'Foreigners, go seek help elsewhere!'

Each morning a 35-year-old Zimbabwean refugee wheels his young disabled sister to the city centre. He parks her wheelchair at a busy intersection and they start begging for money and food.

But Tapfuma* doesn’t only need food to keep him alive. He also needs antiretrovirals (ARVs).

Tapfuma discovered his HIV status early this year.
He went to Médecins San Frontières (MSF) for help and doctors sent him to a clinic in Hillbrow, saying that he would be given treatment there. But it was not that simple.

“One of the health workers said: ‘You foreigners! We don’t have time for you. Go seek help elsewhere.’”

In despair Tapfuma returned to the one-room flat he shares with his sister and wondered what to do next. He didn’t know that the Hillbrow nurse was disobeying a government directive when she refused to treat him.

Under the directive, issued by the Department of Health in 2007, all refugees and asylum seekers—whether they have documentation or not—have the right to access primary and emergency healthcare. This includes ARVs.

Luckily for Tapfuma, a friend recommended another clinic that agreed to treat him. Now, at least, he is given ARVs. He also receives a monthly allowance of R200 from the Jesuit Refugee Service. It all helps, but only a little.

“Some days I am too weak even to wheel my sister, but I have no option. I don’t have a job and I am taking strong medication that can work only if I have a proper diet. That is why I need to beg to survive.”

Few people understand Tapfuma’s predicament. Sometimes he and his wheelchair-bound sister are harassed by the police. Once a motorist told them they were a “nuisance” and threatened to run them over.

Maria*, a Congolese refugee who came to Johannesburg five years ago with her two children, aged 11 and 6, was not turned away from a clinic, but she was asked to pay R70 for tuberculosis drugs before she could start her ARV treatment.

Maria has no place of her own, and moves from one friend’s house to another.

“Some of my friends are refugees from Zimbabwe. Others come from Congo. But for three nights I slept outside and was rained on—with my two children.”

Maria knows that ARVs cannot be fully effective in such precarious living conditions, but she has no choice.

MSF is concerned about the way refugees are handled by government health facilities. In the past month alone the organisation’s Johannesburg branch has identified about 100 refugees who have been turned away from clinics and hospitals.

According to MSF nurse Sara Hjalmarson, the refugees have to deal with language barriers, unfriendly attitudes from health workers and demands for exorbitant consultation fees.

“The nub of the problem is that policies are not implemented at the coalface and there are few, if any, meaningful systems to monitor staff to hold them accountable to directives,” Hjalmarson says.

MSF believes that health workers are either unaware of government directives concerning refugees or choose to ignore them. Without proper training, says MSF, the situation will not improve.

The organisation wants to see “help desks” in every government clinic to educate refugees and migrants about their rights and to offer support when needed.

The Aids Law Project (ALP) agrees that despite “positive developments” the health department should do more to communicate its policies.

“The message is not clear enough for the health workers and administrative staff who are implementing these policies,” says ALP advocate Agnieszka Wlodarski.

United Nations High Commissioner for Refugees public health specialist Gloria Puertas said female refugees often experience special difficulties when trying to access HIV-related treatment.

The problem is particularly acute for women who have survived rape because they have to report to the police before they can access post-exposure prophylactic treatment to counter HIV infection. It is not easy for a rape survivor to go to the police, but for refugee women without official documentation or IDs, the idea of walking into a police station is often unthinkable.

The M&G made repeated efforts to contact health department spokesperson, Fidel Hadebe, but did not receive a reply.

* Not their real names.

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