JRS South Africa: towards dignity and inclusion, the JRS health team

At noon, somewhere on the road to Melville. «Time is not on our side,» murmurs Floyd Maphetha, the Jesuit Refugee Service (JRS) driver from South Africa. Marceline Sangara, the head nurse of the JRS health team’s Home Based Care programme, makes a call from the back seat of the car and finds that Didi*, the first patient of the day, was available. «How many minutes do you think you’ll be with her», Floyd asks. «Just ten minutes, I won’t stay long today because she just wants me to see the girl, the boy is at school,» says Marceline. This is a common scene during JRS home health visits, part of the EPGO II programme which is aimed to meet the basic needs of refugees and asylum seekers living in Johannesburg and Pretoria.

«Just ten minutes, I won’t stay long today because she just wants me to see the girl, the boy is at school,» says Marceline

Lack of documents, language barriers, fees and institutional discrimination often exclude these people from access to health centers in South Africa. Many JRS beneficiaries have been waiting as asylum seekers for refugee or residential status in South Africa for more than a decade. As they are not fully recognized citizens, they do not have access to certain types of medicines or important interventions within the public system. In addition, they pay higher health tariffs than the South African population and not everyone can afford them, as they also have difficulty finding work and obtaining accommodation, paying school fees, purchasing food and cover other basic needs.

«They don’t know they can live with what we call a chronic disease forever, you just have to know how to treat it. When we do workshops, south africans can say: i’m living with cancer, with epilepsy, with hiv, and now i’m coming back to life with my medicine,» says Marceline.

Access to health is a step towards dignity and social inclusion for those who have been forced to leave their country. «Democracy is in the health department» says Marceline. With eight workers and three volunteers under the supervision of Marceline and the social worker in charge of the health department, the JRS health team assists more than 1,000 refugees and asylum-seekers through home-based care services, counselling and financial support.

«From Monday to Thursday we go from house to house to meet patients basic needs» explains Marceline. «For those who are very sick, JRS can even go along with them to the hospital, collect medication for them, clean, bathe, cook and make sure they take the medication properly.

Every Monday and Tuesday, Marceline also provides health counselling at the JRS office in Belgravia «for people who have an appointment at the hospital, but not the money to go there or for those who do not understand their illness». Some patients may apply for JRS funds for medical care consultation fees and transportation to health centers.

Marceline examine about 20 people a day in the office (mainly from the Great Lakes region, but also from Eritrea, Somalia, Uganda, Southern Sudan and Bangladesh). And visit an additional of 40 patients in the home-based care programme. Shifts are long and intense. There is no time to lose. «Once you start, you don’t stop,» admits Marceline. «I am strong and dedicated when it comes to dealing with them. I can even go on Sunday to take care of those I didn’t have time to visit», she says.

JRS also offers routine health checks (blood pressure, sugar testing and HIV testing) and conducts workshops in different areas around Johannesburg. Marceline tells how they even go to different neighborhoods, knocking on the houses, shops doors and asking the people on the street to refer to JRS any asylum seekers, refugees or undocumented migrants who need assistance.

Accompaniment and information are crucial. In fact, some of the main challenges that JRS addresses in South Africa are witchcraft, as well as stigma and lack of information on some diseases. «They [patients] don’t know that they can live with what we call a chronic disease forever, you just have to know how to treat it. When we do workshops, South Africans can say: I’m living with cancer, with epilepsy, with HIV and now I’m coming back to life with my medicine», says Marceline, «but a Congolese person will never accept the disease, they will continue to pretend to be fine. You can’t deny being sick. Illness is part of our life.

A quick visit to Didi at his modest roadside stall helps Marceline make sure that both, the women and Didi’s youngest son are doing well. As a single mother from the Democratic Republic of Congo, Didi tries to get to the end of the month by selling avocados, sweets, peanuts and other foods. His 17-year-old daughter hugs Marceline as soon as the nurse gets out of the car. All three family members are HIV-positive, as Didi and her daughter were sexually abused in their country more than 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 at the time. Since 2008, JRS has been addressing their needs and helping children learn and understand their disease.

For Marceline it is crucial to work closely with the patient. «When [the public health staff] deny treatment or medication to someone because it’s not documented, that’s when we go there and talk to the hospital manager to get the medication. Because they charge them more, they don’t have enough to meet their basic needs, which means they end up not taking the medication. «The JRS health service is important because most of the time, when you are in a chronic condition or if you have some kind of disease, you are alone. And no one is on your side…We [JRS] are now like a family member for people who are sick”.

*Didi is a fictitious name intended to preserve a person’s privacy.

«The JRS health service is important because most of the time, when you are in a chronic condition or if you have some kind of disease, you are alone. And no one is on your side… We [JRS] are now like a family member for people who are sick”.