Save women from breast cancer in South Africa

This year certainly kicked off with a bang as the Hlokomela Women’s Clinic staff dived in the deep end to do what they do best, despite harsh working conditions. This quarter, thanks to our GlobalGiving family, we were able to reach women from marginalised communities with basic yet life altering health care services.

Cervical cancer screening for sex workers

Approximately 80 people of whom 60 were sex workers, attended the awareness day. Screening for sexually transmitted infections (STIs) and Pap smears were done for 30 sex workers. Eight women received Implanon (subdermal contraceptive device) insertions.

Many of these clients were diagnosed with STIs, although they did not report having any symptoms before the screening. This shows that continuous education on sexual reproductive health and STIs in particular are absolutely vital in our communities to detect debilitating disease and cancers early on.

These outreaches, despite long travelling times and less than favourable conditions, have always been a highlight of my calendar. It gives me a sense of reaching people. Whether it’s meeting needs, with the sharing of health care information, kindness or approachability. It is a vital part of what Hlokomela stands for. Reaching the unreachable, the judged, the ostracised. Together we will brake stigma and keep our sex worker beneficiaries safe.

When the system fails

Approximately a year ago *Khensani Ndlovu walked into the Hlokomela Women’s Clinic. She complained of lower pelvic pain and constant vaginal bleeding. At the time Khensani was 72 years old and had 5 children. Khensani was not a Hlokomela patient and had never had a Pap smear.

After performing a pelvic exam and a Pap smear, I suspected that Khensani may be facing some serious problems. The Pap smear results came back and Khensani had tested positive for cervical carcinoma.

At this time Khensani was not doing well. She was severely underweight, tired and in pain most of the time. Her family and a representative from the NPO Seeds of Light, who supported Khensani before, during and after her diagnosis, came to the clinic for a meeting.

Khensani and her family decided not to attempt entering into the Government referral system for treatment. Instead, Khensani opted to stay at home and enjoy the little quality of life she had left. During this time Khensani came to the Women’s Clinic every month. We provided her with some vitamins and sanitary pads monthly. The times she spent with us receiving her Vit B complex IV was also a time when Khensani received love and care from all of us at Hlokomela. It was a time where she was heard, comforted, and counselled. Over the course a year we grew close to her - she came to us for more than just IV treatment.

The last time I saw Khensani was at the beginning of January 2023. Khensani was tired. She was losing more weight and faced family problems on top of her deteriorating health. During the last hours of her life, Khensani called for us here at Hlokomela. Khensani lost her life on 21 February 2023. Our thoughts and prayers are with her family and friends.

*Khensani Ndlovu is a pseudonym used to protect the true identity of our patient.

Donations needed for winter

We are fortunate to continuously receive donations. We are however entering the winter months. We are in need of winter clothing, scarfs and beanies. We also find that many patients come to the clinic hungry. From time to time breast feeding mothers send their babies to the clinic with a grandparent or a friend - without formula or a bottle. If anyone is able to donate or would like to donate items to the clinic, kindly contact Sonja Botha at 082 560 0248 or on sonja@hlokomela.org.za during office hours to arrange a pick-up/drop-off. A more detailed list of items needed can be provided on request. We are also currently supporting a few families of sex workers in our community. If anyone would like to donate to a specific family, also kindly enquire with Sonja. She is in contact with these families and would be able to arrange that donations reach them.

Breast cancer patient receives surgery

Last year was a sad year for Hlokomela Women’s Clinic patients, specifically for patients either diagnosed with or suspected of having breast cancer. The COVID-19 pandemic haltered the referral system we had established with the Breast Health Foundation (BHF) and the Helen Joseph Hospital. To make matters worse, Professor Carol Benn is no longer associated with the Helen Joseph Hospital. Since her resignation, the BHF was also forced to part ways with the hospital. This caused massive challenges for our patients needing further investigation and treatment.

