Making clinics youth-friendly
When Nokubonga Ntzimela lost her patient’s card for the local clinic, she was scared to go back, fearing that the nursing sisters would shout at her.
Ntzimela’s experience is perhaps unusual from other 16-year-olds in that she visited the clinic at least once. Surveys show that most adolescents avoid public clinics because they are concerned about being chastised, embarrassed or rudely treated by clinic staff.
Most young people would rather suffer in silence than consult the local clinic staff — who are often judgmental and sometimes even hostile in their attitudes to young people, especially when dealing with matters related to teenage sexuality.
The realisation that the prevailing attitude of many nurses is more of a hindrance than a help to teenagers prompted the formation of the National Adolescent-Friendly Clinic Initiative (NAFCI) as an integral component of loveLife and it’s multi-dimensional campaign throughout South Africa. NAFCI is working with the national and provincial departments of health to accelerate implementation of sexual health services in public clinics that are responsive to the needs and sensitivities of teenagers.
For Ntzimela, the fear of being shouted at for losing her patient’s card was enough to deter her from seeking medical advice. But the loveLife’s Sakulutsha Y-Centre and clinic in Motherwell, Port Elizabeth provided an alternative for Ntzimela.
“I heard from my sister about the clinic. They are very caring and they talk slowly so I can understand,” says Ntzimela. “They told me I must look after my card, but if I lose it, I must not worry. I must come and tell them. I’ve been learning about HIV and AIDS and how we must look after ourselves as girls to prevent the disease.”
Nomalizo Mlisana is a former nurse and now manager of loveLife’s Sakulutsha Y-centre. Her aim, central to the Y-centre concept, is to provide a non-judgmental environment and attractive drop-in site for youngsters in her area. loveLife is piloting in different parts of the country the concept of multi-purpose recreational venues or Y-centres as more appropriate environments for adolescent sexual health education and clinical services.
“Our approach is very youth friendly, we’ve learned to be tolerant and to understand people’s different backgrounds,” says Mlisana. “The idea is to give young people the opportunity to learn and to make informed choices.”
The approach seems to be working. Noxolo Lupseke is 15 years old and lives in Motherwell. “I came to the Y-Centre because I’d heard they were friendly,” she says.
“I feel happy here and free to talk. I’ve heard that in other clinics the nurses shout at you, but that doesn’t happen here.”
loveLife’s Y-centres are operated on behalf of the loveLife consortium by the Planned Parenthood Association of South Africa (PPASA). “We are building on the experience of organisations like PPASA and others in developing adolescent services and taking it to a new level” says Shirley Ngwenya, National Director of loveLife. “loveLife’s goals” says Ngwenya, is not to create a parallel health service, but rather to use the Y-Centres to develop best practices in adolescent reproductive health services. It is these best practices that we hope will inform national adolescent services.”
Other Y-centres have been set up in Orange Farm outside Johannesburg, at Acornhoek in the Northern Province and Kutwalanong near Odendaalsrus in the Free State. Two more Y-centres in KZN and the Easterrn Cape will opne shortly. They offer youngsters a place to come for counselling, treatment and reproductive health advice. They also provide a “trendy” recreational venue where various activities are on offer.
But nurses’ attitudes are changing, says Ngwenya. “Nurses who previously said that kids shouldn’t have [sexual health] services are getting the message. They are starting to see the impact of AIDS and know they need to provide information to youngsters.”
Ngwenya says a recent survey shows that in 1995/96 the average number of adolescents visiting local clinics was between 60 and 65 per month.
“That number is now up to between 170 and 200 youngsters per month. Nurses are playing a major role in providing sexual health information to young people.
“Where you provide support to nurses they do a good job,” says Ngwenya, “and loveLife is one of the sources from which nurses say they are getting relevant information.” ‘ Health-e News Service
| Research by the NAFCI shows that teenagers are starting to become sexually active at an increasingly younger age. By the age of 13 or 14 many South Africans are sexually active. Teenage pregnancies represent one third of all births (330 per 1 000 live births). In 1998, the estimated HIV infection rate among teenage girls aged 15 to 19, increased from 12,7% in 1997 to 21%. This figure dropped in 1999 and stands at 16,5%.The 1999 ante-natal survey showed that 22.4% of women attending antenatal clinics nationally are HIV positive. |
