Six elderly women sit inside a corrugated iron shack in the Ngangelizwe township in Mthatha, a region with among the highest poverty rates in the Eastern Cape, to share their stories.

Like many South African grandmothers, they have become, in their old age, their families’ breadwinners, supporting both their children and their grandchildren with their pension grants of R1 600 per month.

Academics describe this phenomenon as the “feminisation of ageing”, or the gender switch of the breadwinner role in impoverished communities.

An analysis of the 2015 General Household Survey data shows that the heads of households are predominantly male up until the age of 60, after which women begin to take over the role of breadwinners.

Almost 1.5 million – or 11% – of all South African households are now run by women of pensionable age.

Nozukhile Hadi (60) maintains the vegetable patch of the Sinovuyo Disabled Children’s Centre in Tabase. Picture: Kim Harrisberg

Like many townships in South Africa, the roads between Ngangelizwe’s shacks are narrow and untarred. In the more rural areas, such as the mountainous Tabase region, traditional homes are often difficult to reach without a 4×4.

This, together with a shortage of ambulances, means accessing medical attention urgently is often difficult, if not impossible.

The same data reveal that, for households earning less than R10 000 per month in the Eastern Cape, one in five residents needs to travel between 30 and 90 minutes to access their nearest healthcare facility. (See data analysis by Daniela Q Lépiz from Code for Africa.)

For the elderly and the sick, this journey can mean the difference between life and death.

“The ambulance simply does not come here,” says Nomana Lize, one of Ngangelizwe township’s elderly women residents. “When we contact the call centre, they say there is only one ambulance. This waiting can often lead to death.”

For this reason they will sooner turn towards a neighbour with a car, and being a substitute ambulance has become a business.

“The cost varies all the time,” says Lize. “During the day it can cost R200. At night, the driver will complain that you woke him and charge you R400.” This constitutes up to a quarter of their monthly grant.

In October 2015, the SA Human Rights Commission released a 104-page report into emergency medical services in the Eastern Cape after a two-year investigation that exposed how the provincial government failed to provide adequate medical services to communities.

The investigation included a two-day provincial hearing where residents testified about their health horror stories.

One was Xolise Sam, whose sister Tumeka died after writhing in pain with multiple seizures for a week as they waited for an ambulance to take them to Frere Hospital in East London.

Eventually using their mother’s old age grant, they were able to pay the R600 for a private car to take them, but Tumeka died at the hospital a day later.

“Sometimes we are referred to another clinic, but when we get there, they say they need to save the medication for more serious ailments”

The hearing drew hundreds of Eastern Cape residents with shared experiences, triggering a list of recommendations by the Eastern Cape department of health.

These included promises of 11 new ambulances, 157 replacement ambulances and 10 planned patient transport buses.

The department also committed to achieving, among other fulfilments, a fleet of 667 ambulances leading up to 2021.

Eastern Cape health spokesperson Sizwe Kupelo listed the following actions taken by the department:

. Clinics have been built in Tabase (north of Queenstown) and Baziya (west of Mthatha) to strengthen primary healthcare;

. Nurses have been employed to visit schools under the schools health programme;

. Directly Observed Therapy supporters and occasionally nursing students are visiting the elderly in villages;

. There are currently 411 ambulances in Eastern Cape, as well as three air ambulances and helicopters; and

. 730 emergency medical services practitioners have been employed.

Despite this, stories of medical neglect are still being told in Mthatha.

Marvellous matriarchs:  The grandmothers of Ngangelizwe township use their social networks to care for their grandchildren, share groceries and provide emotional support to one another Picture: Kim Harrisberg

A report by the Rural Health Advocacy Project published last month explores the gaps in the public health sector in the Eastern Cape, both in terms of emergency medical services, medicine stock-outs and medical staff.

Among many poignant case studies, the report cites the story of a 60-year-old grandmother, Philasanda Tonayi from Canzibe, who is forced to carry her 15-year-old grandson, who has cerebral palsy, on her back to the clinic.

His motorised buggy does not get him far on the rough terrain, and taxi drivers refuse to carry the buggy in their vehicles.

She complains of swollen ankles and knees from these trips, but, as he has epilepsy, she knows the importance of these check-ups. He developed cerebral palsy as a result of untreated fits when he was younger.

