From Hospice to Care Centre: Tugela Ferry’s International AIDS Research.

(This article has been printed in the Zambian Traveller).

by George Irwin.

Dr Tony Moll has lived in Tugela Ferry, KwaZulu Natal, for 22 years. He is a doctor in the Church of Scotland Hospital, a government-run hospital which serves 2000km2 of Zululand’s rural Msinga district. He has treated patients suffering from all of South Africa’s ills: gunshot wounds, stabbings, rape, TB and HIV/AIDS. Despite seeing more of South Africa’s darker side than most, Dr Moll’s children were educated at local schools and his family lives with him on the hospital grounds. In his own words, he has made a “personal commitment to the community of Tugela Ferry”. It is hard to meet a more selfless man.

Tugela Ferry has a reputation for being a dangerous, somewhat lawless town; stories of random shootings and hijackings abound. After the nearby murder of historian David Rattray in 2007, Tugela Ferry was reported in national and international media to be one of South Africa’s most dangerous towns. Dr Moll admits that during his early days in Tugela Ferry, faction fights would rage for days, even weeks at a time. It was not unusual for Dr Moll to receive thirty gunshot victims in one day during these inter-tribal conflicts. Today though, he maintains that the local community has calmed as the political instability of the 1980s and ’90s has given way to the less explosive politics of recent years. Today, the biggest killer in Tugela Ferry is HIV/AIDS.

The tidal wave of the HIV/AIDS epidemic began to affect KwaZulu Natal’s health service in 1997. The once missionary-run Church of Scotland Hospital was inundated to the point of collapse. There were simply not enough beds for the number of patients coming into the hospital with diseases such as tuberculosis (TB); diseases which began to kill patients whose immune systems had been all but destroyed by HIV/AIDS. Mixed messages from the Minister of Health hampered public education while initiatives such as the mother-to-child prevention scheme were delayed. While other African countries such as Botswana immediately initiated preventative programs, it was not until 2004 that Anti-Retroviral drugs (ARVs) were made widely available by the South African government. These drugs had been on the market since the early 1990s.

Dr Moll does, however, support the then Minister of Health in the KwaZulu Natal provincial government, Dr Zweli Mkhize. “He was amazingly level-headed despite walking a tightrope. He had a difficult job having to balance the needs of his department and keeping his dissenting superiors happy, but he was in contact with reality. He pushed things ahead as quickly as he could.” However, the result of this political uncertainty was that the Department of Health did not provide adequate support for Dr Moll and his team who were struggling to deal with the evolving epidemic: “we were watching people die”.

Ever-committed to the community, in 2002, Dr Moll decided to establish Philanjalo – a charitable hospice designed to fill the gaps in what care was being provided by the Department of Health. Through the hospice he began to train members of the local community as primary care volunteers. These 200 volunteers were trained as home-based carers taught how spot and alleviate the early signs of the onset of HIV/AIDS, bringing patients to the hospital for diagnosis in the earlier rather than later stages of the illness. Philanjalo, a non-governmental organisation, began to make inroads into the prevention and treatment of HIV/AIDS in this rural Zululand town.

In 2004, with the widespread release of ARVs, Philanjalo’s work began to change. “It was magic,” said Dr Moll. “With ARVs, Philanjalo was no longer a hospice, it became a care centre.” While the hospital was able to administer ARVs, often to out-patients, Philanjalo was able to concentrate on those patients for whom treatment was more complicated. Patients with advanced HIV/AIDS who had suffered liver or kidney failure often responded badly to ARV treatment and required careful monitoring; Philanjalo was able to provide the care and in-patient treatment that they required.

But work did not stop at in-patient care. Many community-based projects were also initiated. Philanjalo now has four vehicles which form mobile test stations. These vehicles visit markets where whole populations turn out to buy provisions; remarkably, people begin to queue for HIV testing before the vehicles even arrive (these test stations have found 30% of the population aged between 16 and 55 to be HIV-Positive). Thirteen satellite clinics, which provide localised supervision and care for patients receiving ARVs, have been established throughout the 2000km2 region. There are also plans to establish a day-care centre at Msinga Top, employing local women to look after orphans and vulnerable children. Philanjalo has become more than a small care centre: under the leadership of Dr Moll, it has become the basis of a massive and much-needed community support network.

Alongside this work, a research centre has been established at the hospital which focuses on the treatment and understanding of TB and HIV/AIDS. It was this research centre which, in 2005, discovered a drug-resistant strain of TB: XDR-TB or extensively drug-resistant TB. This deadly strain has killed 84% of the 266 people diagnosed with XDR-TB since 2005. Over 90% of all those diagnosed with XDR-TB were HIV-Positive. It is the discovery of XDR-TB alongside such a high prevalence of HIV/AIDS that has prompted strong financial support for Dr Moll’s on-going research. A collaborative research effort has been established called TF CARES; there are currently six doctors from Yale University working in Tugela Ferry alongside 40 permanent Philanjalo staff. This research is supported by major organisations such as The US President’s Plan for Emergency AIDS Relief (PEPFAR), The Global Fund, The Albert Einstein College of Medicine and Yale University, all of which have provided support for Dr Moll’s research (unfortunately, The Global Fund stopped all support to South Africa at the end of 2008). However, the bulk of this support is focussed on Dr Moll’s research department, not on Philanjalo, not on patient care and not on his community-based projects.

Philanjalo itself has an agreement with the Department of Health under which the charity is paid per patient per night, financial support which helps pay for basic food and maintenance costs. The care centre also receives help from the Hospice Association of South Africa and the Durban-based Container Ministry. In 2002, a cover-page article in Time Magazine brought in a huge amount of financial support. But, according to Dr Moll, this welcome support was merely “a flash-in-the-pan”.

The care centre and its affiliated projects are in constant need of financial support in order to continue serving the community; the cost of food, transport, and wages is increasing. Government funding is in place but it is simply not enough. Despite this, Dr Moll is remarkably optimistic. He maintains that if the research centre can maintain its high profile, then Philanjalo and the Tugela Ferry community will continue to benefit.

It is abundantly clear that Dr Moll has achieved something extraordinary in Tugela Ferry. In bringing about such a positive movement for change in such an often-maligned community, Dr Moll and Philanjalo have set an example and a standard which can and should be met throughout South Africa.