GOGO (77) CAN’T AFFORD MONTHLY E700 HOSPITAL TRIP

VUVULANE—Eswatini is one of the few countries on the continent that provides free medical care and treatment to the elderly despite the challenge of a drug shortage.

However, one must acknowledge that this does not help much in the face of the current drug shortage crisis. 77-year-old Matilda Vilane is diabetic and living with a disability in that she is not able to walk; the issue is not lack of drugs, but that she cannot afford to go to the hospital to get medication even when it is available. The nearest medical facility is 53 kilometres away, in Siteki. She lives in Vuvulane, and at least once a month, she is required to go for medical checkups to ensure that she gets the much-needed refill of the medication. Without this medicine, her medical condition only worsens.

Speaking inside her one-roomed house, Vilane, sitting on her bed, said she had no other option than to ask the members of the public for help getting to the hospital. She expressed that she lives in an area known as Khombaso and that many people there cannot afford much due to the high rate of unemployment. "I need to go to the hospital at least once a month for my checkups," Matilda explained, her voice clearly frustrated. But I haven't been able to go for two months now. It's too expensive," she added. According to UChicago Med and MedicalSA., elderly diabetic patients over 60 need regular checkups at least every 2-3 months, depending on their type of diabetes. However, they should never miss their medication dosage.

Matilda's health, and even her life, now hang in the balance because of the steep costs and long-distance she must travel just to receive primary medical care. With no significant healthcare facility nearby, she relies on the Good Shepherd Hospital and the Lubombo Referral Hospital in Siteki for her checkups. But getting there is no small feat, as the 53-kilometre journey costs E700 per trip. This excludes other expenses such as food, especially because she spends almost the whole day there whenever she goes to the hospital.

Despite her pressing need for medical attention, Matilda's financial situation leaves her with limited options. She lives on a monthly stipend of E540 from the Social Welfare Department under the Deputy Prime Minister's (DPM) Office. Elderly people who have reached the age of 60 receive a stipend as a social welfare grant. With a small amount of money, the E700 required to hire a vehicle to transport her to the hospital is far beyond her reach.

She also revealed that the transport fee to hire a vehicle could generally cost more, especially now that she is sickly. She wondered whether there was a facility where health officials visited communities to assist sick people. "This is what happens in other areas," she said. "The E700 was a favour," Matilda says. "Normally, it would have cost even more, but the person who used to take me tried to help by charging less. But even that is impossible for me now." Further, she revealed that the E540 she receives every month barely covers her basic living expenses. She said she always makes hard choices, often deciding between purchasing food or saving money for medical care. The res lt? Matilda has been unable to go to the hospital for over two months. Her medication is running low, and she worries about what might happen if her diabetes spirals out of control without treatment.

Further, she added that she spends most of her time alone. "I live alone most of the time," Matilda explains, "but my grandchildren come to visit me sometimes. Still,   need to be monitored regularly, and without going to the hospital, I feel helpless." Asked what she used to do for a living in her younger years, she stated that she grew up in Vuvulane and unfortunately did not attend school due to poverty all her life. " I grew up very poor and ended up working in the sugarcane fields seasonally like most people in the area until I could not work anymore due to old age," she narrated.

Mambazo Mabuza, the bucopho for Vuvulane under the Mhlume Inkhundla, is one of the few local leaders aware of Matilda's dire situation. He acknowledged the severity of the challenges she faces, not just as an elderly woman with diabetes but also as someone who lives far from the services she needs most. "Matilda's situation is a serious concern," Mabuza said. She needs urgent help. She is an elderly woman, and her health condition makes things worse. The disability and the cost of getting to the hospital are simply too much for her. "

Mabuza adds that one of the community's critical issues is the lack of health motivators, known locally as bagcugcuteli. Health motivators are essential workers in rural areas like Vuvulane, helping to provide necessary healthcare services, deliver medication, and educate the public on hygiene and disease prevention. In some parts of the country, they play a vital role in reaching people like Matilda, who cannot easily access healthcare.

 "In my area, we have two health motivators, and they have been a great help to the community," Mabuza explained. Mabuza lives in a community known as Mgidzangcunu, which is also under Vuvulane and neighbouring Vilane's area.  "I wish we had someone like that in Vilane's community. If there was a health motivator, they could assist Matilda and others who face similar challenges," said Mabuza.

... case should be prioritised to assist woman

VULANE – "We can work on it".

These were the words of the Minister of Health, Mduduzi Matsebula when reached for comment about Matilda Vilane's situation. The Minister, who is also the Member of Parliament (MP) of Siphocosini Inkhundla, said there was a need to ensure that all health services were easily accessible to the communities that needed them. "This is part of our decentralisation," said the Minister.

He said the plan was to reach the 'hard-to-reach' areas.Matsebula said a programme of health motivators (bagcugcuteli) was in place and that these formed part of primary healthcare. He said they were an arm of the nearest clinic.He said arrangements could be made for refills to be done at the community level with the assistance of the health motivators and other health personnel.

... Bagcugcuteli can make life easier for woman

VUVULANE – In rural areas, health motivators, also known as bagcugcuteli, provide a lifeline for residents, especially the elderly and those with chronic health conditions. By delivering medication and offering guidance on health-related issues, they ensure that even the most remote communities can access vital services. In addition, health motivators help educate people on maintaining cleanliness and preventing the spread of diseases, tasks that are especially important in areas where healthcare facilities are scarce.

With a health motivator in her community, Matilda can rely on sporadic visits from family and neighbours. The abs nce of this crucial support system makes her already limited access to healthcare even more precarious.In some parts of Eswatini, health motivators can coordinate with local clinics and hospitals to ensure medication is delivered to those who cannot travel long distances. They also act as a bridge between healthcare providers and communities, ensuring that information about disease prevention, hygiene, and nutrition reaches those who need it most. For Matilda, such a service in Vuvulane could drastically change her quality of life.

Matilda's story is a stark reminder of the challenges faced by many elderly and people living with disabilities in rural areas. The lack of accessible healthcare services, compounded by financial hardship, leaves them vulnerable, where even primary medical care becomes a luxury.The Minister of Health, Mduduzi Matsebula, was reached for comment on the need for more health motivators at Khombaso under Vuvulane. The Minister said the community should choose a person to take the role. The Minister said he was aware of the need for more health motivators as many had retired or left their positions due to various circumstances.

Matsebula said that, as a result, there were areas in the country without health motivators. The Minister noted health motivators played a very important role in the communities as they assisted medical personnel and non-governmental organisations (NGOs). He said health motivators were the first point of contact for community health services and added that challenges such as Vilane's could be resolved.

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