What we do

The services we provide the community are very broad. While we started out as a charity to combat the AIDS epidemic, we saw that poverty is an equally pressing issue which cannot be ignored if we are to improve the lives of our community. We take, what is called in the business, "a holistic approach" ; trying to meet all the different needs that the people have rather than just tackling one issue.

We have organised our staff into several departments to meet these needs:

• Family & Health Services
• Community Development
• Social work

More detail can be found on these by going to the relevant pages.Here is an overview described through the eyes of a visitor:

A 3 week visit by Helen Reid

Through accompanying several members of Isibani Sethemba’s staff, ranging through a number of different specialities, over the 3 weeks I am here in Ingwavuma, I hope to give you, present and potential funders of this incredibly worthwhile work, a small sample of what it is you are sponsoring. I am sure by the end you will agree with me that there can be no argument over the value of the services Isibani Sethemba’s workers provide.

Nursing

Nomusa is one of Isibani Sethemba’s 3 nurses. As we drive down the mountain from Ingwavuma, she answers some of my questions: an estimate of the percentage of HIV infection in the area? More than 50% is all she can say, but so many neglect or refuse to do the test that no-one can be sure how high the numbers really are. It takes us one hour of bumpy dirt tracks to get to our first patient’s home, after having dropped off three women, part of Isibani’s team of home-based carers, each with a basket of basic food supplies for the families of the ill people they look after.

We arrive outside two shacks; a pot is on a fire in the smaller one and a woman sits watching it. She stands up as we climb out the truck, and her baggy long skirt and sweatshirt belie her emaciated frame. She brings out two plastic chairs for Nomusa and I, and the consultation begins. Mary became sick in January, and a member of the community alerted Isibani Sethemba: the organisation has a very good network of care-givers even in these incredibly remote areas, and the name is well-known. A nurse was sent out, and after testing, Mary’s HIV-positive status was discovered. Tuberculosis had already set in, and its ravages are still apparent now, though she has been taking both ARVs and TB medication since February, thanks to Nomusa’s weekly visits, delivering the medicine.

Yet she declares she feels better; empowered and comforted by the weekly visits from nurse Nomusa, and hopeful of someday being restored to full health.

Mary and 8 other family members live and sleep together in a single shack; luckily Orphancare’s much-needed services are provided free f charge, otherwise her family would not have been able to support the healthcare costs. It is already a burden on the family to have one less pair of working hands; there are three children to look after, one of which is Mary’s 6-year-old girl.

Our 5 subsequent home visits are more of the same cases. One man is HIV positive and has meningitis which affects his brain, making him confused and unable to ask questions. His family has to closely monitor his taking of ARVs as he would otherwise forget, unaware of the importance of the treatment.

Palliative Care

Palliative Care is an approach that improves the quality of life of patients and their families, facing problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems; physical, psychosocial and spiritual.

Marcus has been working for Isibani Sethemba for 9 years, and he intends to keep working for them: “If Isibani Sethemba is here, I work for them”, he declares at the end of a hard day.

The nurses’ job is to deliver medicine and ask about the patients’ health. Marcus, and the other palliative care-givers, give emotional, psychological support, give hope. He says that in 2001 Orphancare conducted a survey about treatment of sick people by their families, and discovered the sad truth that more often than not, the sick were kept isolated, away from their families, neglected and stigmatised. Today the situation has improved; many more people are educated and responsible about AIDS, and agents like Marcus serve to further this education to the families they visit in even the most remote parts, teaching basic hygiene, prevention of cross-infection, and safe sex. His role, apart from this, is in bringing regular companionship to the sick, talking and laughing with them; a huge step from the isolation they were experiencing before. Marcus brings hope to those who would otherwise feel as if they were already dead.

Each of the patients has a story. Almost all are HIV positive, and only one today seemed to be completely supported by her family; “All my family members know my status”, she declares. This absence of stigma is unusual and an encouraging sign of the improvement of mentalities around HIV/AIDS.

In the afternoon Marcus visits Level 3 patients: those too weak to walk, living in very isolated huts which it takes hours to drive to. Siyaphi, our last patient of the day, declares, with perfect imagery, what the others have also been telling me: when a visitor comes, asks her how she is, talks to her and laughs with her, the pain, as unbearable it may be, goes away. Being able to count on Marcus, week after week, arriving at her door, is a beautiful gift and gives a precious sense of security to this woman living in isolation far away, and, with children working in the mines of Johannesburg, relatively alone.

