Part two | Home-based care a lifeline to migrants
In the conclusion of our two-part series, New Frame looks at the challenges and sacrifices made by the people who help refugees and migrants neglected by the state health service.
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10 March 2021
After knocking, Patrick Ilunga leans against a wall and waits a few minutes before the door slowly opens. Behind the security gate stands Abo Oloba, slightly bent over and out of breath from the short walk from his bedroom to the front door.
They greet each other warmly before Ilunga makes his way to the bedroom, with Oloba following behind. Ilunga, 34, has been treating Oloba, 46, for the past three years after he had a stroke and injured his spine. During this time, the two have grown close. Oloba has no family in South Africa.
Like so many people with compromised immune systems and health complications, the Covid-19 lockdown meant he was hardly able to leave his house and interact with other people. Often, Ilunga’s visits two or three times a week to perform intensive physiotherapy are the only interaction he has with someone outside the apartment he shares with other migrants.
When Ilunga met Oloba, he was completely bedridden, but after a lot of hard work, Oloba is now able to walk short stretches at a time. “One of the main issues is when we go on holiday in December, we lose some progress,” says Ilunga, while Oloba does stretches on his bedroom floor.
“So the problem is, he wakes up and feels there is a problem and then he just stays in bed.”
Oloba has spent even more time in his bedroom this past year, especially during the hard lockdowns, because of his struggles with mobility and other health issues. This, compounded by the fact that his family is still in the Democratic Republic of Congo (DRC), means he also suffers from bouts of depression.
“It’s very, very difficult. It is really not easy,” Oloba says between exercises. “Sometimes I have feelings of committing suicide because it is so difficult.
“I don’t have family here. I only have friends who are like brothers and sisters to me,” he says. “I am staying with a friend and that friend has become my brother. He sometimes helps me with rent or anything else I need.”
Becoming a health worker in South Africa
Ilunga offers counselling and emotional support to patients such as Oloba, and he says his own experiences as a refugee in a new country help him relate to his patients. Ilunga completed his nursing studies in the DRC before he was forced to flee to South Africa.
When he arrived in South Africa, he didn’t know anyone and knew very little English. He hoped he would eventually find work as a nurse, but when he was told his qualifications weren’t recognised, he thought he had failed to fulfil a promise he made to himself after his younger brother’s death.
“The feelings that I had to pursue medical studies came up after I lost one of my younger brothers, the one [who] came after me, due to the negligence of the healthcare worker. So it started to give me an idea of why this happened and that people taking care of others should do better,” he says.
“I started to dream. If this sort of thing happened because of negligence, can I also do something to correct these sorts of mistakes that happen in hospitals? So I decided to change [from studying engineering], and this passion started to grow in me.”
While trying to find his feet in Johannesburg, Ilunga briefly worked as a security guard in the inner city and later as a car guard at a mall in the south of Johannesburg. “It was not easy,” he says.
He eventually found work as a security guard on a farm in Mpumalanga. After about a year there, he moved back to Johannesburg and took English classes in the evenings for about four months while doing piece jobs during the day. He was still dreaming of finding a job as a nurse in South Africa, but was turned down several times because he was an asylum seeker.
“It was so painful. It was one of the biggest disappointments in my life because I was just imagining all the years spent at school, the energy, the passion of helping care for people and later on I found myself working as a car guard, standing under the sun, sometimes being undermined, sometimes they insult you,” Ilunga says.
“They can treat you the way they want because you being a nurse or you being qualified whatsoever [doesn’t matter to them when all] they see [is] you as a car guard. So it was a painful time I went through for, I think, five years doing such kind of jobs … You are disappointed in life.”
Ilunga questioned his decision to come to South Africa. “I thought it was the biggest mistake of my life, that I messed up my future. I didn’t think anything good could come out of me. There was no hope for me and I was accepting that no good will come out for me. I ended up crying a lot.”
Eventually his wife was told about a home-based caregiver position available at the Jesuit Refugee Service (JRS). He submitted an application along with her. “The applications were already closed. But I went the next day and explained, ‘I am just here to try my luck.’ Later, they called me and said they were impressed with my CV and papers … On 1 September 2017, I got the call that I got a job. Both my wife and I got the job.
“It is actually a kind of comfort and consolation for me. It’s not only just about having a job. Yes, it helps me to live, buy bread and pay rent, but I am comforted because this is what I wanted for my life. The most amazing [thing] is I am doing it in the community where I understand the problems they face.
“You know sometimes you work in a hospital, where the relationship with a carer or a nurse is quite limited … But here it is not about only treating people, it is about building a relationship with that person,” he says.
Ilunga’s wife, Millene Tshika, who has since been retrenched, and their four-year-old daughter, Gladness, have had to learn to share him with his patients. “Losing a patient is one of the worst parts of the work. You know, losing the patient in the hospital as a nurse sometimes doesn’t affect you, because you don’t develop that strong relationship.
“But if you work as a community health worker, as a caregiver in the community, this person could become like a relative. They become like a brother or sister to you. So losing a patient in the kind of work I am doing, has a very, very strong impact on me.”
