‘€œAg, this air conditioner isn’€™t working,’€ protests Millicent Issel, as she gives up trying to relieve the stifling heat and clings to the steering wheel, guiding the vehicle around a blind bend on the Strykhoogte mountain pass outside Robertson.


In the backseat, Sister Mariana Matthyser wipes the sweat from her forehead. Battling through late summer heat of close to 40 degrees, the two women have meetings with cancer patients on farms in Steenboksvlakte, nestled in the mountains between Robertson and McGregor.


Issel guides the white Toyota Venture down the farm road where their first patient is waiting in the early morning sun in front of his whitewashed house.

The 65-year-old man cradles a ginger kitten on his lap while he fiddles with a guitar he says he is trying to repair. An upright man, dressed in shorts and knee high socks, he leads Matthyser and Issel, a community caregiver, into the simple lounge, adorned with several porcelain animal figures.


Matthyser and Issel work for the Breede River Hospice, which serves a vast part of the fertile wine and fruit valley. Patients include a number of farm worker patients who are often living in homes that are far off the beaten track.


‘€œA farmer once took one of our nurses on a tractor as you need a special vehicle to negotiate some of these roads in the winter,’€ says Maria Demjan, general manager at the hospice.


Demjan says the nurses and community workers have to be skillful in negotiating their way through the dynamics that are often present between the farmers and their workers.


‘€œBut we often find that the farmer’€™s wives are very benevolent and we find a way to work via them,’€ adds Demjan.


At the farm, Matthyser takes about 30 minutes to sort through her cancer patient’€™s medication, over 20 packets of different pills, prescribed by various doctors and hospitals. The man and his wife can’€™t read and find all the medication confusing.


‘€œSometimes the patients need nothing, but you go and visit them anyway,’€ says Matthyser as they drive to the next farm.


‘€œI believe there is always something I can still do for the patient. Even if I just dry their tears or help them to get their will in order. The doctors may tell them there is nothing they can do for them, but for me that’€™s not true,’€ smiles Matthyser.


Back in McGregor, Issel waits in the van as Matthyser visits a patient who has a cancerous growth on her face. ‘€œIt’€™s too sad for me to go inside,’€ says Issel, shaking her head.


Lisa (not real name) sits on a chair in a shack, knitting a light blue scarf.

Her face is swollen on the one side and she struggles to speak, her tongue dragging.


But she smiles as Matthyser enters and wipes the sweat from her face with a faded pink facecloth.


Her eyes shoot full of tears when the women discuss her impending visit to Groote Schuur Hospital where specialists will decide how to proceed with her treatment.


‘€œWe will pray for you Lisa, all will go well,’€ says Matthyser.


Issel later shakes her head when asked how she deals with loss. ‘€œOoh, when my last patient died I had to take three days off. It’€™s very hard for me,’€ she says.


Issel recalls another patient: ‘€œShe lived on a farm and I used to take care of her over weekends. One day she asked me why she always felt different when I was there and she commented that maybe I have the Holy Ghost in me. They moved to town and she called for me. When I arrived she asked me to look after her husband and told me she was now going to leave us. She died in my arms.’€


Breede River Hospice operates with 30 staff members including a doctor, a team of nurses, community caregivers, social workers and a spiritual counselor.


In March the hospice cared for 145 patients, including 60 people living with HIV, 47 with cancer and 38 with other chronic illnesses.


Demjan says the arrival of anti-retrovirals (ARVs) definitely changed matters.


In September 2003 the hospice adopted a programme designed by a Hospice in Kwazulu-Natal allowing for one sister to supervise 10 carers and for each carer to in turn look after 10 patients.  


‘€œIt was designed to allow palliative care to reach the masses of HIV patients being referred,’€ explained Demjan.


By September 2005, Breede River had 135 HIV/Aids patients and expected more.  


‘€œWe saw them all as terminally ill with a very limited life expectancy.   Then the ARV roll out began.   Patients started to get better to the point where their needs changed,’€ recalls Demjan.


A year ago, they had 223 patients of which 134 were HIV positive.  By August  they had  144 patients of which 63 were HIV positive.  


In May, June and July 2006 the hospice discharged 89 patients, most of whom were HIV positive but no longer requiring home based care as ARVs had improved their condition so much that when hospice tried to visit them it would take three or four attempts just to find them at home.  


‘€œSome were working, others had moved back to the city to look for work and others were just out and about,’€ says Demjan.      


Currently most of the HIV patients on the hospice register are referred for a social assessment so that the hospice can facilitate their ARV treatment.     These patients are then admitted to the hospice service and receive a  visit from a nurse or social worker to assess the living conditions and how they will fare on ARVs. The following month they are discharged.      


The remainder are Aids patients that have either not qualified or have come off of ARVs and are categorized as having a limited life expectancy.  


 Asked how they deal with the ‘€œdeath worker’€ tag, Demjan is quick to respond. ‘€œWe are the ‘€˜angels of death’€™.   We cannot move away from that.   But is that necessarily bad?   We’re all going to die sometime – wouldn’t you rather have an angel at your side than be alone?’€