Hlokomela: a case study in partnership excellence

In the early 1990s, nurse Christine du Preez became puzzled by the deteriorating health of 25 local fruit pickers in Hoedspruit, Limpopo, where her husband Johann is a citrus and mango farmer. She tracked their health for 10 years from 1991 but despite her best efforts, every one of them died.

"No matter what I did, I just couldn’t get them better,” she says. “They were mothers and fathers and left many orphans behind. I was with the province at the time but was authorised to do outside work. I’d approached a farmer on Richmond Estate in our Hoedspruit district to start a local clinic. He gave me a room in a farm village house, and I began working by candlelight there at 05:30 every day. Those 25 HIV and AIDS deaths are why I started the Hlokomela Programme."

"Hlokomela" means "to care" in Sepedi and is a life-long vocation for Christine who grew up with patients knocking on the door of her family home at all hours. Her father was a doctor on the mines at Virginia in the Free State and her mother a nurse. She and husband Johann were head students at the Sentraal Hoërskool in Bloemfontein in 1977 and went on to study nursing and agriculture at the University of the Free State. Today, Johann manages the Bavaria Fruit Estate in Hoedspruit and Christine voluntarily oversees the HIV and AIDs prevention, care and treatment of an estimated 30 000 farm workers and their families on 72 sites in the surrounding community. Her multiple and international award-winning programme also cares for the staff of several local private nature reserves adjoining the Kruger National Park, plus hundreds of foreign migrants. An estimated 1 700 clients benefit from Hlokomela’s HIV testing services while 2 000 receive antiretroviral therapy at three wellness clinics and seven mobile sites.

None of this would be possible without the financial, logistical and intellectual input and partnership of nine other outfits over time, ranging from a global migration body to the provincial health authority, two farmer organisations, a major pharmaceutical company, two philanthropic health foundations and two major corporations, including the Discovery Fund.

Responding to the dire need for antiretroviral therapy

Real caring means doing the right thing regardless of adversity. Christine was a pioneer in dispensing antiretroviral treatment at a time when doing so risked government sanction and victimisation at healthcare facilities across the country.

“Other farms and game lodges began asking me to help. There were no ARVs to begin with – we were doing family planning, immunisation, breast feeding and STIs (sexually transmitted infections). After appointing a nurse to run my clinic for a while, in 2002 I quit working for the province at primary healthcare clinics and expanded our farm clinics to six in the Maruleng district. With so many migrant workers in the area, the International Organisation for Migration approached me, wanting to research condom use among farm workers. In 2005, they offered to fund us. That’s how we began as the Hoedspruit Training Trust, using Nompilos or caregiver peer volunteers.”

The International Organisation for Migration funded healthcare awareness and memorandums of understanding with local farmers and helped develop progressive workplace policies, unwittingly helping Christine set the groundwork for Hlokomela, which she founded in 2005. As a result, local farmers today both understand and enthusiastically support her work.

“I realised people were dying all around us and nobody knew what to do. So, I went to the Right to Care people in Johannesburg and asked for help. They began to courier ARVs to me in 2007. I started with 50 people. They’re all alive today. After three years, the Limpopo provincial department of health asked me to show them how to do antiretroviral therapy. They accredited our clinics long before their own,” she says. Hlokomela also has two peer educators assigned to sex workers and their clients at busy local transport hubs and fruit and vegetable markets.

By 2010, Christine’s sterling work was being noticed, including by Discovery Health executives who were simultaneously watching Limpopo battling to respond to the now-rampant HIV pandemic.

Christine recalls: “A Discovery person suggested I chat to a doctor at the Tintswalo District Hospital in nearby Mpumalanga where they’d put in aircon units and awarded her a bursary. The Tintswalo doctor said I should apply for the salaries of my caregivers and my operational costs. We had eight clinics and 42 Nompilos dispensing mainly ARVs, doing HIV testing, awareness and compliance. Discovery gave us an initial R150 000 and took me and Antoinette Ngwenya, my programme manager, on a leadership course in Sandton. It changed our lives. We did these personality tests and I found out that empathy was my highest attribute, but that I needed to learn to say no!”

Province withdraws HIV care – Discovery plugs the gap

After several years of ongoing Discovery funding, the major boost came in 2017 when the Limpopo department of health informed Hlokomela that it was stopping all NGO funding including ARVs and other medicine from 1 June 2018 – despite Hlokomela being their primary HIV and AIDS service provider.

“So, I told Ruth Lewin (Discovery’s Head of Corporate Sustainability) that I’ll have to close our clinics. The provincially-funded budget then was R3.6 million for our 10 clinics and the Nompilos’ stipends. Ruth called me to say Discovery would contact 40 companies, asking them to support us. A fee-for-service system was mooted but the stakeholders soon realised that Hlokomela was the local HIV and AIDS service provider, with patients travelling from across the province, Mpumalanga, Mozambique and Zimbabwe for antiretroviral therapy.”

Discovery facilitated meetings with AgriSA and Adcock Ingram to build relationships for long-term support. A delegation from Adcock Ingram and Discovery travelled to Hoedspruit during the first week of February 2018. The pharmaceutical executives were so impressed that they upped their initial R1 million offer by R500 000 in annual funding for three years – which Discovery matched. Christine is proud to say that the Hoedspruit farmers have made up the R600 000 a year budget shortfall.

Christine’s greatest satisfaction comes from watching her Nompilos’ self-esteem and confidence grow by leaps and bounds and the farm workers who so deeply appreciate their efforts. “The other day, I went to a village and a guy came over to me and said I once came to his house years ago and helped him. He said I saved his life – and I didn’t even recognise him, but I really got his gratitude!”

Leveraging Discovery networks to benefit patients

While partnering with the Themba Foundation – which coordinates medical professionals to help communities self-identify needs and empower itself through its women’s health clinics – Christine became aware of the dire circumstances of women with breast cancer and their lack of access to chemotherapy. Discovery, through its hands-on approach and links with one of South Africa’s top breast cancer experts Dr Carol Benn and her Breast Health Foundation, donated ring-fenced funds to the Breast Health Foundation to pay for world-class treatment of Hlokomela-referred patients and to raise breast cancer awareness in the region. Discovery also funded travel to Johannesburg and accommodation for patients and their closest relatives. By early 2019, raised awareness and screening helped detect breast cancer in 12 farm workers, seven of whom were commuting the 400 km to the Helen Joseph Hospital’s Breast Care Centre where Professor Benn consults.

For Christine, Hlokomela is morally and spiritually self-sustaining.

“I remember saying to our very despondent financial lady when we were considering shutting up shop in October 2017: ‘While I’m living, I can’t stop it. If I just close our doors, you all don’t have jobs. What about the farmworkers and the lives we’re saving? I can’t leave it for government; we must take hands!’”

Which sums up how South Africans collectively pull themselves back from the brink every time things seem hopeless.