Maryke Bezuidenhout is constantly on the road in rural, northern KwaZulu-Natal, visiting and helping people with disabilities, and bringing hope and some mobility to their lives, writes Sue Segar for Spotlight’s Rural Health Heroes series.
On a sweltering morning in Makwakwa in the far north of KwaZulu-Natal, about 20km from the southern border of Mozambique, a bakkie drives up to a small home in the middle of the bush, and out climbs an unlikely duo.
One is a tall woman,wearing short-sleeved blue scrubs with shorts, who hoists a large wheelchair off the back of the bakkie on to the ground and wheels it towards the passenger seat. The other is a man, who slowly manoeuvres himself into the wheelchair and pushes himself alongside her towards the house.
Maryke Bezuidenhout and Moses Mthembu are on an outreach visit to a family with disabled toddler twins who need wheelchairs. One twin has cerebral palsy, and the other has brittle bone disease which leads to regular fractures.
Today, as part of their service, Bezuidenhout, a physiotherapist and head of rehabilitation at Manguzi Hospital, is fine-tuning the twins’ wheelchair seating. “I seated them last November, but they’ve grown,” she says. “I’m also measuring one of the little girls for a standing frame.”
Mthembu, who has paraplegia, is here to talk to the children’s father. Having a person with a disability in a home, he says, has repercussions on many levels, with one common problem being that “many mothers of kids with disabilities are left by the fathers”.
While Bezuidenhout goes into the house with the mother and children, Mthembu stays outside with the father. The two men talk animatedly. The dad tells Mthembu he’s spent lots of money on his children and loves them dearly.
Bezuidenhout describes Mthembu as “my wheelchair repairer and my support”. Besides helping fix wheelchairs for Manguzi’s rehabilitation department and repairing wheelchairs at the disability care centre next to Manguzi, he runs an NPO offering peer support to other people living with disabilities and their relatives.
“As Manguzi rehab, we collaborate closely with Moses’s NPO to ensure that vital peer support happens in the community,” says Bezuidenhout. “If you break your spine, you want to hear from someone in the same boat.”
A rural hero known to many
Visiting disabled patients at home is a key part of Bezuidenhout’s work at Manguzi Hospital. The 222-bed public hospital is in Kwa-Ngwanase (Kosi Bay), just south of the Mozambique border, and east of eSwatini.
The hospital, Bezuidenhout says, officially serves a population of more than 140 000, but the true number is probably higher due to the many undocumented residents and transient patients who rely on the hospital and its 13 linked clinics.
“There are just under 500 people on our system, requiring routine home visits. Among them are 284 wheelchair users, of whom 231 are intermediate or advanced cases requiring our attention at least twice a year. People who require home visits could typically be the elderly, and those with conditions like cerebral palsy, paraplegia, quadriplegia, strokes, and mental health conditions.”
Bezuidenhout and her team visit patients regularly to do a combination of physical rehabilitation, wheelchair repairs, reseating, or servicing, wheelchair skills training, and peer support.
Long, bumpy bundu-bashing trips
Bezuidenhout and Mthembu return to the bakkie and head to their next appointment.
These home-based outreach visits involve driving long distances along bumpy dirt roads, to scattered homesteads in the bush, often through the thick red sand which characterises this area. Both point out that it’s bad enough driving a four-wheel-drive vehicle in these parts, let alone a wheelchair.
Their next stop is Qhamkile Gumede (58), who has paraplegia. “She’s very independent and likes going shopping in her three-wheeler rugged-terrain chair,” says Bezuidenhout. “But we’ve had a lot of rain, and her wheelchair is really rusted.”
On arrival, the gogo greets them and chats to Mthembu as he works on her wheelchair. He checks the chair’s bearings, changes the footplate, and sorts out the brakes.
He says he learnt how to fix wheelchairs through having to fix his own. “Maryke organised training for me in Cape Town where I learnt a lot,” he says.
While chatting to the grandmother, he’s quietly checking in on her and her family. “I ask how they’re coping financially. I talk to them about hygiene. It takes time to build trust,” he says.
Mthembu’s story
Mthembu (45), was born in Manguzi and moved to Durban as a young man. At 23, he became paraplegic after being shot during a home robbery. The doctor told him he would never walk again.
He recalls his shock and helplessness when he was discharged from hospital, unable to walk, and without a wheelchair.
“From being a strong young man, working in a Coca-Cola warehouse, I was spending my days alone. The people I lived with went out to work. I thought my life was dead,” he says.
He moved home to Manguzi, and was treated in Manguzi Hospital’s rehabilitation unit, where he learnt how to live as a paraplegic. There, he started helping fellow disabled people. “I would share what I’d learnt about how to look after myself as a disabled person, and I’d support them on how to just be a person again.”
Bezuidenhout said that when she arrived, she was blown away by the close collaboration between the rehabilitation department and community stakeholders involved in disability care.
“That was my first exposure to a collaborative approach to disability. I’d never dealt with any community health workers or traditional authority structures, and I learnt fast that there has to be lots of thinking out of the box when working rurally.”
She spent the first decade of her career learning “the musculoskeletal stuff”, before becoming increasingly involved in policy issues. She’s done courses on the practical skills of repairing wheelchairs as well as a Master’s in public health, a diploma in health economics, and courses in advanced wheelchair seating and repairs.
It’s not uncommon for her to drive home from the bush at 8pm. “I’m always busy,” she says. She manages a team of more than 16 people, including therapists, occupational therapists, speech and audio therapists, as well as community service students, general assistants and wheelchair repairers.
Hustling for resources
She spends much of her spare time at the Phumelele Mntwana Disability Care Centre, a residential care facility run by mothers of children with disabilities. She has worked hard to help renovate the centre and is constantly hustling for resources to keep it going.
She clearly loves the inhabitants. There are eight people living in the centre, each with their own story of why they cannot live at home with their families in this rural setting.
Asked what drives her, Bezuidenhout responds: “I like standing up for the underdog. I like the challenge of beating an unfair system. I like the outcomes of the work I do, like seeing somebody slowly mastering their wheelchair skills to the point where they can get into a taxi, start a business and get a family. I like seeing a mother becoming proud of her child with a disability and taking him out with everybody else.”
Outside work, Bezuidenhout is involved in rehabilitation-driven work, from supporting the NGO Rural Rehab SA, and organising Manguzi Gijima, an annual disability sports and advocacy event, to running a campaign to provide an adapted Segway chair for a girl with paraplegia who is struggling to get to school.
She says it is particularly fulfilling getting children with physical disabilities into mainstream schools and challenging the negative attitudes that keep them out.
“Although our country has a policy of inclusive education, it’s not very inclusive… Many children with disabilities are simply excluded from mainstream schooling and told to go to special schools.”
Most teachers and principals lack experience with disability, she says, and cites concerns about school infrastructure not being suitable for all pupils.
This year she managed to get a child with quadriplegia accepted into a school on condition that she devises a plan to have ramps built. “I’ve found the donor funding so we will start building the ramps.”
She finds the healthcare system unfair for many reasons. “There is inefficiency everywhere, with parallel processes happening all the time, and planning and implementation happening in silos. The service delivery platform is designed around what works for healthcare workers, rather than what works for the patients.”
See more from MedicalBrief archives:
Disabled students call for education system reform
Thousands of people still waiting for wheelchairs in Eastern Cape
6 000 waiting for wheelchairs, says Health Minister