Social and legal work

Charity is one of Orphancare’s social workers, and Celani is a paralegal.
Charity says she enjoys her job a lot; she has been a social worker for Isibani Sethemba since 2006. As part of the network of IS staff, the nurses evaluate living conditions in the homes they visit, and refer cases to a social worker when necessary. Charity then steps in and investigates the family’s problems. Many of the families she has known for 4 years and has developed a strong rapport with; this is essential if she is to get to know and resolve difficulties in the family relationships.

Children are an especially important issue, and possible cases of child abuse are investigated through a very subtle and effective technique: children are invited, during school holidays, to join holiday camps animated by social workers and other Isibani Sethemba staff. During these camps the children will be asked to communicate with the staff in various ways (drawing pictures, playing games- Charity calls this “play therapy”), and it becomes immediately apparent, through the games and simply conversations about their homes and families, which children are being maltreated at home. The social workers will then take action through follow-ups with the family or neighbour responsible for the abuse. In extreme cases such as rape, the case is referred to the police and the child is removed from the family; a foster family is found as quickly as possible.

Celani’s job is far more clear-cut; less emotional but essential nonetheless: a large proportion of the population in these rural, isolated areas, have no official documents such as ID or birth certificates. Celani is the legal ambassador for the area, informing people of the importance of getting these documents, and supporting them in the long procedures required to obtain them. The first young girl we visit has finally received her ID document, after 1 and a half years of waiting.
Having an ID document is essential in order to apply for child support grants, RDP housing, and jobs! Paralegals such as Celani deliver application forms to these rural homes; Isibani Sethemba has the advantage of transport, where the Department of Social Development has none. Celani and Charity will drive for hours every day to deliver these essential services. Today it is raining and the dirt tracks are becoming mud-baths. The car gets stuck in the mud and locals help us release it; after an hour we can continue on our way. The lack of infrastructure in this rural area is a huge obstacle to Isibani’s work, but valiant and optimistic staff such as Charity and Celani make it possible to help the needy in any situation.

Social Work and Spiritual guidance

Jimmy (Mhlengezinto) is the Church Support Coordinator. Working in conjunction with the social workers and Family Support Team, he helps individuals bear heavy emotional loads through spiritual guidance and counselling. Hlengiwe is part of the Family Support Team; she started as a home-based carer and has a lot of experience in working with HIV positive children. Most of the families she is responsible for are child-headed households of orphans.

We visit children at school before visiting their homes and assessing the home situation. At Nkungwini primary school we meet Sithembile, Siphamandla who have lost their parents and live with their gogo (grandmother). Jimmy tells me the gogo has a serious problem with alcohol and often spends the day at the local shebeen while the children are at school, telling the children that she also goes to school.

But when we arrive at the childrens’ home, Gogo is there, as is the youngest child, Nokwazi; she ran away from school because she was hungry and had no money to buy from the tuck shop at school. The gogo says Isibani Sethemba has improved their lives immensely; indeed, IS provided the building materials to build a little brick house with beds for all the children in it; before this, the family’s only shelter was a hut of sticks.
IS’s gardener (see below) also provided the seeds and the know-how to plant a small vegetable garden: an avocado tree grows there, as well as tomatoes, spinach, cabbage and carrots. This is a huge advantage to the family which is living off child support grants of R250 per month.

As a member of the “OVC” (Orphans and Vulnerable Children) branch of Isibani, Hlengiwe works mainly with orphans and child-headed households.

Our next visit is a very grave one; Hlengiwe must follow up on a case of sexual abuse. In the family in question, four sisters live alone with their father; the mother is gone. We meet three of the sisters at their school; Senenhlanhla, the second eldest, is 16. Her older sister, 18, was the father’s victim, raped multiple times. Senenhlanhla was then also targeted, but she did not submit to rape and reported the abuse to their neighbours. Charity the social worker, was called upon, and a referral was made to the police, who imprisoned the abusive father, but two of his friends payed bail for him. The mission for IS now is to imprison him permanently, but the procedure will be challenging as long as the father’s victim, the eldest daughter, remains unwilling to testify. Denial and refusal to testify are common difficulties in such cases; the sisters now live in an Isibani Sethemba safe home, but the shadow of the father, still unpunished, looms over them, threatening.