Prof Benn has since been running her private practice in Johannesburg and is accommodating some public patients. One of the patients fortunate enough to have been seen by her is from Hoedspruit and is a Women’s Clinic patient.

This patient, Cindy, is a 35-year-old mother of a 13-year-old daughter. She came in for an ultrasound which indicated that a full work-up, as well as a biopsy, was needed. Prof Benn cared of this patient and we received a call recently from Cindy, happily reporting that she had had a mastectomy in a private hospital in Johannesburg and that she is recovering well.

More news will follow in next month’s report. Thank you to Prof Benn and the BHF (who continue working with Prof Benn) for giving this patient a new lease on life.

Links:

• Hlokomela website

The past three months at Hlokomela went by in a flash. What we realized once again is the dire need in our communities for support to breast and cervical cancer patients to access lifesaving treatment. Something as simple as this is not readily available and we dare not rest in trying to achieve dignity for our patients. We thank our GlobalGiving family for all your support over the past year. Without you we would not have been able to support our patients at all. In 2023 we will carry on with renewed energy for the women who need us the most!

Cervical cancer patient failed by government healthcare system

During the last year, we referred many patients to the government system, with the hope that they will receive the treatment they need. One such patient is *Pretty Nkuna. Pretty came to the Women’s Clinic in the first quarter of 2022. She suffered from severe vaginal bleeding, lower pelvic pain, and anaemia.

After doing a Pap smear, Pretty was diagnosed with HSIL, which basically indicates that she has cancer of the cervix and needs immediate surgical intervention or possibly chemo/radiation therapy first.

After sending her to her local hospital, with her going back and forth for months without getting help, we decided to call a gynaecologist friend who works in the private and government sector in Polokwane. This doctor is an Oncology gynaecologist.

After Pretty got financial help from her employer, she was finally able to make a trip to Polokwane to see the doctor.

She was examined and depending on her blood test results, she would start chemotherapy the following Monday. Unfortunately, when Pretty arrived at the hospital on that Monday, she was told that she would not be able to start with chemo due to a low white blood count. Pretty travelled and spent money that she did not have, to and from the hospital several times without being contacted prior to her date regarding blood results. All of this caused stress and delayed her treatment.

When she eventually was admitted, she was so sick that she received palliative care. Her time was up, she was too sick to receive chemotherapy.

Pretty lost her fight against cervical cancer. Our hearts go out to her family, friends and the people she touched through her journey.

Unfortunately, this is not the last time a woman will die as a direct result of a failing healthcare system in South Africa. Without medical insurance the chances of survival are slim to none.

Teenage pregnancies

A 35-year-old patient visited the Women’s Clinic this month with complications related to an abortion done at a “back street” abortion clinic. The procedure left her with an infection and possibly a damaged womb.

After counselling this patient, she revealed that her 15-year-old daughter had a 2-month-old baby. She just did not have the finances to take care of her own baby and her daughter’s baby. When she found out her daughter was pregnant, it was too late for an abortion, besides that, her daughter wanted to keep her baby. The only way out of this situation was for her to have an abortion herself.

This story just sheds some light on the very difficult task we have and the challenges we are dealing with regarding teenage pregnancies. More needs to be done at primary level, in schools, at community level, in churches and at youth centres.

GoodX Expo

On 12 November 2022 Sonja Botha from the Hlokomela Women’s Clinic attended the GoodX Expo in Boksburg, Johannesburg. The event was hosted at the Birchwood hotel, spa and conference centre. Many stake holders and related companies in the industry attended. It was an opportunity for Hlokomela to share with all the attendees the way that we implemented the GoodX practice management system and integrated it with the Ideal Clinic and Hlokomela’s sustainability project, the Partial Payment System (PPS).

Sonja’s presentation about the Hlokomela model was very well received. This was a great networking opportunity for us and we thank GoodX for extending the invitation to us.

