‘Nozizwe.’ The deputy minister of health extends her hand and offers her first name as a greeting to the nurse.
She then turns and greets the patients in a male ward at Don McKenzie Tuberculosis Hospital in Botha’s Hill outside Durban.
About 80% of patients are also infected with HIV and some 30 patients die every month at the 180-bed facility, according to staff.
Her message, like her greeting, is simple: ‘I want you to get better. You don’t need to die of TB or even AIDS. You don’t have to be afraid about AIDS anymore because government is working with the hospitals to fight AIDS. You must make sure that you eat properly. But if the time comes when you are getting sick, you can get pills. Then you will get strong and even be able to run again.’
She then introduces Vuyani Jacobs, who represents people living with HIV/AIDS at the SA National AIDS Council (SANAC).
‘I have asked this young man to accompany me today to bring you a message of hope,’ she says, leaving Jacobs to explain how antiretroviral drugs saved his life four years ago.
Madlala-Routledge is both tall and substantial. When stationary she has a calm presence, but she does not stay still for long, moving surprisingly quickly from ward to ward in elegant black leather running shoes.
She makes a point of shaking hands with patients, even asking one man whose hands are folded under his blankets to bring one out so she can shake it.
Her visit to the hospital is unexpected. She is there at the request of the little hospice that runs from the hospital grounds.
‘I don’t know how they got her number, but one night they phoned her to complain that patients were not being treated properly at the hospital,’ says Mabel Dlamini, Madlala-Routledge’s spokesperson.
Madlala-Routledge asked Lindiwe Mvusi, head of government’s TB programme, to investigate the problems at Don McKenzie.
‘When I got the report, it pained me. I decided to come and see if we can propose some solutions,’ she says.
Aside from Jacobs, who flew up from Cape Town to join her, the deputy minister has brought down a high level delegation from the Department of Health’s Pretoria headquarters, including Mvusi and David Kalombo, manager of government’s comprehensive HIV/AIDS treatment and care programme.
After the hospital tour, the deputy minister heads down to the dilapidated hospice where its founder, Nonhlanhla Mavate, pours out her problems with passion and tears.
Aside from patients being ill-treated, Mavate is concerned that the hospital is not accredited to provide ARVs.
RK Khan Hospital in faraway Chatsworth is the closest government hospital accredited to provide ARVs to the people of Botha’s Hill.
Madlala-Routledge wants her entourage to catch public transport there to experience first-hand how long the trip is. Time is against her so she reluctantly settles for the official cars but asks her driver to follow the laborious taxi route.
At RK Khan’s HIV/AIDS clinic, Chris Jack, the province’s head of HIV/AIDS treatment and care programme, is there to meet her.
While encouraged that Jack has ensured that treatment is available at 50 sites, she is not impressed when he tells her that government tender regulations are hampering the expansion of clinics. ‘Why haven’t you written and told us that? If it is a problem at national level, you need to let us know.’
While Madlala-Routledge is an active listener, she is focused on addressing problems with one of her favourite phrases being: ‘Propose a solution.’
When she tires of the litany of problems at RK Khan, her tone toughens: ‘Sometimes I wish I was back in the army. There, people work according to orders. I could draft an order tonight and send it to you tomorrow.’
Prior to becoming deputy minister of health 14 months ago, Madlala-Routledge was deputy defence minister ‘ an appointment that initially seemed nonsensical as she is a Quaker and committed pacifist.
When reminded of this, she laughs. ‘I was interested to find out what the defence force people thought of me being a Quaker, but they were more concerned that I was a woman!’
She spent her time in the military ‘engaging the department daily on how to use our military resources to build peace and reconstruction, both in South Africa and in Africa’.
One of her responsibilities was HIV/AIDS, and Madlala-Routledge championed a programme to provide ARVs to defence force members.
‘It has felt like a natural move to be directly involved in health as I trained as a medical technologist,’ she says.
However, Madlala-Routledge’s career as a medical laboratory technician was cut short when she became fulltime organiser for the Natal Organisation of Women ‘ a position that earned her three spells in detention, including an entire year in solitary confinement.
In 1994, she became a Member of Parliament and she, her husband Jeremy Routledge and their two sons, Simon and Martin, now aged 23 and 16, moved from Durban to Cape Town.
Madlala-Routledge’s ministerial work means she also has a house in Pretoria and spends a lot of time away from her family. ‘I sometimes have to resort to telephone parenting and that is not easy. But I am a strong believer that women have the right to work and hold leadership positions.’
Health Minister Manto Tshabalala-Msimang has delegated chronic illnesses, mental health, oral health and pathology services to her deputy.
Madlala-Routledge explains that she is involved in HIV/AIDS because, ‘if it is managed properly, I regard HIV as a chronic illness’.
Her immediate agenda is to increase the number of people who have access to HIV/AIDS treatment.
‘Government is investing a lot of money in the comprehensive HIV/AIDS plan. Why is it not reaching people in larger numbers? The people we have on treatment are a drop in the ocean compared to the need.’
Unlike the minister, Madlala-Routledge is clear that nutrition is not an alternative to ARVs.
‘I consider it extremely irresponsible that proponents of nutritional supplements are persuading people not to take or to discontinue their treatment, especially as we struggle against multi drug resistance whose main cause is people interrupting treatment,’ Madlala-Routledge said in a recent speech to the Planned Parenthood Association of SA.
‘I am also concerned when people are asked to take diet supplements whose efficacy and safety is only based on anecdotal evidence.’
From her defence force involvement in HIV/AIDS, she has already established a good relationship with most role players in the field.
‘She is very passionate about AIDS. She has even helped to set up support groups for people with HIV in her constituency in Ugu in rural KwaZulu-Natal,’ says Jacobs, who is also a member of the Treatment Action Campaign (TAC).
The TAC’s Zackie Achmat says his organisation has been impressed by Madlala-Routledge’s compassion, commitment to dealing with HIV/AIDS and knowledge about the subject.
However, spokesperson Dlamini stresses that her boss ‘will meet with anyone. This is part of her style.’
For Madlala-Routledge, reaching out to civil society is an important part of her approach as a democrat.
‘For democracy to be participatory and for the people, government has got to interact with the people. If a distance develops between us and them, then the people suffer,’ she says.
‘Government has to govern. We were appointed to give leadership. This means that we need to offer clear, consistent direction and be seen to be listening even if we disagree.
‘My relationship with the TAC and many other civil society organisations is based on the fact that many of their members struggled with us to reach the freedom we have. They might bring up problems with government, but in the end they all want to help people to access their constitutional rights.’
When I mention that her approach appears vastly different to that of the health minister, Madlala-Routledge says simply: ‘I would prefer us to concentrate on my programme.’
Hers is an unenviable position. Tshabalala-Msimang has antagonised virtually all major players in the HIV/AIDS field and is notoriously confrontational.
However, Madlala-Routledge is skilled at human relations and exudes immense inner strength and quiet self-confidence.
Not interested in the limelight, she is guided by a deceptively simple approach to life: ‘There has to be integrity and openness in everything that you do. If you show openness, others respond to that. Maybe this is my Quaker roots speaking, but I believe in the triumph of good over evil. Good is in everyone.’
Email Kerry Cullinan