Mama Marceline Sangara spends her days travelling between some of Johannesburg’s most densely populated migrant neighbourhoods. As the head nurse at the Jesuit Refugee Services’ (JRS) home-based care programme, Mama Sangara, 53, provides a lifeline to migrants, refugees and asylum seekers who have been marginalised and excluded from public healthcare services.
Besides giving treatment to people who live with serious and chronic health conditions, Mama Sangara also plays a role in a woman’s pregnancy journey, ensuring the mother and baby stay healthy and safe.
Mama Sangara is a mother of three children. She says her work tending to the healthcare needs of migrants, refugees and asylum seekers requires the same compassion and strength one needs to raise children. While she is warm and soft with her patients, she is stern and determined with healthcare workers and officials at the state facilities where her patients are often neglected.
“It’s very difficult fighting with nurses and doctors in the hospital. It is not easy because they will tell you to pay money that you don’t have or they will tell you to go back home,” Mama Sangara says about her work accompanying many of her patients to state healthcare facilities.
During the nearly two years that South Africa has been in a state of disaster to enforce lockdown measures against the Covid-19 pandemic, Mama Sangara has seen a shift in the attitudes of healthcare workers and facilities to provide services to migrants, refugees and asylum seekers.
“For the past two years, since the start of the pandemic, things have totally changed because they [healthcare providers] make migrants and asylum seekers pay money now. Especially when they send them to hospitals,” she says.
“It is quite strange because antenatal care is free of charge. But for pregnant women, once they send them to hospital – to big hospitals – they have to start paying money for consultations and that is not fair.”
The Gauteng Department of Health issued a circular early during the Covid-19 lockdown reclassifying non-citizens as private patients, making migrant, refugee and asylum seeker mothers pay for maternal healthcare services. Antenatal checkups cost between R250 and R400. Natural births in a state hospital range between R5 000 and R8 000, and a caesarean section costs up to R25 000. This is despite the Constitution and the National Health Act ensuring free access to maternal healthcare services for pregnant and lactating mothers and their children under six. If mothers are unable to pay, hospital administrators withhold the notice of birth certificates necessary to register the birth at home affairs.
But Motalatale Modiba, head of communications for the Gauteng health department, has denounced reports that documents are being withheld. “The practice of withholding notices of birth is not supported by the policy and legislation. Hospitals should refrain from that practice,” he says.
The need for informed caregivers
One of Mama Sangara’s more recent patients was Gloria Kalenga*, 36, a refugee from the Democratic Republic of Congo, who gave birth to her third son on Boxing Day. On Mama Sangara’s advice, Kalenga went to the Hillbrow Clinic to give birth after doing all her checkups and antenatal care at Edenvale hospital.
“Even myself, I was surprised. For my youngest child, I gave birth at Hillbrow, it was not the same. I was in Hillbrow in 2017, the nurses I found there just sat there and said push. So the baby just came.
“I was so surprised this time with the new baby, because there were not too many people and the nurses were kind. Even when I went to get the proof of birth certificate they were so nice. They didn’t make any complications,” says Kalenga, who shares a room with her three sons and husband in a house to the east of Johannesburg’s inner city.
Kalenga received the birth registration document for her newborn in January without any problems. “For my first son, it took very long to get his birth certificate. It took four years … For the second one, I went after giving birth and they gave it to me quicker.”
For Congolese parents Patrick Ilunga, 35, and Millene Tshika, 28, navigating the birth of their second child in November was easier than their first because they both have experience as home-based caregivers. Ilunga works for the JRS and closely followed his wife’s pregnancy. But there were complications when their son, Donciel, was born.
“The challenging part was mostly on the delivery day. The staff were not very friendly and helpful. She got tired and she was suffering because of that,” Ilunga says. “It was very complicated but luckily the doctor who was looking after her just passed by and saw her and found that it was a case that he was following. My wife had a miscarriage before this pregnancy and that doctor knew this story very well, so he followed it closely.
“Luckily he came and pushed really hard to help her … It was really a sad time for us because having the professional understanding we knew what was happening and that it was a very complicated birth.”
“I was scared and confused when it was happening. I was asking myself what was going to happen,” Tshika says, holding Donciel close. His sister, five-year-old Gladness, sits next to them. Despite the complicated birth, Donciel and Tshika were both healthy and able to go home soon after the birth.
“I did not leave anything up to the clinic,” Ilunga says. “As a caregiver, I made sure she went for the scans. I made sure that the medication was taken correctly, looking for any dangerous signs for her and the pregnancy. When you are not informed, [the hospital staff] can just tell you anything and you will go with it. But when you are informed, you try to understand that in this stage they should do this or in that stage they should do that.
“So I can make sure everything goes well. If I was not a caregiver and working in these communities, it would be different. If it was someone else, you can just find yourself in trouble and not knowing what to do,” he says.
Tshika says her second pregnancy and birth was easier than her first with Gladness. “Sometimes they reject you at the hospital or they leave you and don’t help you. It was a worry in the back of our minds going to hospital this time,” she says. “Even giving birth to the first one, it was difficult and it took long to get the birth certificate. But now it went better. It helps that we are informed about what to expect at the hospital.”
Mama Sangara says her experience navigating the healthcare system makes pregnancy and birth easier for some patients. “Many foreigners can’t speak English and most of the time when you go with them to the hospital as they are about to deliver, they can’t understand what the nurse is asking them to do, so it is important that I am there to help them.”
*Name changed to protect her identity
This project was undertaken in partnership with Wits University’s African Centre for Migration and Society, Sonke Gender Justice and the Consortium for Refugees and Migrants in South Africa, with funding from AmplifyChange. This story is part of The Endless Journey.