By: Lunga Memela (HST Communications Engagement Lead)
Health Systems Trust's warm-hearted Psychosocial Advisor, Ntokozo Gumede, is a custodian of holistic care for all who need support through physical illness and social challenges.
In her work for HST's Delivery Optimisation for Antiretroviral Therapy (DO ART) Demonstration Project, Ntokozo exemplifies everything a compassionate social worker should be, especially for people living with HIV (PLHIV). She spared a moment with the Communications Unit to describe her commitment to improving the lives of people in eThekwini's Umlazi Township.
Through a grant from the Bill & Melinda Gates Foundation, HST has built on the findings of a research study conducted by the Human Sciences Research Council (HSRC) and partners that provided community-based ART (CBA) initiation, monitoring and resupply to HIV-positive people in South Africa and Uganda to optimise delivery of HIV treatment through community-based services.
The goal of HST's DO ART Demonstration Project is to determine, within a real-world setting, the potential of CBA services for improving the numbers of ART-eligible clients being initiated on treatment, and their continuity of care towards viral suppression within six months.
The DO ART team has provided comprehensive screening services, ART initiation, and ongoing community-based management of patients on ART in eThekwini South and Nongoma Sub-districts in KwaZulu-Natal (KZN).
Working in the DO ART project
"What I love the most about the DO ART project," says Ntokozo, "is that I get to bring about change in people's lives at their doorstep. Walking into someone's home to bring hope and giving them a better chance of overcoming their deep-rooted struggles brings me so much joy. Helping people to find themselves, heal, and realise that they are capable of developing themselves despite their challenges makes me love my job."
Ntokozo grew up exposed to social ills that burdened her community in Umzinto, on the South Coast of KwaZulu-Natal. She knew then that it was her calling to help other people, and she studied Social Work at the University of KwaZulu-Natal (UKZN), where she is currently pursuing her PhD. She has been a community worker since, and has never looked back.
Speaking about her typical work day, Ntokozo says: "As soon as I get to work, I call our patients to check their availability for scheduled appointments for the day. Then I head into the field to each and every one of them to deliver my services in the comfort of their homes."
During some of the home visits, she is accompanied by another healthcare worker and/or a Nurse Clinician, as well as a Driver Mobiliser. With the patient's consent, these team members are able to observe the intervention strategies, different counselling methods, and treatment adherence plans that Ntokozo develops with patients. "Having Nurse Clinicians present is helpful," she explains, "as we can consult each other on our respective specialist areas, allowing for continuous learning and merging of the clinical and psychosocial elements of our work. We prioritise confidentiality, and will share the patient's personal information with other healthcare workers only with the patient's consent."
This provides practical training for the project's healthcare workers. "It is also significantly beneficial for patients," adds Ntokozo, "because they can share their challenges in one sitting, as opposed to doing so with different healthcare workers. This reduces their risk of being re-victimised by having to repeat their stories of abuse and emotional trauma. Most of our patients are pleased with this approach, as it shows the care that the team has for them and their health."
"Throughout my career, I've worked in community-based projects," recalls Ntokozo, "and HST is one of the prestigious organisations within the province that provides different intervention models for health care. Having learnt about the DO ART project, I was attracted to the implementation of this outreach model, which prioritised bringing services to people instead of waiting for them to come to facilities ‒ this maximises their access to health care at a limited cost to them."
"The social issues faced by our patients are varied and very complex," she says. "Many of them are unemployed and rely on the social grant system, which results in a huge demand for nutritional support as they often run out of food before their next pay-date. We also come across people who do not have ID documents, which makes it difficult for them to secure employment or social grants," Ntokozo says. "Other issues they face are drug and alcohol abuse, homelessness, and domestic issues, such as non-disclosure of their HIV status and cases of gender-based violence. These are some of the social factors that directly and indirectly affect these patients' HIV treatment journeys and contribute to their viral load suppression challenges."
The importance of psychosocial advice for patients
"I believe that a holistic intervention strategy is beneficial for patients," notes Ntokozo. "South Africa's health system has done exceptionally well for HIV-infected patients, but in order to meet the 95-95-95 targets, a lot more than the clinical element of managing patients' health has to be considered. Advising and assisting patients to cope with their social needs is crucial for ensuring that they adhere to their medication and achieve viral load suppression. Interventions such as cognitive behavioural therapy, person-centred approaches, counselling and psychotherapy sessions are essential to support patients who are struggling with daily challenges."
"Some patients need to be linked with facilities, community-based organisations and government departments that have the specialised capacity to help solve some of their problems," she explains. "That is where I come in: linking patients to all the services they need outside of our health institutions. Intervention outcomes depend on the initial assessment of the patient. Some simply lack an appropriate support system, so sometimes just talking with them and building rapport, providing constant reassurance and affirmation, makes a huge difference to their emotional and psychological wellbeing."
Among the examples that Ntokozo shares is one of a patient whose family was selling and consuming alcohol in the same household. "He was virally suppressed at the time of his assessment," she says, "but he was concerned about not being able to maintain his treatment adherence in this home environment. With no alternative options for housing being available, we developed a plan to assist the whole family, and linked all of the household members with SANCA for ongoing specialist support; they have since embarked on their own interventions, and follow-ups are being made with the patient and family."
Another patient was addicted to substances and needed an ID because he had lost his when living on the streets. "The patient's family was traced in order to recover the details of the person who had applied for his ID," says Ntokozo. "We proceeded to Home Affairs to apply for a duplicate of his birth certificate, which would enable him to acquire his ID number and subsequently apply for a replacement ID. In turn, this made him eligible for registration on the Dablapmeds programme for easy collection of medication."
Ntokozo helped another patient with the same issue, who was able to start her ID application process and is waiting for an interview at Home Affairs. "When I first assessed her," she recalls, "her viral load was over 1 million copies, and she initially indicated that she saw no need to take treatment because she did not have an ID to secure employment – but the prospects of receiving assistance encouraged her to take her treatment, and she is currently virally suppressed."
The team followed the required processes for a patient who needed admission to a rehabilitation centre for help with overcoming his substance addiction, and he is currently on the waiting list of a free facility in Durban.
Towards a better future
Ntokozo did her Master of Social Science (Public Policy) degree at UKZN, scoring a Golden Key International Honour award. Her research focused on the analysis of laws and policies guiding the legal determents and businesses of funeral parlours in Durban. She is currently doing a PhD in Human Science: Public Policy, focusing on the bottlenecks of law and policy implementation in the South African justice system when handling crimes of gender-based violence.
In her spare time, Ntokozo enjoys travelling and exploring new places. "My bags are always packed and ready for an adventure," she says.