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South Africa: The impact of health care services on those in exile

Time is not on our side, mumbles Floyd, driver at the Jesuit Refugee Service South Africa (JRS). Marceline, 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 national health care facilities. Many of JRS's beneficiaries have been waiting as asylum seekers to be granted refugee or residential status in South Africa 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 and not all can afford them.

Assisting over 1000 refugees through health care services

Democracy is in the health department, Marceline feels. With eight workers and three volunteers, JRS provides assistance to over 1000 refugees and asylum seekers through home care-based services, counselling, as well as funding support. The JRS's health team offers routine health checks and workshops in different areas around Johannesburg. Marceline explains how they even go to different neighbourhoods, 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 refugee communities. In fact, some of the main challenges that JRS addresses 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, states Marceline A Congolese person will never accept that they have them, they will continue pretending that they are ok. You can't deny being sick. Sickness is 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 to make ends meet selling avocados, candies, peanuts, and other consumables. Her daughter hugs Marceline as soon as the nurse gets out of the car. All three family members are HIV positive. 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.

Standing with refugees throughout all stages

Back to the car, Floyd and Marceline head to Ivette'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.

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 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 health care staff] deny to treat or give medication to someone because he is undocumented, 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 you will give me ten steps, mama! Marceline encourages a scared Estelle, I will help you on your way forward, but on your way back you will come alone. An asylum seeker from the Democratic Republic of Congo, Estelle* 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.

Estelle 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 Estelle. 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.

Source: Jesuit Refugee Service

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