“Community care should be person-centric and people-centric, and when we talk about person-centric care, it means that I don’t only do what I think you need, I also address some of your needs in a fashion that will actually complement your living.”
Dr. Ellenore Meyer sits in a circle with a dozen community healthcare workers (CHWs) in between containers next to Woodlane Village informal settlement, home to over 8 000 people in Tshwane east. It’s clinic day and there’s the continuation of Covid-19 screening to be discussed, routine primary care to continue, and a variety of new projects on the cards.
As her colleagues say with a laugh, there’s always big plans if Meyer is around. She is clearly a force to be reckoned with.
This is one of four sites in informal settlements around the city that form part of Meyer’s community oriented primary care (COPC) work, and her role at the University of Pretoria’s (UP) Family Medicine department. She and her team, including site managers, registered nurses and a dietician, visit each one at least weekly, but a variety of programs run alongside them.
The core of Meyer’s work, and seemingly its efficiency, is that she sees her sphere of influence as much bigger than direct medical assistance. According to Meyer, there’s a tendency in healthcare professional circles to work in silos, thereby reducing patients to their conditions.
‘Get to know a person’
COPC is her way of playing offensive instead of defensive. “I don’t think you can actually change a person’s health if you don’t get to know or support the person and their needs,” she says.
Beyond primary care, Meyer and her teams focus on nutritional and educational issues.
“We cover everything it seems like,” says Retha Erasmus, executive director of Lift Community Development, who manages several projects at Woodlane Village. She describes Meyer as driven and compassionate.
At Zama Zama, north-west Pretoria, they have built a vegetable garden and kitchen and teach cooking skills to parents who bring their children to the clinic. “They eat the food that we cook, they learn how to prepare it and then they also take some of the vegetables that have been grown there home.” The dietician developed recipes are cheap and nutritious, as well as made with local ingredients.
Education and nutrition
Meyer is involved with monthly assessments of children through early childhood development programs, and the supplementation of micro-nutrients has led to promising results. According to Meyer, malnutrition rates in Woodlane Village have dropped from about 30% to 12% since 2017 and before the pandemic. In her Melusi site there are almost no more children in their programs who are malnourished.
Nutrition and education work hand-in-hand, and the UP team regularly works with schools in the areas where clinics are located. Meyer currently partners with schools and non-governmental organisations to create educational kits for children under five years of age who are at home during the Covid-19 lockdown.
Partnerships have been key to actualising these plans. This includes corporate sponsorships of needed resources, working together with other local organisations and district healthcare services. Meyer seems to have a particular knack for noticing a need and then proactively finding a method or a person to fill it.
She tells a story of her early days at Zama Zama, about seven or eight years ago, when she was running the clinic out of the back of her car and eventually an empty container. “We just put a chair and a table, opened it up weekly, and just said to people ‘Come’.”
She remembers seeing a small child who seemed malnourished, so she gave the mother the medicine needed and asked her to add water to the small container of powder. But, the municipal tanks had not been replenished recently, so there was nothing to fill it with.
Meyer recognised the need and came with water for her clinic day the following week. Some time after this the site was able to get a borehole sponsored by Afgri through a partner school Zama Zama Hope School. “If we really want to address health, we have to look at things that we now tell our patients to do,” she says.
Understanding the community and what it needs is the guiding principle of the COPC work, but Meyer cannot personally know or understand the thousands of residents who may access her clinic. This is where the role of community healthcare workers come in.
CHW key to interventions
These healthcare workers are embedded in the communities, and work closely with the 200 to 250 households assigned to them. While there are also local government community healthcare workers who serve these areas, the ones working with Meyer are paid salaries through the UP Family Medicine department or partner organisations.
“They know their people and they stand with me in the clinical consultation room. They become the second voice to lobby for the patient to defend, but also to fight when they don’t do what they’re supposed to do,” says Meyer.
To illustrate, she tells a story of a woman who came to the Woodlane Village clinic that morning with Covid-19 symptoms such as a cough and loss of taste. Meyer was about to do a test for the virus, but checked in with the allocated CHW, who happened to be the person’s neighbour. It then turned out that the patient had not complained of any symptoms before the previous night, when she and her partner had a big fight.
The CHW advised that she may have just been upset, and Meyer avoided isolating the patient at home for two weeks and attempted to assist her in a different way. She says, “that’s the richness of what we get to do, that we get to hear patient stories and sometimes live through it with them.”
Lineage of care
Meyer’s desire to work with people not only spans throughout her work, but her life. She remembers being as young as five or six–years–old wanting to be a doctor, and pursued medical studies despite being rejected at first. Community-based work is also in her blood.
“I come from a family of activists,” she says.
Her grandmother was a nurse who worked in the black male surgical ward during the Sharpeville massacre. Her great-aunt, also a nurse, assisted Dr. Christiaan Barnard during the research and transplant program that led to the world’s first human heart transplant.
While Meyer’s work looks more like handing out vitamins to children and driving to make house calls with pregnant mothers in the middle of the night, she has a clear dream about how community-centered care can make a long-lasting impact.
“I think more people should focus on bringing the beauty back into medicine. We say it’s a science and an art, but it seems like we’ve lost a lot of the art part.”