Hiv/Aids public clinic in town. Primary Health Care referrals and awareness campaigns will also be part of the clinic communication programme. Over and above the basic medical services Senzokhule, which has a trained occupational therapist assistant, would offer pain relieving and therapeutic massages at a greatly subsidized cost (estimated at around R10) to residents in need on a separate morning of the week.

The clinic will be set up in an existing outhouse building at Kenneth Gardens, which has two rooms and a bathroom facility. As mentioned above, the eThekwini Housing department has agreed to lease this building to UKZN for a nominal annual fee, and in turn UKZN has agreed to let this to Senzokhule for a community clinic free of charge. Once the venue has been refurbished Senzokuhle will register the clinic with the Department of Health. Donations and financial assistance are required for such refurbishment and for the resourcing of the clinic. The National Lottery Fund is being approached in this regard, and calls have been made via the local media for local donations from the surrounding communities. The clinic has received some existing assistance such as beds from The Hillcrest Aids Clinic and DUT, glucometers from the South African Diabetic Society and Senzokuhle has received R15 000 worth of funding from Eskom for basic medical and first aid equipment.

The founders of the Senzokuhle Community Based Organisation will be the ‘champions’ of the clinic, as will the task team of the UKZN Kenneth Gardens Intervention Project. We are also hoping that retired doctors living in the municipal ward will act as champions. The Ward Councilor in the area, Mr Warrick Chapman, has offered his assistance in identifying such champions through existing networks of benevolence societies such as the Berea Round Table and Durban Rotary.

Home-based Care Programme Aims:

  • To train/upskill at least 5 members of Senzokuhle in home-based care, specifically in regard to Hiv/Aids and TB.
  • To identify which Kenneth Gardens residents are in need of home-based care.
  • To provide quality home-based care for identified individuals
  • To assist in linking up these households to existing resources in the community, and to facilitate the service delivery of  these resources, such as  the clinic and the feeing scheme
  • To create a viable programme for caregivers through providing basic stipends for trained home-based care workers in Kenneth Gardens

Home-based care strategy and modeling

The home-based care initiative of this health proposal aims to reach residents who have more specific health needs than addressed by the clinic, or who may not be able to access the clinic themselves. There is a fairly high a number of Hiv/Aids and TB patients, chronic illness patients, stroke victims, and wheelchair bound residents in the housing estate for whom home based care would provide a great improvement in health support. Although informal home-based care is already occurring to some degree within Kenneth Gardens through Senzokuhle, these voluntary caregivers have little access to economic income themselves and are often forced to take on temporary work (such as beadwork) to provide for their own families. Access to ongoing and quality home-based training (noting that some members of the NPO have already put themselves through short home-based care courses), coupled with basic stipends for caregivers, would go a long way to formalizing this home-based care service into a more reliable and effective offering to residents in dire need of assistance.

Enabling home based caregivers from Senzokuhle to fulfill their desire to service their community in this way also has positive spin-offs for the running of the clinic.  Receiving a basic stipend for home-based care work offers an incentive to volunteer at the clinic one morning a week, over and above their home based care services.  Linking these two health initiatives under Senzokuhle means that this unit of volunteers and caregivers at Kenneth Gardens will identify individual and communal health issues, assist with linking people in need to relevant health service providers, and develop collective responses to problems of vulnerability and illness within their community. This in turn promotes ownership and capacity building amongst Kenneth Gardens’ residents in regard to health care problem solving.

We would like to note that we anticipate that the City Health Department and the Berea Round table will play an active role in assisting with the clinic renovations. We are seeking required medical equipment from other established health care facilities and from retired doctors living in the areas surrounding Kenneth Gardens. Funding is required for the home based care providers, transport services and administration costs.

Revisions

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