Donations  

We have been very grateful to have received a continued flow of donations from local volunteers and visitors to our town. We would like to thank everyone who has donated to Hlokomela.

Dr Majoie Hemelaar

Dr Hemelaar has been involved with the Hlokomela Women’s Clinic for the past 5 years. She recently came back to Hoespruit after 3 years in Klerksdorp. She is currently volunteering in the Women’s Clinc on Fridays. Seeing patients where the women’s clinic staff have identified the need for a gynaegologist. She, like in the past, uses each opertunity to train our staff and better equipped them to improve the care we provide to our patients.

Tekkies4Tieties

On 5 November 2022, Hlokomela Women’s Clinic hosted a fun walk in aid of breast cancer awareness and fund raising to support patients with breast cancer.

This event was held at the Kamogelo Centre in Hoedspruit. The main attraction was the walk between the centre and the four-way stop on the R40 and back.

The atmosphere was one of standing together for a cause. Laughter and some sadness as many people came to support family members, and friends of patients still fighting the good fight, or who have lost the fight.

The Hoedspruit Café had milkshakes, juice and mini cupcakes available to everyone at the finish line and the first 30 people to finish each received a goodie bag from Hlokomela.

The morning ended with a prize-giving ceremony. Prizes were plenty and given away to the best-dressed male and female, dog, girl, and child. Team prizes and a lucky draw were held. We thank all the amazing people who attended and sponsored items and prizes for the day!

Links:

• Hlokomela website

Hlokomela takes care of men’s health too

On 29 June 2022, Hlokomela hosted a men’s health awareness day in Hoedspruit town. The objective of this day was to provide men with information on prostate health, diet, fitness, and general health. We offered blood glucose tests, PSA tests as well as blood pressure and BMI. We were very well received in the community and had a great turnout. We are already planning another awareness day for the men in our community.

Baby survives, mother and twin dies

The past three months at Hlokomela Women’s Clinic have been jam packed with activities and a wide variety of clients. We are so grateful to our GlobalGiving family for enabling us to provide health care services to the vulnerable people in rural Limpopo Province, South Africa.

At the beginning of March 2022, one of the beneficiaries of the Sex Work Program delivered twin girls. The Sex Work Programme targets sex workers in the Mopani District of Limpopo Province and teaches sex workers to make better choices for their own health and the health and wellbeing of their families. The twin pregnancy was diagnosed at Hlokomela Women’s Clinic. It was a great shock for this expecting mother as she already had 4 children who she was struggling to care for.

Her pregnancy was very challenging; living in poverty, battling to care for her other children, and stressed about how she would take care of two more children. On top of having existing stressors, she had a high-risk pregnancy, which lead to the premature delivery of her twins. The babies were very small at birth and spent a week in the hospital after delivery. Hlokomela donated formula, baby clothes, and some other basic necessities. Unfortunately, the mommy did not recover well after the birth and sadly passed away 3 weeks later. One of the twins passed away a day before her mother. The cause of the baby’s death is unclear, but we suspect dehydration because her mother was very ill.

The surviving twin is doing well and Hlokomela is still involved with the her and the family who is taking care of her. We are grateful that we were able to assist this family, although this story once again shines the spotlight on the massive struggles we face in our communities. We have our work cut out for us and we rely on the support of each and every kind-hearted friend of Hlokomela to assist us in helping families like these.

Breast cancer

Hlokomela celebrated the Women’s Clinic’s 6^th birthday on 7 July 2022. During the past 6 years, we have reached thousands of women; if not through medical consultation, then by outreach campaigns and awareness days. We have assisted more than 25 women through their breast cancer journeys and unfortunately lost 3 patients to this devastating disease. In the last month, we have had three new breast cancer diagnoses and we are fortunate to have identified this early in two of the patients.

With breast cancer awareness month coming up in October, we will be partnering with other local organizations to host an event in the community, for the community - raising funds, spreading awareness, and celebrating survivors.