On a recent Saturday morning, after a long week of walking around inner-city suburbs such as Yeoville and Bertrams to visit his patients, Ilunga prepared to go to a patient’s funeral. “It’s difficult work, but I am proud of him,” says Tshika.
Patients like family
Amita Ngaziami, 30, who is another JRS home-based caregiver and a mother of two, says her husband now understands her patients are like family and that her job sometimes extends outside of working hours into the evenings and weekends.
“My husband, we spoke, he knows that sometimes my patients will need more help. In my yard, I made a garden with vegetables, and when they don’t have money to buy, they come to my house to get some vegetables. Some of them even come and wash their blankets at my house using the washing machine,” she says with a laugh.
“Even when I’m busy and I must attend [to] another patient [in] hospital, I will cook food for some patients and ask my husband to drop off this food [at a] patient before he goes to work or when he has free time. So he is also helping me. He helps me a lot.”
Ngaziami has been connected to the JRS since her arrival in South Africa as an unaccompanied minor from the DRC. “I had to travel from Kinshasa to the eastern part of the Congo when my parents were separated. I arrived there, and I was rescued by a neighbour. The neighbour passed away in Zim as we were on our way to South Africa.”
Ngaziami was 13 or 14 when she eventually made it to South Africa without any documentation and barely able to speak English. It was then that she got in touch with the JRS. “When I reached here, I spent a year without going to school because of the English language barrier and the documents. I didn’t even have [the asylum seeker permit] or a birth certificate to take to school. It was really hard for me,” she says.
She eventually enrolled and received support throughout high school and into further education, where she studied to become a community health worker. “My dream was one day to be a doctor. But because I didn’t have parents and the issues with school fees, I couldn’t meet my dream. Since I can’t be a doctor, [I thought] let me do nursing, it’s also in the medical field … I am still hoping to become a professional nurse, but funding is the problem.”
Despite her love for what she does, Ngaziami says walking from one patient’s house to another in the inner city makes health workers targets for criminals. Ilunga has been robbed twice, and Ngaziami has to deal with harassment from men on the street.
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“Walking, we are at risk,” she says. “Next to one of the houses of a patient I visit is an abandoned house. There are a lot of people staying there. They are selling drugs. They are smoking, so anything can happen.
“So when I’m going, I just pray to God. I ask God to please protect me from leaving the house until I come back again. Please, just protect me. Sometimes on the way, a man will approach me and speak isiZulu and my isiZulu is not very good. So when I try to answer, he will say, ‘You’re a kwerekwere [pejorative for a migrant]’.
“Especially in winter time, when it’s still dark, I have to hide my phone because there [are] not a lot of people on the street. It’s really not safe if you are walking alone. Maybe if you are two or with a man, they will be afraid, but if you are alone it is easier to attack you,” she says.
Despite these fears, Ngaziami says she has found fulfilment in her work. “For me to be good at what I am doing, I have to love what I am doing and love my patients as well. Because if there is no love, then you do it just for the sake of money. That love makes me build good relationships with all the patients. And there is also trust. The work you are doing, you have to be patient with the clients,” she says.
Difficult to stay, impossible to leave
Ngaziami is close to Faida Hakizimana, 35, whose eldest son, Lukumani, 18, has cancer and needs his leg amputated. One of the younger boys, Yusuf, 6, lives with sickle cell anaemia.
The five boys are now raised by their single mother after their father was arrested and deported to Burundi before lockdown. “He can’t send us money. Where is he going to find money? Our country has a lot of problems,” says Hakizimana. Besides the issues with money, returning to Burundi is simply not an option for the family as Hakizimana’s parents and sister were killed in political violence before she fled.
She sells vegetables to earn money but is barely able to cover rent and food with her income and assistance from the JRS. The family was told that Lukumani’s leg must be amputated if he is to survive but, even with counselling from Ngaziami, it has been difficult to accept.
“He started to cry,” Hakizimana says. “He doesn’t want his leg to be cut. According to the child, they should let him die with his legs.”
Hakizimana says the family is not able to afford chemotherapy and cannot consider prosthetics, which is out of reach for them. Ngaziami says she still needs to do a lot of counselling work with Lukumani to help him understand the amputation is necessary to save his life.
Another one of her patients recently had her left leg amputated after suffering from diabetes, high blood pressure and anaemia. Also a single mother, Mariam Ndimuriwo, 41, relies on Ngaziami and her 19-year-old daughter to look after her.
“Before, I used to sell vegetables in the street. But I have not been able to work since the operation. It is difficult to pay the rent. My daughter used to … wash clothes and she made some money. But it is really difficult to pay the rent and buy food if there is no job,” she says while Ngaziami washes her amputation wound and applies a new dressing.
“My daughter wants to go to nursing school, but she hasn’t registered because there is no money,” Ndimuriwo says.
She fled Burundi with her two children and lost touch with her family. All she knows is that her parents fled to the DRC. “I don’t know where they are,” she says. “It is difficult in South Africa, but for me it will also be difficult to go back to my country because of my condition and to go to hospital there will be difficult.”
