On a dusty street in Siyathemba township outside the Mpumalanga farming town of Balfour, Dr Jana Oosthuizen climbs out of the bright red CitiGolf (on loan from Avis for a year), humps a heavy rucksack full of medical paraphernalia onto her back and heads for the tin shack that is home to five children orphaned by Aids.
The children are cared for by their gogo - grandmother - whose only source of income is her R620/month pension. Nomsa (19) is the eldest of the orphans. She's HIV-positive and her own baby girl died recently of Aids through mother-to-child transmission. The other four orphans are at school.
"I will look after them as long as I live," says Gogo, as Oosthuizen takes the old lady's blood pressure.
Oosthuizen works at the Topsy sanctuary for HIV/Aids children at Grootvlei (FM Focus February 23 2001). The sanctuary is the nerve centre of Topsy's huge holistic home-based care programme, which looks after 711 HIV-stricken families - 3 555 individuals - in surrounding townships. Its orphan care development programme, started in February, cares for 151 children.
The Mpumalanga sanctuary opened its doors 16 months ago. Today, there are 23 "vulnerable" residents, aged between 18 months and 12, at Topsy. Some of them are HIV-positive; others are described as simply needy.
It's the lull before the storm, explains Topsy Foundation co-founder Silja Elena. Sooner or later, she is certain, an Aids "tidal wave" will hit SA. When it does, Topsy, with its exceptional residential facilities, will be ready.
The projections support Elena's fears. The UK's Save the Children charity predicts that by 2005 there will be 1m Aids orphans in SA and 2,5m in 2010.
Rose Smart was government's national Aids programme director at the health department. Now she's an independent HIV/Aids consultant. "They speak about the three waves of the epidemic," says Smart. "First, the people who are infected with HIV; second, those people becoming sick; and third, the fallout as a result of them dying.
"I would say we're clearly between the second and third waves now. The scale of the problem in terms of children is so large we cannot ignore it."
The Topsy sanctuary's Rufford House central facility can accommodate 150 children and there's room for a couple of thousand more at its nearby village in 23 six-room house units once occupied by miners. Full-time staff include a doctor, a registered nursing sister, a social worker, eight care givers and six crèche staff.
Government policy is against institutional care for HIV/Aids children or Aids orphans. To date there has been just a trickle of referrals from Mpumalanga social services.
Until the tidal wave hits, the staff at Topsy are kept busy with training, the outreach work in surrounding townships, a crèche at the sanctuary for 75 local children and activities such as candle making, ceramics and pottery. And, most importantly, preparing for self-sufficiency should big business begin to suffer from donor fatigue.
Oosthuizen spends three days a week visiting townships in Topsy's two-pronged community programme of home-based care and orphan care. "I love children, I love working in the community," she says. "I love going into somebody's house and giving them something to make them feel a little bit better ."
Educating their employees about HIV/Aids has become the priority for corporates. Ignorance of the basics is illustrated by the experience of Oosthuizen's field co-ordinator, Mapule Motloung. A long-time resident of Siyathemba, Motloung says: "I find the people who are sick and tell Dr Oosthuizen. The HIV infection rate is bad here. We find many new patients; two or three new ones every day.
"Many die. The work is a challenge. When we hear there is someone who is sick, we must introduce ourselves. We tell them we are coming from Topsy.
"When we started, the people said: No. You come with your HIV from Topsy Foundation. Your tablets have HIV or Aids.' They think the medicine is the HIV. I say: No, that's not true. Doctor is here to help, not to kill anyone or give HIV in medicine.' "
Despite the small number of HIV/Aids patients at the Topsy sanctuary, children and mothers have died there. The administrators follow government's line of eschewing antiretrovirals; standard treatment remains vitamin pills and prophylactic antibiotics.
For one child, though, the administrators have relented; antiretrovirals are being given to a four-year-old boy.
Says Oosthuizen: "I phoned Silja (Elena) and said: We're going to lose this child.' His mother had already died . His CD4 cell count was down to 200."
No problem, said Elena. Oosthuizen shopped around for the cheapest antiretroviral package she could find - R570/month. Today, after three months, the little boy's cell count is up to 500. "That's safe, though he'll stay HIV positive," says Oosthuizen. "He's doing unbelievably well."
Oosthuizen is looking forward to the day when antiretrovirals are widely available at Topsy.
Elena agrees that multivitamins and antibiotics aren't the answer to Aids. "They help to boost the immune system, but when you get to a certain point , they can't be effective any more," she says.
Topsy's initial ban on antiretrovirals, Elena explains, "was just in line with government policy. But when you look at a child and know that if you don't give medication he is going to die, how can you allow that with a clear conscience?"
Topsy enjoys generous support from the private sector. R1m seed money came from the Rufford Foundation, a UK charity. Sasol has pitched in R616 000 over two years. Old Mutual paid R200 000 for the ceramics and pottery studios. Iscor has donated corrugated iron roofing sheets. Bidvest put in an industrial kitchen for Rufford House.
JD Group has just increased the R7 500/month it donates towards running costs to R10 000. Frozen fish company I&J plans to raise R600 000 through a cause-related marketing campaign. The money will be used to refurbish and kit out a clinic at Topsy.
Surrounding farmers and the local butcher are generous with food. But a steady flow of funding is essential for Topsy's survival. The Rufford Foundation now pays the salary of a newly recruited fundraiser, whose brief is to bring in at least R2m without too much delay, though if he manages R20m there will be no complaints.
But will there still be money for ventures such as Topsy as corporates become aware of the threat of HIV/Aids in their own workforces and run costly programmes to tackle the pandemic?
In preparation for this, Topsy, which has running costs of R120 000/month, including refurbishments, plans to become self-sufficient. The aim is to build up a capital base and run the sanctuary on the interest. So hopes are pinned on the latest onsite project, a brick-making venture run by Peter Kaufman, retired businessman and father of Topsy co-founder Duke Kaufman.
Sasol has given two brick-making machines and production is already running at 6 000 bricks a day. Peter Kaufman says brick sales could generate R100 000/month profit for Topsy, on turnover of R180 000. One contract to supply a local housing project is expected to generate R500 000 for Topsy.
"You can't shake the little tin in front of people every day," says Kaufman. " We must look after ourselves."
The project has created 22 jobs. Ingredients for bricks are fly ash, cement and crusher sand. A nearby mountain has enough free fly ash to last 100 years. Cement is the costly item. "We'd love to find someone to sponsor us, just to get going," says Kaufman.
