If the community stays vigilant, lives will be improved for many years.
Lusikisiki Village Clinic is one of the many healthcare facilities in the Eastern Cape that have suffered because of the deterioration of the province's healthcare system. But the situation at the clinic is looking up, a result of the unique power held in the combination of social mobilisation and the use of the law.
The clinic has a complex history. It began as a container building run by the Eastern Cape department of health, and is situated next to the Lusikisiki town hall. In the early 2000s, the human rights organisation Médecins Sans Frontières (MSF) added another container next door as part of a pioneering antiretroviral treatment programme. In 2005, both operations moved into a building previously used as a clinic by AngloGold Ashanti.
The new site was ideal. It had private consultation rooms, a waiting area, bathrooms and a pharmacy. The rent to Teba, the company that owned the building, was only R8?800 a month.
In 2006, MSF handed over operation of the antiretroviral treatment programme and the lease on the building to the Eastern Cape department of health. From 2005 to December 2012, the clinic thrived, providing primary healthcare services to between 4?500 and 7?500 people every month and an antiretroviral treatment programme to as many as 1?500 patients by 2012, in a health district known for poverty and rated the worst place to access healthcare services in the country.
An HIV support group also thrived, with up to 30 people at a time gathering for twice-weekly meetings.
Nozaliseko Ntwana, local Treatment Action Campaign (TAC) member and organiser of the support group since 2005, said in an affidavit that it "has been a great source of comfort and support to me personally and has enabled me to adhere to my treatment. The group provides education and creates a community in which people can find the support they need to live with HIV and adhere to treatment."
Shock as clinic shut down
But in December 2012 the provincial health department shocked the community by shutting down the clinic.
The department threw up a few tents and an old mobile home on a plot of dirt on the outskirts of town, dubbed it the new village clinic, and walked away. The community, supported by the organising efforts of the TAC, responded forcefully by holding a series of protests and meetings with local authorities to try to understand the reasons for the move and to address the abysmal conditions at the new clinic.
But the situation did not improve. One of the tents blew over in February and wasn't put back up for over a month. The single pit latrine filled and poured a stench over a considerable radius. Most people refused to use it and instead braved the bushes. Several women were mugged while doing so.
The mobile unit, and the medication stored in it – some of it heat-sensitive – baked in the sun. There was no electricity or running water. Bug bites spotted the legs of the nurses. People queued for hours in the hot sun or the mud and rain. There was no privacy.
The nurses, unable to examine patients, diagnosed sexually transmitted infections on the basis of whispered descriptions of symptoms. People who could manage began to leave the clinic in droves. The support group shrivelled.
But the protests continued: sit-ins and pickets at the clinic were regular affairs. The Eastern Cape health department repeatedly promised, in writing to the TAC, to fix the situation. But by May, the only progress made was a big hole on the site, supposedly for a new pit latrine. It never came.
In concert with its efforts to engage with the provincial health department, the TAC approached rights group Section27 in February. A chain of correspondence was initiated with Health MEC Sicelo Gqobana.
Gqobana gave increasingly contradictory explanations for his department's actions, first complaining that his department had been "chased away" from the old location by Teba – a claim the company denied under oath. He later claimed the department had been unable to afford rent.
But Teba provided emails attached to a sworn statement in which it told the Eastern Cape health department that it would allow it to use the building despite ongoing nonpayment.
By May, the community had lost faith in the power of organising tactics alone. The TAC helped dozens of people to come forward to provide affidavits to testify to their experiences at the clinic. They spoke of chronic drug shortages, children regularly turned away for vaccines, waiting in the mud on rainy days for hours and other indignities.
The TAC filed a lawsuit against the Eastern Cape health department on May 29. Almost 30 affidavits from community members affected by the conditions at the clinic supported the founding affidavit.
Motsoaledi moved to action
The TAC also named Minister of Health Aaron Motsoaledi in the lawsuit because of his oversight role of provincial health departments. A Section27 staff member met the minister and placed the thick application in front of him. Motsoaledi took one look at the pictures and was moved to action.
He advised the MEC that he would take over operations and tabled a plan to provide a proper temporary structure by July and to build a large permanent clinic in the following eight to 12 months.
Construction of the temporary site began immediately and is now complete. The TAC and the department have settled the matter and the plan for the new improved facility will be made an order of court.
The final outcome is still a work in progress, but it is work in which progress has been achieved. If the community and activists stay vigilant, their efforts will improve the lives of thousands for many years.
The village clinic is a story in which ordinary people came together to claim their rights. People in other communities throughout the Eastern Cape hold the power to do the same.
On September 13, the Eastern Cape Health Crisis Action Coalition will be marching at 11am at the Bhisho Stadium to demonstrate frustration at the collapse of healthcare services in the Eastern Cape and to hand a memorandum to the MEC for health.
Sasha Stevenson is an attorney at Section27 and John Stephens is a legal researcher at Section27