Townships on the Cape Flats

I have to admit to being a little nervous about travelling into the Townships. I’d heard so much about muggings, car jackings and shootings. I guess anyone driving into the most deprived areas in a shiny new car might draw unwanted attention – people there really are living hand to mouth. Unemployment runs at 75% at best, and for young men in particular, it might be all too easy to be tempted towards using guns and violence to get not only desperately needed money, but some kind of status, unpleasant as that thought might be.

So I asked a friend, Luann Hatane, to guide me in to the townships. I followed her local well known car in my shiny brand new black hire car feeling a little scared. Despite the obvious poverty, I don’t think I’ve seen a more vibrant community elsewhere in South Africa. It was a freezing cold morning, so most people were wearing blankets over their clothes. The streets were lined with little shops or stall with hand painted signs, street traders walking up and down, and on almost every corner wood-fired braziers with sausages and chicken barbequing. The smoke from those braziers combined with wood smoke from people’s homes to make a dense but pleasant all pervading background. I could still smell it on my clothes when I arrived home later. However as pleasant as I found the smokiness, along with the dampness from the proximity to the coast and the closeness of the shacks and houses, it contributes to astonishingly high rates of tuberculosis.

Luvuyo Zahela runs the Etafeni Centre in Nyanga, a township on the Cape Flats south east of Cape Town. He showed me round their impressive facilities. Etafeni helps the local community affected by HIV in many ways. Unemployed people are offered training, and others can work on an income generating project making clothes, quilts and beaded gifts. There are counsellors and a nursing sister who offer VCT (voluntary counselling and HIV testing), both at the centre, and outreach in the community. They have created some kitchen gardens, growing vegetables which are then used by the cooks who make wonderful lunches for all at the centre. This includes the 50-60 children attending the nursery.

On the day I was there, a dietitian Baheya Najaar was carrying out a nutritional assessment on the children. The kids were playing around whilst this was happening, and the noise was deafening – it left a happy ringing in my ears. But after they had eaten lunch, they all ran upstairs to the purpose-built dormitory above the nursery, and a contented quiet spread over Etafeni like a blanket.

The next day, I shadowed a community dietitian Katie Pereira at Crossroads Community Clinic HIV outpatients. We arrived shortly after 8, and a queue of people waiting to see Katie quickly built up on the benches outside the consulting room. It was almost 2 o’clock before the last patient had been seen.

People presented with a side range of complaints. One woman had experienced metabolic side effects as a result of her ARVs – deposits of visceral fat around her abdomen, and a wasting of fat in her buttocks. There was little we could do other than suggest exercise, healthy eating, and a watch-and-wait approach. Hopefully alternative ARVs will be available in the not too distant future.

Most HIV patients attending the clinic were malnourished and receiving food parcel supplements. Only two patients were working. One lady was a farm labourer, putting in 12 hour days, and underweight as a result. She had no breaks apart from a short lunch – it was hard to see where she could find time to stop to have any snacks or supplements to help her gain weight. Some unemployed HIV patients were receiving a disability grant from the Government – 110 rands per month (about £2 per week). A few more seriously unwell were receiving a more “generous” care dependency grant of £15 per week. Although most things are cheaper in South Africa compared to, say, the UK, basic food will cost a lot more that £2 per week. A fresh chicken costs £1.50, a can of sardines 40 pence.

Sadly, although food parcels are available from several NGOs operating in and around Cape Town, few of the patients I talked to had been able to access them. There seems to be little co-ordination between the NGOs, and certainly no cross checking to ensure fair distribution.

I suggested to one patient at the Crossroads clinic to try Etafeni for meals or the income generation project. Sadly however they said they would not go to Etafeni for fear of being seen there, and having their HIV status disclosed.