Isibani Sethemba is constantly available to help vulnerable children; in emergency cases like this one, and also on a routine basis, with the Support Groups. These are meetings held once a month in various different communities, with orphaned children, during which the aim is to provide them with life skills and knowledge they cannot learn in the absence of a normal family setup. Special classes are given on HIV/AIDS, drug abuse, self-confidence and resilience in the face of grief, especially where the parents have recently died. Hlengiwe has a real rapport with all the children of the area she is responsible for; she knows hundreds of childrens’ names, and while she cannot replace a loving family, she gives as much as she can to fill in the void in their lives. This essential care for orphaned children was the first building block of Isibani Sethemba, from which all the other activities branched out and developed.

Schools

Thembi Nsinbini is the School Support Facilitator of Isibani Sethemba; taking care of the organisation’s regular visits to rural, isolated schools which would otherwise not benefit from extra lessons about such important issues as HIV/AIDS, substance abuse, self-confidence, puberty… Today the lesson is HIV/AIDS and prevention of the disease. Thembi explains the main stages of the disease to the assembled class of Grades 4-8, and then demonstrates how to use a condom.

We also help clear up some of the children’s misconceptions: they think HIV can be passed on through hugging or kissing. Thembi tells me afterwards that this is already an improvement in mentalities: ten or so years ago, the majority believed HIV positive people had to be quarantined, away from any human contact, at all costs.

Education is the most powerful tool, or weapon, in the fight against the further spread of HIV/AIDS. If this generation is educated about the risks of infection, they will pass the knowledge on to theis progeny and the cycle of ignorance and denial of the disease will be broken. Thembi does the rounds of local schools, working for 6 weeks in an area before moving on to the next, and covering a range of subjects with each school she visits.

Marriage counselling

Lawrence (Fano) Mngomezulu is IOC’s marriage counsellor since 2008. Before then, he worked as the organisation’s chaplain for two years. He takes a spiritual stance on the marital matters he has to deal with daily, and is also a very pragmatic man with insight into the complicated social issues at the root of the intense marital conflicts which are all too common here.

Lawrence is very aware of the dire situation of gender relations in Ingwavuma and the surrounding area. To him, the biggest cause of HIV/AIDS spreading is rampant adultery. Men will often go out, sleep with other women, leaving their wife at home. The cultural acceptance of polygamy is at te root of many problems as traditional Zulu culture blends with other outside influences.
Traditionally a woman marries a man and his family: after the wedding she is adopted into the partner’s family; thus if the wife experiences problems during the marriage, such as beatings by her husband, she must report the incident to the husband’s family, and a meeting is called to reach a decision on what action to take. Beating is regarded as a private family matter and only very rarely will the police be called upon. The lobola which the husband’s family has paid the wife’s family in order to have the honour of marrying her is also a factor: the wife’s family will encourage her to stay with her husband, even in an abusive situation, as they have received payment for the bride from the husband’s family.

Lawrence spends two days a week counselling, and two days a week conducting workshops, meetings which all the couples of a certain area are invited to attend. It is during these workshops that Lawrence can set out the guidelines for a good marriage, and afterwards couples approach him, asking for private counselling sessions. Every 6 weeks he moves on to a new area, new couples. He feels passionate about his job, says his job is “in his heart”, even after work. Sometimes his wife accompanies him in counselling sessions to offer advice; Lawrence has been happily married for years and it strikes me as a very good idea for the couple to act as role model for others facing difficulties.

Often it is the woman, without her husband, who meets with Lawrence. Lawrence tells me it is Zulu culture that women should not ask questions and should not voice their problems or concerns. Talking to Lawrence is, for these women, a liberation. This inequality will take years to disappear, with very gradual, infinitesimal changes, but Lawrence works hard at making the husbands realise that their female companions must have voices too, must be granted their right to opinions, to feelings independent of those of their spouse. Many of the women Lawrence meets are beaten by their husbands. It is up to them, he says to decide whether or not to report their case to the police, through Isibani Sethemba.

