Transcript for Zinny.mov

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Kwa-Zulu Natal South Africa

August 2007

Kwa-Zulu Natal is one of the 9 provinces in South Africa.

As much as it is beautiful--

the culture and the people are still having to deal with a lot of challenges inherited from the apartheid regime

poverty, crime, rape

[on billboard] Midlands Funeral Home

HIV and TB

[on billboard] Umthuthuzeli I am a woman and a comforter. My Funeral Plan has given me strength in times of sorrow

-- Niginavo amandia--Inspired, Motivated, Involved

that are challenging our province and our people.

[Dr. Bruce Walker] What Zinny does, day in and day out, is, she works as an ARV counselor

and she does it in the area with the highest prevalence of HIV infection--

[On screen] Dr. Bruce Walker, Director Partner AIDS Research Center

--and it's in one of the areas with the least resources available.

So--talk about taking on a challenge--Zinny has taken on a challenge.

I met Zinny at a hospice in Durbin.

And I was going there, bringing some food--

[On screen] Dr. Krista Dong TEACH Program Director

--to a hospice support group, and when I arrived, the whole group was--

--some of them in wheelchairs, some of them in stretchers, others were sitting on chairs--

--and there was this ver-r-ry thin woman in the back seat, singing like an angel

[singing]

[Zinny] When she met me, I was straight from being in hospital

with meningitis, which is a headache that usually gets to trouble people with end-stage AIDS

I had already started helping other patients in the clinic that I was receiving my antiretroviral in-

working in ARV clinics, in support groups, visiting patients, singing for patients

just spending time with them.

So what would be helpful for you?

Zinny and I started as--we started as trainers--and I would give English and Zinny would give the Zulu translation..

So Zinny was my translator.

It didn't take long for me to figure out that Zinny had much more important things to say--

and valuable things to say--to patients than I did.

[Dr. Walker narrates] What Zinny and Krista decided was that, in order to have a real impact

on this epidemic in South Africa

They had to be able to have an impact within the Department of Health--

And so they specifically chose one of the least-resourced hospitals in one of the worst-affected provinces in the world.

It was a very strategic decision--"Let's go where it's the worst, to see if we can make it the best there."

"Then we will have an easier time other places."

[Krista narrates] In Kwa Zulu Natal--every other person--you look down the road--was positive--negative--

positive--negative

Every other adult walking down the street is HIV infected.

The clinic here--pregnant women coming for antenatal services--60% of them are infected

And of those, up to 30%--without any intervention--are going to deliver positive babies.

We have 1500 nurses trained that join the workforce here in the public health sector every year.

One thousand, five hundred.

2000 nurses die from AIDS every year.

[Zinny narrates] We have a huge shortage of human resources.

There are not enough doctors.

There are not enough nurses.

There are not enough resources for basic care.

You can imagine how impossible or difficult it is to roll out an ARV program

to a system that is not ready for basic things.

[Dr. Walker] The good news is that, medications are now available to treat HIV infections in the public sector in South Africa.

The problem is that--there still is not sufficient access to those medicines.

The number of people now needing therapy compared to the number of people that have been placed on therapy--

through all these various efforts--that gap is actually widening.

HIV is not a social problem. It is not a Department of Health problem. It is not a welfare -- Department of Welfare problem--

It's everybody's. The community. Parents. Children.

It's the people in South Africa that--needs to be also engaged in the fight against HIV.

singing, clapping, drumming, dancing

[Dr. Krista Dong] Izlate is the name of an old African tree--it's an old name for a tree where they took branches

before the time of having matchsticks [sound of rubbing hands together] and they rubbed them together and with the friction start fires.

You know, Izlate--to make fire in the community--so if we can rub the sticks and make a fire in the community to support patients.

[gentle instrumental music] Orphan Feeding Program

He says he likes coming here because he can get something to eat here--

whereas at home he can't get food because he lives with his granny-- and his granny and his grandfather--

--his mother passed away and his dad lives in Durbin. So that part -- that he doesn't have a mother--makes him not happy.

[speaks in Zulu] Little boy says "Fix that. Yeah." Zinny says "I'll fix it. Your button was unbuttoned."

[singing and dancing] We do talk a lot about HIV prevention because we want them to participate.

It's everybody's responsibility to talk about it--the more they know about it--the more they know what to do

when they are faced with circumstances where they have to make a decision.

If you can prevent the children from getting HIV, then you won't be having another generation that we need to be treating.

[Dr. Walker] What we're challenged with right now, is educating people to make them understand that this is a treatable illness--

--that there are things that can be done, and getting people into care, getting people tested-

and helping people become motivated to really do something--that I think gets people around stigma.

ARV Adherence Training Program

We call it adherence here, because we are trying to empower patients to feel so much the part of taking medications

versus compliance, which is the responsibility of a healthcaregiver.

In our setting, the healthcaregivers do not have a huge role to play, but the patients do.

So we empower them to take care of their lives and have control,

and we, as healthcaregivers stand in as a support system.

Home Visit Program

What we are trying to bring to people is hope.

And hope is not a medication.

It's the human ability to uplift someone else.

[Boniwe "Mam-T" Thabethe Treatment Warrior in Zulu]

I've got a feeling for the patient.

I want to help the patient.

. . .what HIV is.

Because I am on ARVs too.

It gives them hope.

Some of them when you look at them they are so miserable;

and you tell them "No, don't worry, I'm also taking some."

They change.

All of a suden you'll see that the person becomes happy.

You could see on their face, "Oh, she's fine."

They look relieved . . .when you talk to them.

If they don't start the treatment early,

they are to wait in a long queue then for the doctors, for about a month or two.

Some of them . . . they die . . .

before theyt even see the doctor for the first time to initiate the drugs.

[speaking in Zulu]

Mrs. Thabethe helped me . . .[breathlessly]

because I was taking so long . . .

I think they said we were waiting three weeks

or one month to come to see the doctor.

We felt there wasn't enough time

because her CD4 count was going down

and she was ill. She had TB. . .

and she had some PCP

which is an AIDS-defining illness

which forces us to give them ARVs as soon as possible.

So how do you feel about Mam-T?

She looks in at me.

Every time she phones me

I like her so much . . .

[chuckling] Okay, okay. [in Zulu]

This patient, Zodwa Zondi, passed away nine days after this visit.

chorus singing

We live the challenges. We know the challenges of the systems we are working in.

We need some sort of intervention--some sort of innovative intervention that can allow us to spread our wings.

chorus singing South African National Anthem

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