Fundraising for Hlokomela in Big 5 territory

Before COVID-19, Hlokomela hosted it’s most important annual fundraising event, the Hlokomela Bush Party, each year in various exclusive Big 5 game reserves in the area. The event is well known and loved by locals and their guests. This year we were finally able to host the 10^th annual Bush Party at Pridelands Game Reserve outside Hoedspruit. The evening was a great success for the organisation and the funds raised will be used to improve facilities at Hlokomela’s Blyde Clinic venue where the Women’s Clinic is also situated.

Staff wellness

Charity starts at home and at Hlokomela we have taken this to heart. Through the Employee Wellness Programme we offer our staff annual medical check-ups, access to our clinic services, Tension Releasing Exercises (TRE) as a body-based therapy for debriefing, health talks and healthy cooking demonstrations and much more. Thank you for helping us offer these services to our valued employees.

COVID-19 Vaccination Program

On 1 July 2022 Hlokomela partnered with the Ndlovu Care Group to reach 20 000 migrants from neighbouring countries as well as local farm workers and get them vaccinated against COVID-19 by January 2023. This project has not been without challenges, however. We have a vaccination team that travels to farms and villages every day in an attempt to reach as many people as possible. On 29 August 2022, the total number of people reached and vaccinated stood at 3600. We will continue to work tirelessly to reach our goal!

Links:

• Hlokomela website

The past few months at the Hlokomela Women’s Clinic has been jam packed with activities! We are pleased to report that we were able to care for and support those who needed it the most, thanks to your support through the wonderful service offered by GlobalGiving!

Sex worker gives birth to twins

At the beginning of March, a beneficiary of Hlokomela’s Sex Worker Programme, *Maggy, gave birth to twin girls. The pregnancy was diagnosed at the Hlokomela Women’s Clinic. It was a great shock for the mother who already has 4 children.

Her pregnancy was very challenging; living in poverty, battling to care for her other children and stressing about how she would take care of two more babies. In addition, it was a high risk pregnancy which lead to pre-mature delivery of the twins. Both of them are healthy and doing well. Hlokomela donated formula, baby clothes and some other basic necessities. Over the course of the two weeks since the birth of the twins, *Maggy’s health deteriorated. Just in time, the Hlokomela Women’s Clinic learnt of the situation. One of the Hlokomela Women’s Clinic nurses drove to the informal settlement where *Maggy and one of the twin girls live. The structure is unstable and there is no running water or sanitation. When our nurse got to *Maggy, she was not very responsive and just sat there with the one baby in her arms. She was pale, breathing fast and seemed dissociative. We learnt there that the other twin was sent away with another sex worker, as to lighten the burden for *Maggy.

When our Nurse took the baby from *Maggy, the baby was dehydrated, had a fast pulse and was extremely lethargic.

There was nothing for the baby. No milk, no diapers, no bottles. All the donated supplies were sent away with the second twin, and that twin one was left to her own devices, with a very sick mommy.

*Maggy and the baby were rushed to the Hlokomela Women’s Clinic where both were attended to by a doctor from the Tshemba Foundation. The doctor established that *Maggy is in cardiac failure and has floral effusion. The situation was serious and she needed to be admitted to hospital immediately.

The baby just needed 2 hourly feeds, to be dressed warm and monitored. Two Hlokomela nurses offered to foster the babies until the situation improved and the mother was healthy and able to make good decisions. It had become clear at this time that *Maggy did not want to keep her twins.

The twins spent a total of 10 days in foster care. They gained weight and did very well.

They are both back in the care of their mother and a social worker is monitoring the situation closely. Unfortunately, because *Maggy ran away from hospital before her treatment was complete, it is difficult to say how she is doing health wise. We trust that the outcome will be good for everyone involved.

Teenage pregnancies

Teenage pregnancies are at a staggering high in South Africa, with Limpopo being one of the highest rated for teenage pregnancies.

