Taking services to young people

When the mobile clinic visits regularly, there’s a lot of changes to that community, to that area, because there’s a decrease in teenage pregnancy, there’s a decrease in HIV. – Debra Lamola, Mobile Clinic Nurse

As the mobile clinic moves through the community to its strategic location for the day, Debra Lamola, a qualified nurse, bounces about on her seat in the front cab next to the driver. Her passion for connecting with and caring for people motivated her to join a mobile medical team offering comprehensive medical services in the heart of communities. In a country where most new HIV infections occur among young adults and adolescents who find it difficult to access health services, providing professional and easy access is critical.

As Debra explains, access to health services  for young people is difficult on a number of levels. The communities where they work are typically low income, so it costs money they don’t have to travel to clinics that are often far away. People have to stand in long queues, and clinic environments can be overwhelming and judgemental spaces for young people wanting an HIV test, dealing with childhood pregnancy and other issues. The result, as she so plainly puts it, is teenage pregnancy and the transmission of HIV.

By contrast, the mobile clinic she works in goes directly to people, providing quick, easy and professional access where it is needed, seeing approximately 30 people a day between 10am and 5pm, and initiating about half of the people tested for HIV on PrEP (pre-exposure prophylaxis). Clinics typically close at 3pm, whereas schools in the area finish between 2:30 and 3pm, so Deborah and her team set up near schools at times convenient to the students.

When working with young people, you must have love for them and you must be patient. And then, when they come to you to explain their problem, you mustn’t judge them. You must just listen.

Debra is light on her feet, moving about the information stand her team has set up outside the mobile clinic with an ease that draws and welcomes people to the space. She knows how to connect with the youth around her. “I enjoy talking to them about life in general. And then when I am with them, I act as if I am the same age as them. When they are 16 years old, I become 16 years old… so that we can have a good communication between me and them.”

Her positive attitude stands in contrast to the difficult and traumatic experiences surrounding her in the communities she serves. Research shows that young people, particularly adolescent girls and young women, are disproportionately affected by HIV and AIDS in South Africa. Her observations and experiences confirm this, as she explains some of the interconnected dynamics that make life challenging for young women. Very often the financial situation within families and communities make adolescent girls vulnerable to older men who, knowing their situation, target them, offering money for food in exchange for unprotected sex. Then, either because the perpetrator doesn’t know their status, or because they don’t care or are abusive, HIV is spread. She explains that many girls are vulnerable because of their age and their lack of agency in standing up to older men. “The main issue that they come to me with is the sexual abuse that they get from their family members.”

She is confronted daily with numerous cases of abuse but she steadfastly provides the medical assistance and information they need, and encourages them to take control of their sexual and reproductive health.

We teach them, girls let’s prevent, let’s use the contraceptive, so we don’t end up with schools with high numbers of teenage pregnancy.

She is not alone in her task. The mobile clinic is part of a network of services that NACOSA helps to equip and facilitate through community organisations like MIET Africa, with funding from the Global Fund. So she can draw on trauma counsellors and a range other crucial services to support young people who have experienced violence.

It was Debra’s mother who identified in her the ability to be a professional nurse. Thanks to her mother’s encouragement, Debra now loves what she does and also sees the impact of it: “The community is happy with us. Wherever we go they tell us – you must come back again next month!”

Photographs and story: NACOSA/AnotherLove Productions