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The South African children's Aids hospice that ran out of business The South African children's Aids hospice that ran out of business
(about 1 month later)
Every Sunday the long, ebony cars rolled in. “For some reason our children tended to die over weekends,” recalls Sister Kethiwe Dube, a worker at the Cotlands children’s Aids hospice in Turffontein, Johannesburg.Every Sunday the long, ebony cars rolled in. “For some reason our children tended to die over weekends,” recalls Sister Kethiwe Dube, a worker at the Cotlands children’s Aids hospice in Turffontein, Johannesburg.
In 2002, deaths at the 70-bed hospice were at a peak: 87 infants passed away – an average of more than seven a month. So many succumbed to Aids between 1996 and 2003 that three memorial walls were created for them in Westpark, one of Johannesburg’s largest cemeteries.In 2002, deaths at the 70-bed hospice were at a peak: 87 infants passed away – an average of more than seven a month. So many succumbed to Aids between 1996 and 2003 that three memorial walls were created for them in Westpark, one of Johannesburg’s largest cemeteries.
“You’d take those children as your own and learn to love them, but you never knew if they’d be there the next day,” Dube says. “It made me so anxious. It still does.”“You’d take those children as your own and learn to love them, but you never knew if they’d be there the next day,” Dube says. “It made me so anxious. It still does.”
But fourteen years later, as South Africa hosts the international Aids conference for the second time since 2000, the Cotlands centre is a very different place – its original purpose now redundant. Thanks to a legal battle by Aids campaigners which forced the government to provide pregnant women with antiretroviral drugs, the country has seen infection rates in babies drop staggeringly.But fourteen years later, as South Africa hosts the international Aids conference for the second time since 2000, the Cotlands centre is a very different place – its original purpose now redundant. Thanks to a legal battle by Aids campaigners which forced the government to provide pregnant women with antiretroviral drugs, the country has seen infection rates in babies drop staggeringly.
In 2004 the number of deaths at the centre fell to 35. There were 19 in 2005, nine in 2006, two in 2008, and in 2010 not a single baby died at Cotlands. Since then, there hasn’t been one HIV-related death at the hospice.In 2004 the number of deaths at the centre fell to 35. There were 19 in 2005, nine in 2006, two in 2008, and in 2010 not a single baby died at Cotlands. Since then, there hasn’t been one HIV-related death at the hospice.
Jackie Schoeman, Cotlands’ executive director, says the centre soon faced a dilemma. “Dying children were an emotive, tangible cause to fund. But what do you do when your cause starts to evaporate?”Jackie Schoeman, Cotlands’ executive director, says the centre soon faced a dilemma. “Dying children were an emotive, tangible cause to fund. But what do you do when your cause starts to evaporate?”
A survey undertaken by the Cotlands revealed that 80% of children in the Turffontein area did not start school with the “required foundational skills in literacy and numeracy”. So the former hospice decided to transform itself into a childcare centre.A survey undertaken by the Cotlands revealed that 80% of children in the Turffontein area did not start school with the “required foundational skills in literacy and numeracy”. So the former hospice decided to transform itself into a childcare centre.
Care workers who previously visited families to offer support to the dying have been retrained to run educational play sessions. There are also several classrooms that kids and teachers from the area can use, including a toy library.Care workers who previously visited families to offer support to the dying have been retrained to run educational play sessions. There are also several classrooms that kids and teachers from the area can use, including a toy library.
[We've seen] a decline from more than 70,000 infants being born with HIV in 2004 to less than 6,000 in 2015[We've seen] a decline from more than 70,000 infants being born with HIV in 2004 to less than 6,000 in 2015
Several studies have also shown that girls who don’t complete their schooling are more likely to become infected with HIV, particularly in poorer areas such as Turffontein. To help combat infection rates, Cotlands has started an aftercare service, where volunteers help them local children with homework.Several studies have also shown that girls who don’t complete their schooling are more likely to become infected with HIV, particularly in poorer areas such as Turffontein. To help combat infection rates, Cotlands has started an aftercare service, where volunteers help them local children with homework.