Recently, a 16-year-old girl from a school in the Mopani District, came to visit the Hlokomela Women’s Clinic as she suspected that she was pregnant. *Susan came to the clinic not knowing what to expect. She was scared and emotional.

After having a conversation with *Susan, it became clear that she was in an abusive relationship. Initially she consented to a sexual relationship with him but later changed her mind. She could not get out of the relationship and ended up having non-consensual sex.

*Susan fell pregnant and by the time she came for her first appointment at the Hlokomela Women’s Clinic she was 25 weeks pregnant and completely unprepared for what lay ahead.

After intense counselling *Susan decided to keep her child. She was given her first month of vitamins, as up to this point, she had had no antenatal care. We referred her to her local clinic.

At Hlokomela Women’s Clinic we strongly believe in not only providing medical care, but also in supporting our patient through emotional difficulty as we follow up, guide and support where possible.

After receiving a donated baby bag filled with baby accessories, and gathering together some more essentials, including a comprehensive book explaining pregnancy and birth, *Susan went home.

We look forward to reach out to more schools and colleges in our area to present the learners with sex education as COVID regulations are relaxed.

Breast cancer diagnosis

This monthtwo very different ladies came to the Hlokomela Women’s Clinic for breast ultrasounds. Both ladies, *Lucy and *Linda, had palpable lumps in one of their breasts.

*Lucy is unemployed, 35-years-old and has a 10-year-old daughter. When the ultrasound scan was performed, there really was no doubt that the mass was malignant. However, *Lucy still needed to go through the process of a mammogram, and a possible biopsy. Being unemployed and at the mercy of the state health system, we knew that the road ahead would not be easy.

Thanks to the incredible networking skills of our director Christine du Preez, the visiting mammogram unit, Cornerstone Radiology, was willing to provide a free mammogram for *Lucy, which confirmed our suspicions of breast cancer.

A miracle happened for *Lucy. Out of sheer desperation we made a call to the Breast Health Foundation (BHF), in hope of some way to help *Lucy. Low and behold, funding was available for one more patient through the programme that was in place prior to the COVID pandemic.

*Lucy consulted with a specialist doctor on 12 April 2022 in Johannesburg.

Then we have *Linda, a 60-year-old lady, working and traveling between South African, the USA and Europe. She has access to private health care. She came to the clinic concerned about a lump in her breast. Ultrasound confirmed that the mass needed further investigation. *Linda was able to go for a mammogram that same day and booked a biopsy for a few weeks later in Europe.

These two ladies both have breast cancer. Both ladies experienced the same emotions. Both ladies deserve the same quality of care. We sincerely hope that they will receive it.

Breast cancer patient journey (follow-up)

As many of you know, Josephina Sekgobela (who we have reported on many times before), is doing well. She was transferred from Polokwane Provincial Hospital to Johannesburg for her chemo therapy. Her children are in Johannesburg and are able to support and assist her with travelling and living expenses.

Josephina reports that she is feeling good, has gained weight and that the mass in her breast has reduced in size since she has been getting her chemo regularly as scheduled.

Josephina is one of the bravest souls I have ever met, may she recover fully and live a long and happy life.

Sex education at local high school

During April the Hlokomela Women’s Clinic visited a local high school to provide sex education and a talk on general wellness and life for teenagers. Topics covered included sex, contraceptives, menstruation, puberty in boys and girls, different sexual orientations and “My body my rights”.

There was great conversation after the talks with many good questions and opportunities to communicate facts and clear myths around sex and reproductive health.

*Pseudonyms were used in this report to protect the identity of our clients.

Links:

• Hlokomela website

The past three months has been jam packed at the Hlokomela Women’s Clinic. From raising breast cancer awareness at a special fund raising event, to supporting sex workers through unwanted pregnancies and tackling the 4^th wave of COVID-19 that hit South Africa during December.