Many wives are left alone at home in Ingwavuma and surrounding areas to look after the children, while husbands work in big cities like Johannesburg or Durban. With prolonged absences of 3 months or more, it is no surprise adultery is so common and HIV/AIDS is brought back to the wife by her husband. Lawrence fights this system of long periods of separation, encouraging the husband to invite his wife to visit him at his workplace in the city, nourishing the relationship.

Gardens

Phila is Isibani Sethemba’s garden and agriculture expert. Yet another branch of the organisation is in providing families and communities with seedlings, fences and garden equipment as well as lessons on how to grow vegetables. The Support groups each have a large vegetable patch, one of which I visited in Madeya, which sends part of their crop to the Ingwavuma Spar, generating much-needed extra income. The Family Support Team refers families to Phila if they find they are on the verge of starvation. Seeds are planted and grow, and much-needed nutrition is provided when the families learn to farm. During the weekly Support group meetings, the farm’s progress is checked and classes are given about good nutrition, as well as farming techniques to provide the markets with the best produce possible, thus fetching a higher price.
The women working on the farm when we visit ask for new hand-hoes; their present ones are decrepit. Insecticide spray is also needed; pests are ravaging the cabbages.

This simple idea of veggie patches has huge consequences: people’s lifestyles are improved as the women have a project to work on, caring for the vegetable patch, and feel more valued when hey generate extra income through selling crops to the local markets. Sick people are provided with essential nutriments through the fruit and vegetables, and with food in their stomachs it is safe to take the essential ARVs and TB treatments. At a garden we visit at Mbalakela Primary, the children are in charge of planting, watering and harvesting the vegetables they take home to their families. This simple activity teaches them self-sufficiency, the fruits of dedicated labour, and gives them a feeling of personal value. A few vegetables go a long way towards realising Isibani Sethemba’s vision: an empowered and thriving community in uMkhanyakude.

VCT (Voluntary Counselling and Testing)

Bongelane, Hlengiwe and Sabelo are three counsellors, who also have medical training, and they form the VCT team. Together they drive out into isolated rural areas with a tent and a large stereo system, and set up camp for a day, playing music so that people will be intrigued and attracted towards the tent; inside, the three Isibani staff will conduct free HIV testing and announce to the patients whether they are HIV positive or not. This job is probably the most difficult of all Isibani Sethemba’s tasks, but is also crucial. Prejudices and superstitions around HIV/AIDS still prevail today, and the only way to stop the spread of the disease is to break the stigma, the silence surrounding it, and bring as many people as possible out of the cycle of ignorance and denial which would lead to certain death. When the patient is discovered to be HIV positive, the counsellors have the very difficult job of explaining the implications of this. The counsellors usually encourage the patient to disclose his status to relatives, if only for reasons of safety so they can care for him while also protecting themselves from infection. However, often the patient will not want to disclose his status for fear of becoming stigmatised and neglected.

This is where the Support Group comes in: one of ISibani Sethemba’s 35 groups of HIV-positive people throughout the Jozini municipality will open its arms to the new patient. The Support Group meets once a month and an Isibani staff member gives classes on HIV/AIDS, ARVs and basic hygiene and medicine, as well as providing the group with a meal. The feeling of being part of a community, being in the same boat as others around one, is greatly comforting to the patient, and each individual in the Support Group is empowered by this companionship. The psychological and emotional support they receive greatly helps them fight their illness.

The VCT counsellors will refer all the new patients tested HIV-positive to the hospital, and the Isibani Sethemba network now envelops them: they will receive visits from the nurses, the social workers and paralegals if need be, will be able to participate in marriage counselling workshops as well as receiving palliative care through Support Group meetings and regular home visits. The Support Group gardens will provide them with food and possibly even extra income. This is truly holistic care.

What is special about Isibani Sethemba?

The diversity and range of the work Isibani Sethemba (IS) performs throughout the Jozini municipality is huge. It is the only organisation in the area to ensure medical support as well as psychological, dealing with a family’s relationship problems as well as organising their documents, by intervening and liaising with schools, churches, clinics, and the Departments of Home Affairs and Social Development. The human contact provided by regular home visits to incredibly isolated patients is priceless, as is the transport provided to and from clinics for gravely ill patients.
Despite the considerable number of branches of IS activities, every staff member’s work links in with their colleague’s; families are referred from one sector to the other so that each individual case is awarded holistic care. The end result is mitigation and prevention of the deep-rooted social problems the region of uMkhanyakude is facing.