We drove for a couple of hours through twisting roads, up through the hillside suburbs north of Durban. Gated family homes and industrial complexes gave way to townships - higgledy-piggledy mixtures of corrugated shacks, brick-built government housing, and desirable new real estate, all tangled together in a sprawling and vibrant community spread across several miles.
We paused to take a couple of pictures of the landscape, which were photobombed by friendly kids playing in a skip by the side of the road. For the first of many times on this trip, we noticed that one of the kids had a surprising amount of scars and skin damage on his legs and hands.
Our car dropped us off at a small clinic to meet a nurse called Ntokozo.
The sister in charge told us that Ntokozo was busy with a young boy in her care, and would join us shortly. To fill in the time while we waited, she told us about the boy. He is one of several live-in patients at the clinic. Born HIV positive, he is prone to all sorts of complications, infections and diseases. Unmanaged HIV depresses your immune system to an appalling extent. Common colds can become life-threatening. A verruca can spread across your foot and envelope your leg. Last winter, the boy contracted tuberculosis. The clinic nurses feared the worst for him, as he rapidly lost weight. Soon after, he lost the ability to walk or feed himself. The sister in charge told us that Ntokozo worked around the clock to support the boy. She fed him, bathed him, comforted him. She slept by his bed, so she could check him through the night. They became close friends. And, bit by bit, meal by meal, pound by pound, the boy started to recover.
When the boy had to have his head shaved to avoid skin infections taking hold on his scalp, he was scared and unwilling. Ntokozo turned it into a bonding experience. “I’ll do it if you do it too,” she told the young boy.
And so, when a slight, tired-looking female nurse with a shaved head knocked on the door, we knew instantly that this was Ntokozo.
“Call me Coach,” she said as she started to tell us a bit about herself. She has worked with sick people for most of her career, usually as a nurse but also as a health counsellor, helping HIV patients to manage their symptoms and find a way to live life amid the debilitating effects of the virus. Her nickname comes from what she does in her precious spare time: playing and coaching football.
“I might look small, but I am strong and I am fast. When I lived in Ladysmith, I set up a women’s team. I’m telling you man: we were good.” Her quiet tone gave way to a huge smile and a rich, infectious laugh. “I’m telling you: We used to beat the men’s team every time!” Now she plays casually and coaches the kids from the local area. Her face after a game tells you how much she enjoys this.
Over the next few days, we filmed Coach doing two of the things she loves the best and does the most: coaching football and nursing in the local community. She took a couple of days off work to help us, but she never fully switched out of work mode. By the time we met her in the morning she had already done her early rounds, and when she left us in the evening she went straight back to check how the clinic nurses were doing with the live-in patients. Patient issues don’t clock off for the night or take a break for the weekend, so neither does Coach.
HIV casts a long shadow across so many clinics in South Africa. The area north of Durban, where Coach works, is sometimes referred to as Ground Zero for HIV. It is where HIV was first diagnosed, and the reported infection rates in the area are the highest in the world.
HIV brings all sorts of complications, but skin problems are among the most prevalent and most visible effects. If you have HIV you stand a 90% chance of developing complications relating to your skin, according to research by the University of KwaZulu-Natal. In many cases, these begin as common problems - like bacterial infections, or fungal infections - running rife across a weakened immune system. I started to understand why I kept seeing scarring and skin damage on the exposed limbs of some local kids in the townships.
Your skin is the interface between your body and the outside world. It is continuously exposed to germs, bacteria and other foreign bodies, and most of the time it does an amazing job of protecting itself from any kind of damage. But sometimes it needs extra support.
Coach was one of many Durban-area nurses who signed up to attend the free dermatology training courses set up by the Vaseline® Healing Project. Every single medical study we came across cited lack of training as a barrier to proper treatments for skin issues - especially when exacerbated by HIV.
Like most nurses, Coach’s expertise comes through continual experience on the job as much as it does through formal training. So the training setup by Vaseline®, Direct Relief and Professor Ncoza Dlova a leading dermatologist in South Africa, aimed to share knowledge of skin related issues by bringing nurses to workshops as well as treatment clinics with patients.
We accompanied Coach to the training course set up by The Vaseline® Healing Project. It was an intense learning experience but from speaking to Coach she sees the value of learning from the expertise in the room:
“This training will definitely help me with my patients, I see a lot of these conditions when I’m working and now I can understand their issues better.”
When the training was over we drove back to Coach’s clinic and said our goodbyes. And just before we left, we saw the difference she makes to her community. There was a young boy standing inside the gates of the clinic. He smiled, nodded hello, and quietly turned back to what he was doing. He was watching some kids across the way as they played soccer in the setting sun. He followed their game intently, but it was clear he couldn’t join them. He was one of the clinic residents. He was small, but he looked strong and healthy. He was the boy Coach had nursed back to health over the last few months. As we drove away, Coach called him in for his evening meal.