‘€œI am basically the advocate for the patient,’€ Hlakudi explains his role in the Thursday noon meeting where the hospital’€™s medical superintendent, doctors, specialists, nurses and other concerned parties meet to decide the fate of patients.

Although around 113 patients are approved to access the programme at a time. Some are lucky and the medical superintendent can intervene allowing extra patients to be added. However, there are many who are turned down for a myriad of reasons, including drug addiction, unsuitable living conditions, alcohol addiction, cancer, obesity, and an inability to be compliant. Others are not accepted due to the 55-year-old age cut off.

‘€œThe saddest part for me is when people are turned down due to lack of space on the programme or they don’€™t meet the set criteria. Some doctors are not comfortable with breaking the bad news and they often ask me to do this. Often I have to face devastated patients and family who question our right to play God. It’€™s not easy,’€ says the stocky father of three.

‘€œThey ask me how when the death sentence has been abolished, does Groote Schuur still practice it. I understand their pain and anger and I try and assist them as much as I can.’€

Once the devastating news has been communicated, part of Hlakudi’€™s task would include writing referral letters to Child Welfare to facilitate the adoption or fostering of the children once the patient has died, advising patients on their wills and facilitating transport to often rural areas in the Eastern Cape and neighbouring countries.

‘€œIt’€™s hard, but I advise them to go home and die peacefully. I always try to arrange homebased care as hospice facilities are often full or not available,’€ says Hlakudi, sitting behind a cluttered desk in his tiny office.

Hlakudi feels strongly that there needs to be more awareness around chronic renal failure and what can be done to avoid patients reaching this desperate and often terminal stage. ‘€œI think patients are failed lower down. Their blood pressure if not treated properly or they are faced with inhumane queues to access health services. By the time they reach us, they are very ill and you often find they were mismanaged lower down.’€

A Groote Schuur employee for the past 16 years, Hlakudi says the role of a social worker is critical.

‘€œOften you will find patients will trust us more that the doctor,’€ he smiles.

But his face clouds over when asked if there are any patients that have stayed in his mind.

He recalls a 17-year-old from Khayelitsha who developed renal problems. She had cardiac problems and when it was found that her heart was not functioning 100 percent she was turned down for dialysis. ‘€œShe was turned down because she was not a transplant candidate. Two weeks later her mother came to ask me for a death certificate,’€ recalls Hlakudi, his eyes filling with tears.

‘€œSometimes I get angry because we are forced to make decisions on behalf of Government and we are the ones who end up looking for excuses to turn patients down. I hate the Thursday meeting, but we must make the decisions and I must do my homework so I present a full picture on the patient, but inevitably a big part of my daily routine involves death and dying counseling.’€

Hlakudi recalls another patient.

‘€œHe was a 21-year-old boy from the Eastern Cape. He had come to Cape Town seeking an education. He was accepted for dialysis and regained the functionality of his kidneys. He went back to the Eastern Cape to complete his education and look after his siblings after his parents passed away. About three years later he got really sick again and I saw him in casualty.

‘€œHe was so well informed of his condition. He was presented at the panel, but turned down. The reason? His home circumstances. In the shack there was no running water, no toilet and too many people living under one roof. The hemodialysis unit was full and the only space was on the peritoneal dialysis side which is not suitable for his home circumstances. He died in casualty.’€

HIV positive patients are currently not assessed for dialysis at all, something Hlakudi is adamant must be reviewed and implemented as a matter of urgency: ‘€œThese patients are not even discussed, they are a non-starter. It’€™s very hard to see these young patients come in and die, we need to do something.’€

Hlakudi follows a stringent process of assessing patients before presenting them to the Thursday panel. This includes interviews with the patients, family, friends, employers and other healthworkers that have been treating them.