We would like to thank you, our sponsors and the GlobalGiving team for making all of this possible. Without your support the Women’s Clinic and our efforts with COVID-19 would not be able to reach so many people as we have done.

Rise in unwanted pregnancies amongst sex workers

During the past 2 months, the unplanned pregnancy rate among sex workers in the Hoedspruit area of Limpopo Province, South Africa has rapidly increased. As part of Hlokomela’s sex worker programme, we work hard to tackle the many issues and challenges that sex workers face every day.

Yet despite numerous attempts to educate on birth control and alcohol abuse, sex workers still default on birth control and in many cases abuse alcohol. This leads to defaulting on condom use also.

At the Hlokomela Women’s Clinic we work closely with the sex worker programme’s. Through referrals from staff on this programme, we become aware of pregnant sex workers. In most cases by the time the sex worker realises she is pregnant, the pregnancy is already in an advanced stage.

Although this poses a huge challenge, we are not about to give up. It is the nature of our business to help, educate, rethink and come up with ways to assist these vulnerable, often abused and neglected women in our society.

We would like to share one particular case with you. One of the sex workers we work with recently had a baby. This sex worker abused alcohol during her pregnancy and the baby was born with a disabled right hand. This may or may not be related to the alcohol abuse. The sex worker’s niece (17 years old) is cognitively disabled and has the intellectual capacity of a 7-year-old child. This 17-year-old girl is currently pregnant. She has no idea what her body is going through and has a very limited understanding of how she got pregnant. She also has very little to no understanding of how her baby will be birthed.

The Hlokomela Women’s Clinic has been seeing her for ultrasound scans for the past 3 months. We are working with the sex worker programme’s social worker and volunteer doctors from the Tshemba Foundation to compile a report in request of an elective caesarean section for this your girl as a normal birth may be dangerous for her, physically and emotionally.

We are also assisting the family with baby products and working on the possibility to have a bilateral tubal legation done on her after the birth. This will depend on her guardian’s consent and a psychologist’s report. We are hopeful that all will go well for her and will report in the months to come on how she is doing.

The Boob-Geosie ladies brunch

In light of breast cancer awareness month, the Boob-geoisie ladies brunch was born. The main aim for this event was to create a space where women from all walks of life could get together for one common cause - breast cancer awareness.

The event was held on 23 October 2021 at the Greater Kruger Hotel School. Tickets were sold out as 60 guests attend the function. The morning started with guests arriving to enjoy a glass of bubbly on the balcony along with a bite to eat. The program was filled with everything from self-breast examination and lucky draws of amazing prizes to a live music performance.

We showed a very special slide show, produced by Discovery and the Breast Health Foundation, sharing the journey of 5 women who have had to travel many hours to get to treatment. Their pain, their hope, their fears and their experience with Hlokomela Women’s Clinic was excellently captured.

A local breast cancer survivor and patient of Hlokomela Women’s Clinic was the guest of honour and she shared her incredible journey with us.

Each lady also received a goody bag filled with fantastic products and the entire event was made possible by donations! The proceeds made during this event will be used to assist patients to travel to and from breast cancer treatment and consultations.

COVID-19 news

As we reflect on the last 3 months, South Africa reached the peak of the 4^th wave of COVID-19 at the end of December 2021. October and November 2021 showed a drastic increase in COVID testing at Hlokomela. We did up to 50 rapid antigen tests per day at our main clinic alone.

Although the positivity rate was high on a daily basis, it was evident that the symptoms patients reported were much less severe in comparison to the previous 3 waves.

Hlokomela Women’s Clinic staff have been actively involved in filling the gap in staff shortages to perform the antigen tests. As with every previous wave, other health care needs have been neglected by patients and the Women’s Clinic has not been very busy with patients accessing women’s health services. Breast cancer and cervical cancer awareness remain important and it is a central part of our outreach schedule.

Links:

• Hlokomela website