Describing the rutted gravel road between Butterworth and Tafalofefe District Hospital in the Eastern Cape, Dr Bukiwe Spondo uses the word “terrible” at least 18 times, saying the 55km journey through the Amatole District can take several hours.
With heavy rain, tractors are sometimes needed to dislodge ambulances and often, staff have difficulty getting to work because of the mud, she tells Biénne Huisman for Spotlight.
Since 2007, Spondo and her colleagues have offered a multitude of services at Tafalofefe in impoverished Centane village. First, she moved the hospital’s ARV clinic from an out-building to inside the premises – reducing stigma – “because if patients went into that building on the outside, automatically everyone knew”, she says.
In 2012, having observed how patients stopped taking treatment due to travel costs, she started driving up to 40km daily, twice weekly, to nine clinics in the area, where up to 50 patients would be queuing to see her.
She also started pre-packing medication to take to them at the clinics. Later she opened a CHAMP (Clinical HIV /Aids Management Programme) site at Tafalofefe to see complicated cases referred from the clinics, and a multi-drug-resistant TB (MDR-TB) review clinic in conjunction with Butterworth Provincial Hospital.
“As a rural doctor, you become a social worker, a pharmacist, a priest – you do everything,” she says.
Rural doctor of the year
Spondo’s efforts have not gone unnoticed. Last month at the Rural Doctor’s Association of South Africa (RuDASA’s) annual Rural Health Conference, she received the Rural Doctor of the Year award.
RuDASA chairperson Dr Lungile Hobe conferred the award at the event hosted near Chintsa.
Spondo also won an Amatole District leadership award last year.
She tells Spotlight: “The roads here at Centane are terrible. It’s a challenge to get ambulances through and the chopper cannot fly either when it’s raining. The other day a truck got stuck crossing the road so the ambulance couldn’t pass. We had to take a private car to go and meet the ambulance halfway.”
The two closest referral hospitals are Cecilia Makiwane and Frere Provincial in East London, a 110km or 90 minute-drive from Butterworth along the N2 highway.
Tafalofefe has 160 beds with 41 professional nurses and seven doctors – including three community service doctors who joined last year. The additions have increased capacity, for example, emergency Caesareans are now available around the clock.
Taking healthcare to the people
The hospital has three 4×4 bakkies for visiting or transporting patients. It is in one of these that Spondo travels to see patients in remote corners between the Kobonqaba and Kei Rivers on Tuesdays and Thursdays.
“Clinics are part of decentralised primary healthcare goals,” she says. “But the problem was that if there were complicated cases – like if a patient is taking ARVs and then develop side effects – the sisters are not equipped to handle that. For example, if there is a kidney problem, they (cannot) do anything about that.
“In time, I realised that for these people, travelling to the hospital costs too much money. Take the clinic at Qolora – for a person to travel from Qolora to Tafalofefe is R100. A return ticket is R200. And most people here are unemployed. They can’t afford this.
“By the time they have saved up enough money to travel to the hospital, it’s too late… it would be the end stage of their kidney problem. You could not send this patient for dialysis, nothing could be done to help them. This is why I started my outreach trips.”
In motivating for Spondo to receive the RuDASA award, Tafalofefe’s CEO Masizakhe Madlebe pointed out how her work days start at 7am, only finishing once all patients had been seen, whether at the hospital or at one of the local clinics.
In addition, he notes how, over the years, Spondo has mentored youth in the area, including children whose parents had died of Aids, and schoolgirls on topics like life goals and contraceptives. She has even paid school fees for children without parents.
Child mothers
Spondo said she had seen girls as young as 12 giving birth in their maternity ward.
“I and some nurses went to two local schools to educate them, to discuss goals and contraceptives,” she says. “We started with grade 12s. No teachers were present. It was just us and them. And I was surprised at how freely they talked.
“I told them education is more important, that one day, ‘you can be a doctor too, but you need to be educated’. I told them they could come to Tafalofefe any time they needed to talk, that I could help them apply for tertiary degrees, to college or to university.”
Spondo has kept a close eye on Aids orphans in the area. “I tell them to bring me their June, September and December school reports, so I can see how they’re doing, so I can motivate them.
“I’ve seen these kids grow up. Some of them I saw angry – with everyone, with their own deceased parents. And I explained to them, don’t be angry. It’s not your mother’s or your father’s fault. It was the government’s fault for not giving your parents access to ARVs.
“Now, take your own ARVs and you will be fine. Some of them have passed high school with distinctions, some even have access to universities.”
Bringing skills home
Alongside two brothers, whom she describes as “wonderful”, Spondo grew up in the village of Nqamakwe, on the opposite side of Butterworth. Although both of her patents have died she still considers it her home – where her family’s farming interests include cattle, goats and sheep.
She attended Blythswood Secondary School in Nqamakwe, excelling at biology and physics, even though maths was hard work.
“Becoming a doctor was just something I always wanted,” she says, relaying how in her formative years she had been a sickly child who often required medical care. However, she says she cannot remember ever being sick as an adult.
Spondo graduated from medical school at the University of KwaZulu-Natal in 2002, completing her internship at Cecilia Makiwane and her community service at Tafalofefe and Frere in 2004.
She says she’s happy to bring her healthcare skills back home to serve the community that shaped her own humanity.
“I know these people inside out. I was born in front of them, raised in front of them…These are our relatives, our aunts, our grannies. It’s giving back to them, to the community that raised you, that has done everything for you, supported you through all these years.”
She pointed out that Tafalofefe’s clinical manager, Sambona Ntamo, also grew up near Butterworth.
“Who would look after these people if we didn’t?” she asks.
Where does she find the resilience that drives her passion to care for sick people, often queuing at the end of long rutted roads?
“Lots of exercise,” she grins.
At Tafalofefe there is a staff gym …
“I tell the guys that after work,” she says. “We’ve got keys and everyone knows that even if they want to go to the gym after midnight, they can go.”
Spondo and her eight-year-old son, Lutho – which means the greatest one – live in a doctor’s house on the hospital’s premises. They travel to their family home in Nqamakwe over weekends.
For Spondo, being a doctor does not feel like a job. “I look forward to my job every morning. When patients return saying they feel better, with a smile on their faces, saying thank you for the treatment – that just makes my day.”
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