Tonayi’s story resonates for many Mthatha grandmothers. Once they arrive at the hospital after the walk, accessing medical supplies is the next obstacle.

“The vital medication is often scarce,” says Novotile Masumpa, one of Ngangelizwe’s elderly women.

“Sometimes we are referred to another clinic, but when we get there, they say they need to save the medication for more serious ailments. And they cannot say when they will next get supplies. Siyasokola, siyalamba [we are struggling, we are starving].”

However, the Eastern Cape department of health says this simply “cannot be true” as R3 billion is currently being spent on supplying medicines to all facilities.

“The wheels of change turn slowly,” says Russell Rensburg, programme manager at the Rural Health Advocacy Project, “when you speak to people on the ground, not much has changed.”

Hear their stories:

Despite the department’s claims, nearly 40km away in Dukathole village in Tabase, another group of elderly matriarchs affirms these stories.

“We used to have home visitors,” says Nozinzile Nelani (55), referring to the health workers who would visit the women personally so they could avoid a long trek to hospital. “Now we need to hire our own vehicles.”

Because of Dukhatole’s isolation, the cost of travelling to the clinic is R350, and R500 to Tabase hospital by private car. Nelani cares for her grandchildren while her daughter looks for work in Port Elizabeth.

She is one of many grandmothers who support both their grandchildren and their children when they struggle to find jobs in bigger cities.

“One of my children has severe heart problems. We have to wait for the hospital to organise an ambulance all the way to Durban for her treatment,” says Nelani. Durban is roughly five hours away.

These stories of rural isolation were also captured in a Health-e documentary, Dying in our Homes, that coincided with the release of the SA Human Rights Commission report.

The 13-hour round trip made by elderly matriarch Nolibele Debe from Nqileni village, about 100km south of Ngangelizwe, to Madwaleni Hospital, captured this well.

Suffering from chronic arthritis, Debe would walk over hills with her joints grinding against each other.

She would then catch a boat across the Dludla river, the only means of transport out of the village. In the rainy season, she would be unable to access her urgent chronic pain treatment.

“The pain makes me feel as if the parts of my body are separating,” she said.

Elders of Debe’s village say they have never seen an ambulance in the 70 years they had lived there.

In the vacuum created by inadequate healthcare, the elderly women have banded together to look after themselves and their communities.

In Tabase, the elderly women have come together to support both one another and local disabled children at the Sinovuyo Disabled Children’s Centre.

They work closely with Happy Homes, a home for disabled children in Mthatha, run by disability activist Vivian Vuyelwa.

At Sinovuyo, there are rows of beds holding disabled children whose parents are unable or unwilling to look after them. Outside is a vegetable garden grown with seeds donated by the municipality, that they use to feed the children.

“We, as parents, united in forming this centre after having been affected by the death of one child who died when attacked by bees in the veld,” says community leader Nozukhile Hadi (60).

Hadi appeals to her community not to keep disabled children “under lock and key”.

“God gave us disabled children for the purpose of helping one another and sharing the challenges that we have in raising these disabled children,” she says.

Sinovuyo has also become the place where the elderly women share food and money – and emotional support.

A shortage of accessible water and electricity makes it difficult for them to pursue their dreams of sewing, baking and selling vegetables, although they hope to do so in future.

Gogo’s in charge:  Nozukhile Hadi (60) alongside her community’s grandchildren whom the grandmothers feed, clothe and raise as their parents seek work. Picture: Kim Harrisberg

It is this shared suffering – and the response of the elderly women of Tabase and elsewhere in Eastern Cape – that has helped to hold these communities together.

This innovation is also cited in the Rural Health Advocacy Project report, where they reflect on the innovation of the Mankosi region where residents, frustrated by the void of medical services, decided to pool money together and build their own clinic.

Despite this, the clinic does not have support from the department of health, and patients have stopped visiting it for lack of adequate services.

Because the provincial health department measures “access” by the proportion of people living within 5km of a clinic, many communities led by elderly matriarchs have little access to primary health care.

The mountains also make access to healthcare a painful and difficult journey for the elderly matriarchs, as well as their dependents.

Nevertheless, they persevere.

“We are raising our children by teaching them,” says Nobonile Ngqenge, a mother of six. “What else do we have? We don’t have money, but we are striving to survive, we are fighting.”

This story first appeared in partnership with the City Press.