Our Work*

We began our work with the construction of a four-building, 450 square metre, clinic and community centre. In constructing the centre, Edzimkulu provided more than R500,000 (over C$100,000 at exchange rates at the time) in income to over 400 Ndawana residents. All the work, which included excavation by hand, cutting thatch and poles, making blocks, and constructing the buildings, was done by members of the Ndawana community. No outside labour, contracting or engineering was done by people outside the community.

The entire community centre was destroyed by fire in June, 2009. The clinic reopened within two days in a small house used previously to house orphans, who were moved to other housing in Ndawana. The addition of a park home (prefab trailer type building) two months later completed the temporary clinic and allowed resumption of the full set of services which previously were housed in the original clinic.

* This page was last updated August 2009.

Establishment of basic healthcare in Ndawana

When Edzimkulu began work in late 2003, Ndawana was a village of 4000 people with virtually no access to health care other than a mobile clinic that arrived occasionally. By 2006 we had established a full time clinic in the village trained over a dozen community care workers to provide rural community care (including HIV/AIDS education, testing and counseling), and made huge inroads in “de-stigmatizing” HIV/AIDS to the extent that today Ndawana boasts a 50% test rate, likely the highest in all of South Africa.

In 2007 the Ndawana clinic was recognized by the KwaZulu Natal Department of Health (DoH) as an official clinic and we began receiving partial funding and resource support from the local DoH. In addition, the DoH was so impressed with the work of Edzimkulu, they requested we assist in replicating our health care model in four nearby rural villages. The Ndawana clinic now accommodates approximately 1000 patient visits per month, has two full-time nurses and manages 25 community health workers.

Prior to Edzimkulu, people in Ndawana had virtually no access to healthcare in the village. We now have created in partnership with the Sisonke District Department of Health a community-focused healthcare system that includes HIV counselling and testing, anti-retroviral treatment (ART) delivered on site for people who are HIV positive, a clinic with two professional nurses, a doctor who provides service one day a week, continuing service from DoH -operated mobile clinics approximately three times a month, and ready access to the nearest hospital (100 km distant)for the people who need other healthcare critical services related to HIV.

All of this has been made possible by having necessary transport available for both people and materials, and transport remains exceedingly important to all our programs. Nurses, medication and supplies are provided by the Department of Health (DoH), and community health workers are paid jointly by the DoH, TB/HIV Care, a major South African NGO and Edzimkulu.

We have counselled and tested over 2,500 people for HIV, some 220 people are taking anti-retroviral (ARV) drugs, and we continue to initiate at least 15-20 new people per month on treatment. In Ndawana, of those tested, the 15-24 year age group is 15-20% HIV positive, while the prevalence rate in the 25-45 year age group remains at approximately 50%. This suggests the opportunity to have a marked effect on the younger group, which we target through HIV education, which is one of the educational goals.

The healthcare system we have implemented has reduced the “short term death rate” attributable to HIV/AIDS by some 70%. “Short-term death rate” has been crudely measured by the decrease in the number of funerals taking place in the community on a weekly basis. During our first year in Ndawana, six years ago, the observed number of funerals was between four and eight every week. Today the community reports that the average number of weekly funerals is one or two. Now, due to a dramatic decrease in the stigma around HIV and truly accessible treatment people learn their status while there still is time to make a difference, and as a result deaths have fallen dramatically. In the long run we know that, even with ART, life spans are likely reduced for those who are HIV positive in this resource-limited environment. However, in the meantime people are once again caring for their children and returning to employment.

Through what we have termed “Edzimkulu 2” we now support people in 7 other villages directly with provision of HIV related healthcare. Most of these people are in the village of Mangeni, 25 km. from Ndawana. This support places heavy demands on our transport. Additionally, we have conducted a stigma reduction project throughout some 12 other communities, and we are heavily involved at the District level with other projects, including integrated management of childhood illness (IMCI) and prevention of mother to child transmission (PMTCT). Edzimkulu has been recognized as a best practice model at the provincial level for our work in community oriented health care and nationally for our work in PMTCT.

The Memeza Africa choir from Soweto became involved with Edzimkulu for six months in the second half of 2008. Members of the choir were trained as VCT counsellors, and they visited many villages with testimonials, counselling and testing. That effort is captured in a video which will be available shortly.

Orphan support

Orphan support has included establishment of a program to feed orphans and their caregivers. This program has provided food for up to 180 orphans per month. We also have advocated for grants for these children and their caregivers, which has meant a major effort to transport people to the municipal centre, which is more than 175 km. from Ndawana. While this effort has been less successful than healthcare because of major bureaucratic difficulties, many grants have been obtained and many orphans now are provided for by the government. This has been a goal of our work and this effort will continue. We now feed less than 100 orphans per month and this number continues to drop.

Construction of an orphan house took place in 2006, and a number of orphans from child-headed households were housed there over the intervening years. Only two orphans remained in the house at the time of the fire, and these children were able to be moved to a family caregiver who had newly returned to the village. This permitted us to convert the orphan house to use as part of the temporary clinic.

Education and literacy

Edzimkulu has at times been involved with adult and family literacy, tutoring and financial support for children in the high school, support and training for teachers in the school system, and most recently in operating kindergarten and pre-schools. Our efforts with the public school system produced some gains for a relatively small number of students, but were dependent on cooperation from the teachers and principals, which in the end were non-existent. These efforts also depended on Canadian volunteers willing and able to do the tutoring, and while some volunteers have been very successful at that, we have not had a continuing supply of such volunteers, so for both reasons the effort was not sustainable.

Kindergarten and pre-school efforts have been very successful. The kindergarten, consisting of some 75 students, was absorbed into the public school system, along with our teachers, which was exactly the sustainable result we hoped for. The three pre-schools also were very successful, but the largest of those was destroyed by the fire. As of August, 2009, all three pre-schools are operating in village housing, and we are paying the three teachers. Efforts are underway to register these pre-schools as places of care, which is the pre-requisite to having them taken over by the government.

Employment training and micro enterprise opportunities

We have made numerous efforts to train people in various handicraft skills, and have had some success with beading, sewing and felting. Many bracelets and other beaded items were sold in Canada and a few in Underberg. Orphan uniforms were sewn for local children. Handicrafts such as these are not native to Ndawana, and access to both supply and retail markets has proven to be too difficult to continue these efforts.

As of August 2009 we have some 40 employees, mostly in healthcare. Most employees are paid by Edzimkulu and other funders, and all have received significant training. Healthcare workers are very highly trained, so that most of them could obtain high level employment elsewhere. While their skills are very transferable, almost all are committed to Ndawana through loyalty to family or to Edzimkulu. Only one healthcare worker has left for employment elsewhere, and she is a single woman with no family in Ndawana.

Permaculture continues to be a focus, with large community gardens at the community centre, where families grow vegetables in their assigned plots and engage in sharing knowledge. Again, retail markets are inaccessible without Edzimkulu transport, and almost all Edzimkulu transport is required for healthcare uses.