Among many other professions she could choose from, Mabuyi Mnguni consciously chose to be a nurse. 40 years on – having made her mark as one of South Africa’s most experienced nurses in the field of HIV/AIDS care – she has few regrets. This International Nurses Day we share her remarkable journey.
Mnguni trained as a nurse at McCords and St Mary’s Hospital in the early 80s, where she developed a passion for community health. She started her community work in satellite clinics as a young 22-year-old nurse in 1982, in the Ugu District of KwaZulu-Natal.
It was barely one year since the first ever news report on HIV/AIDS came out in the New York Times. No-one knew what this mysterious illness was, why it presented like a contagious cancer, what it meant for society, or how it would reach its highest global prevalence in South Africa – in communities like the ones that Mnguni served – decades later.
“I remember well entering a shop around 1987. The shop owner who heard I was a nurse asked me if I knew anything about this new disease called AIDS. Very little was known. About three months later, the news of this disease being present in our country was everywhere. The dark thread of HIV quickly became woven into the very fabric of our country.”
“We really started seeing people getting sick from this new illness from the late 1980s. It was a scary time. All through the 90s people came into our facilities emaciated and very sick. From 2000 until about 2010, KwaZulu-Natal had the highest proportion of people living with HIV and AIDS in the world. We were right there on the front lines while it was devastating our community,” recalls Mnguni.
The pandemic was destroying families and communities, with a direct impact on socio-economic realities. The Ugu District, in the southern KZN province, had a population of about 700 000 in the early 2000s, and an HIV/AIDS prevalence rate of 35-38%. “Perhaps most shockingly, 49% of pregnant women were HIV positive. AIDS had become the leading cause of death, accounting for 54% of all deaths in the province. The death of children was already estimated at 16% in Ugu. It was heartbreaking, because antiretrovirals (ARVs) were not yet available,” she says.
Collaboration in the early days
The high prevalence of HIV and AIDS was no longer just a health issue. It affected every aspect of community life from the local economy to governance, service delivery and more. “It resulted in the fragmentation of services and poor mobilisation of resources. Whilst community-based organisations had to focus on their donor-driven projects such as social welfare issues, all departments in government were overburdened and incapacitated by limited resources and a lack of support.” Around the same period, communities were also ravaged by violence resulting in further devastation of their homes and families.
Mnguni and her colleagues in the Department of Health had to learn to work together with various stakeholders such as community volunteers, politicians, sector governments, religious sector, civil society, concerned individuals and community-based organisations to fight the pandemic that was ravaging their communities.
“Multisectoral collaboration became a viable option,” she says.
Mnguni also shares many initiatives that were undertaken, such as the MEMORY Box project. Parents that were clearly dying were encouraged to write messages and details about themselves, even including pictures, for their soon-to-be-orphaned children. “Our patients placed their most special items and documents in small boxes, which we kept at Hospice for the children, later to be given to the children so that they could one day make sense of what happened.
In the late 1980s, 1990s and early 2000s, it was common to see hospitals overwhelmed, with sick and dying people everywhere and health workers on the edge of burnout. “I remember feeling so tired and overwhelmed. At the time it became an obsession for community health nurses to achieve the goal of ‘Health for All by the Year 2000’ through the vehicle of primary healthcare, so that’s what I focused on.”
In 2003 the US government launched PEPFAR, the single biggest global effort to tackle HIV treatment and care. The unprecedented funding and collaboration between local health departments and other stakeholders allowed for mass ARV distribution. “That’s when I started to feel hope. Community care givers were also trained to provide counselling and palliative care services in the patient’s homes. This made a big difference.”
During this time, nurses became a vital line of defence against the spreading pandemic. In 1992, whilst she was a primary healthcare trainer, Mnguni had an additional role of coordinating HIV and AIDS programme when AIDS was identified as a real crisis in the Ugu District. In 1999 she was sponsored by the American Embassy to study Cultural Diversity focusing on HIV and AIDS in San Fransisco, USA. This led her to join “the NGO family”, initially as a Deputy Director at South Coast Hospice and later in the Ugu District Municipality in 2004 to manage the HIV and AIDS programme in the Mayor’s office.
She joined BroadReach in 2014 as a Health Systems Strengthening Manager in Ugu, a global social impact business that was implementing PEPFAR and USAID HIV treatment and care programmes in South Africa and specifically within her rural district of Ugu. Today she is the COVID-19 coordinator in the BroadReach Ugu office, applying her vast management experience to pandemic threats in the area.
Mnguni recounts meeting Dr Ernest Darkoh, co-founder of BroadReach Group, in 2003 when he first visited the district to help set up systems at Murchison Hospital. “Ernest had the ability to make everyone around him feel important, with his natural gracefulness, he harnessed the diverse talent with ease to form a team. The district was setting up the AIDS Council at local and district level. It was a great honour and privilege to have BroadReach on board to bring a broom of efficiency, and a greater level of collaboration and support between the local Department of Health, international funders and local health workers to fight HIV/AIDS.
A pivotal moment for HIV treatment
“At the time, we helped introduce antiretroviral (ARV) medications in state health facilities, and soon realised that we needed to take a holistic approach to manage community and social issues in tandem. There are many issues that contribute to making people more vulnerable to HIV infections, such as poverty, gender-based violence and lack of education. We needed to do more to fill these gaps.”
In these early years, BroadReach provided training for community care givers, who were at the coalface of AIDS at community level. They also developed and facilitated training for Operation Sukuma Sakhe – a strategic platform for scaling up activities to fights AIDS and poverty – and they supported the AIDS Council at all levels. The collaboration they supported received international recognition, in a multi-country scientific study on the efficient management of HIV in poorly resourced communities.
For Mnguni, the real game-changer in the trajectory of the pandemic was when nurses like her were certified to prescribe and administer ARVs. “That’s when ARV distribution really took off and we started saving more lives. Patients no longer needed to wait in long queues for the doctor to see them at regional hospitals. Nurses could dispense their ARVs in communities.”
Mnguni recounts how those on the frontline organised themselves in the early days of the AIDS pandemic: “Resources from formal and informal sectors were allocated and mobilised, and the focus on localisation of healthcare efforts, which is now one of USAIDS’s top priorities, started taking shape. Funders or donors were guided at a multisectoral level on where and how best to support. Anyone who needed to provide support of any kind or had anything to offer was given a platform at the AIDS Council. Similar structures were set up at a local and ward level. Sectoral plans and financial and human resources were all shared.”
Their efforts paid off. “The best achievement of multisectoral collaboration in Ugu was that HIV and AIDS became a managed and manageable chronic disease. By 2019, Ugu District became the first district in SA to achieve the United Nations’
90-90-90 targets.” These targets refer to 90% of people knowing their HIV status, 90% of those going on ARVs and 90% of those reaching viral suppression.
“If I look back at how far we’ve come together, it makes me proud and gives me hope that we can see an end to new infections in my lifetime, when no-one in my community is spreading HIV, no babies are born HIV positive or dying from AIDS anymore. To do this, we need to keep people on treatment so that we can maintain viral suppression throughout our communities.
“The last thing we want is for AIDS to come back because people are complacent. It was too hard a journey – we must protect our victory and keep the next generation from experiencing what we faced in those dark days. Knowing that we’ve given people the chance to live their lives to their full potential is what gives my life purpose and what still gets me out of bed in the morning. Seeing the progress we’ve made makes all the sacrifices of my long nursing career worth it, a hundred times over.”