“The treatment of HIV has not led only to us changing our cause; it has meant that we can now help thousands of people for the same amount that it cost to keep 70 beds running for mainly HIV-infected kids,” says Schoeman.“The treatment of HIV has not led only to us changing our cause; it has meant that we can now help thousands of people for the same amount that it cost to keep 70 beds running for mainly HIV-infected kids,” says Schoeman.
TransformationTransformation
It did, however, take a long time to get here. Back in the early 2000s when Cotlands was a crucial facility facing an Aids epidemic, “the country’s key leaders were in denial about the cause of the disease,” says Aaron Motsoaledi, South Africa’s current health minister.It did, however, take a long time to get here. Back in the early 2000s when Cotlands was a crucial facility facing an Aids epidemic, “the country’s key leaders were in denial about the cause of the disease,” says Aaron Motsoaledi, South Africa’s current health minister.
“We lagged far behind the rest of the world in our response, and although ARV treatment was already available to treat HIV and prevent mother-to-child transmission we were not availing ourselves of the medicines.”“We lagged far behind the rest of the world in our response, and although ARV treatment was already available to treat HIV and prevent mother-to-child transmission we were not availing ourselves of the medicines.”
It was only after the constitutional court ruling, the appointment of a series of new health ministers, and crucial actions by the health department, such as providing ARVs for free to HIV-positive people, that Cotlands was able to transform from a place of death to a home for the living.It was only after the constitutional court ruling, the appointment of a series of new health ministers, and crucial actions by the health department, such as providing ARVs for free to HIV-positive people, that Cotlands was able to transform from a place of death to a home for the living.
“In 2006 and 2007, we started to see a visible decline in the percentage of HIV-infected babies we admitted,” says Schoeman.“In 2006 and 2007, we started to see a visible decline in the percentage of HIV-infected babies we admitted,” says Schoeman.
This change wasn’t happening only at Cotlands. National Health Laboratory Services data shows that mother-to-child transmission rates of HIV dropped nationally from an estimated 30% in 2004 to about 1.5% in 2015.This change wasn’t happening only at Cotlands. National Health Laboratory Services data shows that mother-to-child transmission rates of HIV dropped nationally from an estimated 30% in 2004 to about 1.5% in 2015.
Related: A letter to an 11-year-old Aids activist who shamed South Africa's president
“That translates into a decline from more than 70,000 infants being born with HIV in 2004 to less than 6,000 in 2015,” says Yogan Pillay, the health department’s deputy director for HIV and maternal health.“That translates into a decline from more than 70,000 infants being born with HIV in 2004 to less than 6,000 in 2015,” says Yogan Pillay, the health department’s deputy director for HIV and maternal health.
Pillay’s goal is now for a mother-to-child transmission rate of less than 1% at 18 months by 2022. “It would still leave us far from the World Health Organisation’s definition of elimination, which is fewer than 50 cases of transmission a year, but we’re negotiating with them for a different, more realistic definition for countries like South Africa which have a generalised epidemic.”Pillay’s goal is now for a mother-to-child transmission rate of less than 1% at 18 months by 2022. “It would still leave us far from the World Health Organisation’s definition of elimination, which is fewer than 50 cases of transmission a year, but we’re negotiating with them for a different, more realistic definition for countries like South Africa which have a generalised epidemic.”
For Cotlands, now getting used to its new role, this shift in purpose is welcome. “I hope that we will be able to have a similar impact on the education sector as we had on the health sector,” says Schoeman. “We no longer want these kids to just survive. We want them to thrive.”For Cotlands, now getting used to its new role, this shift in purpose is welcome. “I hope that we will be able to have a similar impact on the education sector as we had on the health sector,” says Schoeman. “We no longer want these kids to just survive. We want them to thrive.”
A version of this article first appeared on Bhekisisa – Centre for Health Journalism.A version of this article first appeared on Bhekisisa – Centre for Health Journalism.