Weaving her way through the narrow alleyways running between the shacks of Barcelona squatter camp, Nomachine Jali is on her way to see her first patient of the day: Atwell Mbadamana, 69, is lying on a plastic mattress on the floor in the corner of a dark room.
A blanket covers him. He has been here, bedridden, since August after he had a stroke.
“I don’t feel good seeing him like this,” says Jali, a community health worker. “We consider our patients as our own family. He should be in a care home but there’s no space.”
Mbadamana speaks in a whisper: “I can’t move my arm. I can’t eat healthy food. I want a proper shelter. I want healthcare and to be taken care of.”
He is typical of a growing number of Jali’s patients in the camp, about 10 miles (15km) from the centre of Cape Town. Her focus is shifting from HIV and tuberculosis to spotting the symptoms of, and managing, hypertension, strokes and diabetes – conditions collectively known as non-communicable diseases (NCDs).
Most deaths in South Africa are now from NCDs, according to the country’s latest mortality report, published in 2018. Tuberculosis is still the leading cause of death, but diabetes is second. Between 2016 and 2018, the proportion of deaths from NCDs increased.
Jali visits Mbadamana three times a week, but his nephew, Malibongwe Gwege, is his main carer. The only person who works in the family is Gwege’s mother. Five people rely on her salary.
“The last time we went to the clinic to pick up medication, there wasn’t any. We often face delays,” says Gwege. “I’m traumatised. Why is this happening? It’s not supposed to be like this.”
Nearby, Maria Ntombizodwa, 71, is also bedridden after a stroke. She has asthma and diabetes. The machine she is meant to use to check her blood sugar levels has no batteries; she faces delays in getting medication and her eyesight has begun to deteriorate – a side-effect of uncontrolled diabetes. Her leg muscles have wasted away and she cries as her son helps her sit up.
“The left side of my body is paralysed,” she says. “I’m so stressed and I have neck pain.”
This is the reality for many people living with NCDs in South Africa, says Vicki Pinkney-Atkinson, director of the country’s NCD Alliance. While HIV diagnosis and treatment has advanced, care for people living with other serious conditions has languished far behind.
“NCDs are neglected in South Africa as the public health system has focused on the communicable diseases,” she says.
“People often don’t get treatment for common NCDs. There are long queues to be seen, no easy access to medication, screening, diagnosis and treatment. There are few health statistics for NCDs – it’s all guesswork.”
Progress has been made, however. Earlier this year, the National Department of Health released its five-year plan, which Pinkney-Atkinson was involved in drawing up, to raise the profile of, and tackle, NCDs.
In its introduction, Dr Joe Phaahla, minister of health, wrote: “People in low- and middle-income countries are disproportionately affected by NCDs, and the poorest and most vulnerable communities continue to be at highest risk for NCDs and experience the greatest barriers to accessing essential healthcare.”
Pinkney-Atkinson says this is a good first step and that “much has been achieved, but more must be done”.
Pinkney-Atkinson adds: “It is progress but how many people have to die too young from NCDs when they should have had insulin, or [other medication and treatment].”
She has filed a complaint with the South African Human Rights Commission, asking for NCDs to be made a national priority and for people’s rights to healthcare to be upheld.
NCDs are not seen as a financial priority for donors and provincial governments in the country, says Pinkney-Atkinson. However, national and international health organisations are beginning to take heed of the immense challenge NCDs present.
Mothers2Mothers, which has traditionally focused on mother-to-child transmission of HIV, now has a programme in Nomzamo township, about 25 miles from Cape Town, for managing and controlling NCDs.
“NCDs are a big problem in my community,” says Millicent Magwa, 37, a health worker for Mothers2Mothers who lives in Nomzamo. She has HIV and high blood pressure.
“Most people are unemployed and can’t afford the right diet. Whenever you tell people they need to reduce the amount of starch and eat more vegetables, they tell you: ‘I eat whatever is inside my house. I can only eat vegetables maybe twice a week and I hardly eat fruit.’
“It’s going to get worse because most people don’t have money. Food is expensive; everything has increased in price. It’s really becoming bad.”
