‘€œDo you think Sizakhele is still alive? I doubt,’€ says Sister Vicky Sikhosana to her nursing assistants, as she puts the bakkie into first gear and charges up a rough track.

‘€œThis girl was so sick when we saw her last week,’€ explains Sikhosana. ‘€œShe had been living with her boyfriend in an informal settlement in Sydenham [Durban] but he hired a car and brought her back a few days before we saw her. She was moaning and she couldn’€™t even talk she was in such pain.’€

Sizakhele’€™s mother, Themba Mhlongo, is washing a diarrhoea-stained duvet cover when we arrive. She turns her milky-blue eyes towards Sikhosana, struggling to make out her visitor.

Semi-blind and stiff from a fall, Mhlongo is unable to do essential tasks for herself such as fetching water from the river. Yet she now has to care for her very ill 33-year-old daughter plus a four-year-old grandchild her other daughter left with her.

‘€œI was very, very hurt when she came back. I can’€™t explain how painful it was. I thought I was going to have a heart attack. Why did they bring her here?’€ says Mhlongo, of her first-born child.

Mhlongo had last seen Sizakhele, who worked as a cleaner at a Durban school, six months ago. Her daughter didn’€™t even come home for Christmas.

‘€œShe didn’€™t bring anything with her, not even a face cloth,’€ laments Mhlongo.

While doing her Wednesday rounds in semi-rural Dududu south of Durban, Sikhosana was told about Sizakhele and went to find her.

‘€œI had to counsel Mrs Mhlongo. She was very bitter and angry. I had to explain that Sizakhele has nowhere else to go,’€ says Sikhosana.

But today Mhlongo seems more accepting of her daughter, pleased that she is not only alive but little better, thanks to help from her neighbours, a community health worker and hospice.

Sizakhele lies on a thin mattress covered in thick blue plastic on the floor of her mother’€™s hut. Her lips are thick with dry blood. When she tries to speak, emits a high-pitched whisper amid gasps.

Her eyes are large and very fearful, swinging from person to person. She sobs deeply when offered words of comfort.

HIV has weakened Sizakhele’€™s immune system, and she suffers from TB, thrush and diarrhoea. Small smears of diarrhoea mark the wall alongside her mattress.

She has been unable to get TB drugs from the local clinic since she arrived as her boyfriend did not bring her clinic card with her.

Sikhosana takes a greasy brown scrap of paper with a number on it from Mhlongo and dials Sizakhele’€™s boyfriend to find out where she was being treated for TB. She then contacts the social worker at Khanya Hospice back in Umkomaas who promises to track down her records and get them faxed to the local clinic so she can get TB treatment.

‘€œIt is very common, this bringing people who are sick in informal settlements back to the rural areas,’€ says Sikhosana. ‘€œI much prefer to work in the rural areas. At least there is the chance of people growing some food for themselves. Also there is still this spirit of family members supporting one another. People in the informal settlements often die all alone because their partners run away once they get sick.’€

Sikhosana takes blood from Sizakhele so that her CD4 count can be measured to see whether she is ready for antiretroviral medicine. She leaves behind a pile of adult diapers, latex gloves, a bag of old clothes and a packet of donated bread rolls.

‘€œI’€™ll see you next Wednesday,’€ she tells Mhlongo.

Every little valley in semi-rural Dududu has at least one Sizakhele.

Sikhosana wrestles with the wheel of her bakkie like a rally driver as she drives up bumpy roads and down narrow tracks covered in grass, khakibos and lantana in search of her patients.

Sixty-three-year-old Vuyani Msindisi is already dead when we arrive.

‘€œDon’€™t tell me,’€ says Sikhosana in a low voice when she sees his relatives sitting together under the avocado tree, heads covered.

‘€œLast week, about midnight,’€ says Msindisi’€™s daughter, speaking to Sikhosana through the window of the bakkie.

‘€œHow can he do this to us? He was so sweet,’€ she says, spinning the vehicle around to see the next patient.

All day Sikhosana and her three nursing assistants visit the dying, the recovering and sometimes the already dead.

AIDS is the major cause of all deaths and suffering ‘€“ from small screaming babies to a 75-year-old man who died last year.

‘€œIt is very disturbing to see entire generations that are HIV positive, from grandparents to little ones. It is very hard to bring hope in these circumstances,’€ says Salisha Lauton, the hospice social worker.

‘€œEven though there are foster care grants, many parents made no plans for the future and their orphaned children are in very difficult social circumstances. Many of them don’€™t go to school as there is no one to encourage them,’€ says Lauton.

Little Ayanda crams as much bread into her mouth as possible, using both hands to shove in the dough. Then she coughs, most of the bread falls out and the toddler bursts into tears.

Ayanda’€™s mother disappeared last year when the first payment of her disability grant for AIDS came through. A few months later, she crawled home and died. Six months before, her father had also died from AIDS.

Ayanda’€™s widowed grandmother brings the little girl to the Dududu drop-in centre every day, a place that offers HIV tests as well as a care programme for orphans.

‘€œShe is not well today. She has a terrible cold,’€ the grandmother tells Sikhosana of her light-skinned granddaughter, who also lives with HIV and whose father is unknown.

Eighteen-month-old Philile has also inherited HIV from her mother. Her mother died and her father disappeared.

Philile’€™s 22-year-old aunt, Sindiswa Ndlovu, was forced to give up what piece work she had to come and care for the baby. Her mother is an alcoholic who drinks away her pension at the family’€™s home in the informal settlement of New City, KwaMakhutha.

Sindiswa, her two children and the baby live off a R190 child support grant, although hospice has helped Ndlovu to apply for a foster care grant for Philile.

Social problems in the impoverished areas covered by Khanya Hospice are routine. There is a noticeable lack of men ‘€“ as fathers, patients and partners.

There is also often a deep fatalism, where the sick seek help too late, or not at all.

Hospice workers are like mobile social workers as well as nurses, seeing to people’€™s physical needs as well as trying to act as a bridge between their patients and estranged family members or indifferent officials in the Department of Home Affairs and the local clinics.