Providing Treatment for Migrants in South Africa - Community AIDS Response works with the most needy at Johannesburg Central Methodist Church

The Johannesburg Central Methodist Church sits amid thriving businesses and skyscrapers in the city’s bustling downtown. The church is both a place of refuge and a place of controversy. Bishop Paul Verryn has used the building to provide housing for foreign migrants, mostly Zimbabwean refugees, in the face of opposition from neighbors and sometimes local authorities. The church has been raided by police; there is little food; the facilities are inadequate for the number of people; and, every evening, some 3,500 people return from seeking work and food on the surrounding streets to sleep on the floors and in the stairwells. For sick migrants, the situation is even tougher but some have found help from the Community AIDS Response (CARe), a local South African organization funded in part by the President’s Emergency Fund for AIDS Relief (PEPFAR) via the Centers for Disease Control and Prevention.

A small room known as “the care room” sits at the top of a narrow stairway on the fourth floor. Two women and five men, all from Zimbabwe, sit around a wood table and quietly share a meal of rice and beans, tea and bread. A washing machine hums in the corner and mattresses are piled against the walls. For now, they sleep, eat and live in this room which functions as their care and treatment center. The food is especially important because all of them take medications: antiretrovirals for HIV and a combination of drugs for tuberculosis (TB). They are cared for by Daniel Fengu, Kundai Gumbu and Machivei Muzenda of CARe.

This CARe program focuses on locating and providing medical care to migrant populations, both domestic and foreign, in inner-city Johannesburg who lack access to consistent medical care and treatment. Particularly for TB, adherence to medication is crucial to avoid the development of drug resistance. Some of the visiting CARe staff softly rejoices when they realize that the young woman wearing a bright red hat and sitting at the table is the same woman who was immobile and crumpled on a mattress three weeks ago.

“The pills that we are using, they are working,” said Izito Mhlanga, a tall man in a white shirt. “I am feeling better.” The rest of the group nods in agreement. “I used to cough every 15 minutes and now I can go more than an hour without coughing,” said Frank Nasho.

Approximately 480 patients have passed through the program and their treatment adherence is monitored even after they are discharged. Every morning, Fengu and Gumbu work on the difficult task of tracking down former patients, whom local clinics and hospitals have flagged, to try and ensure they are staying on their medications. While patients are in the program, they receive lessons about pain management, hygiene, and they also receive psychological counseling in addition to food and shelter. Outside, the streets of Johannesburg can be tough but the CARe room provides a lifeline to medical care and treatment. “We regard them as a community and encourage them to be a community,” said Fengu of his patients. “We are trying to take care of all of their individual needs as sick people.”