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In Cape Town the rich can access first world health facilities. But in the poorer areas overcrowding, disease and lack of basic services makes voluntary sector provision essential, says Valentia Kadalie.

Cape Town, nestling at the foot of Table Mountain, is a modern metropolis of breathtaking natural beauty and startling contrasts, where first and third world conditions co-exist.

Large-scale poverty is endemic and the spectre of HIV and Aids hangs heavy: while the political debates rage on, our people die. Yet, my chest swells with pride. I see tenacity, courage, ingenuity and a unique sense of humour.

Through the work of the GH Starck centre (assisted living, frail and terminal care) and the Rehoboth age exchange (independent living and community day care services), the City Mission in Hanover Park provides care and services to the vulnerable old. Our motto is "The right to dignity".

While those who can afford private health care have access to world-class treatment, the state health services are in serious trouble. Our community is another that is losing a battle to gain access to appropriate medical and social services.

Housing is formal, low-cost and high density with many families setting up makeshift accommodation in their backyards to alleviate overcrowding. Older people are often found sharing rooms and even beds with younger children or even crowded out of their own homes due to the pressing needs of younger family members.

More than three-quarters of households live in three storey blocks of flats. Many of our disabled elderly are house-bound on the top floor up until we carry them down in wheelchairs to our day centre and carry them back up again later.

Most households have access to electricity but only 4 per cent have electricity which includes a hot water cylinder. Bathing and personal hygiene is hugely challenging for those who are disabled by strokes and are incontinent. Our services include weekly showers, foot care and hair care. We also provide meals, transport, social and recreational activities as well as the services of a multidisciplinary team. For most households, the greatest source of income is from a benefit like an old age pension. Financial abuse and exploitation of older people is a major problem.

With the help of private sector funding, we can now provide day care services that include a geriatrician, nurse, occupational therapist, physiotherapist and social worker.

We provide much-needed respite for families giving the vulnerable old the dignity of access to appropriate care and intervention. With a minimal state subsidy of less than £7 a person a month, we depend heavily on our own fund-raising to ensure that our vulnerable and poor old can receive basic primary health care.

We have also trained four of our elders, all of whom are older than 70, as puppeteers. They made their own puppets and costumes, wrote their own scripts and with them are raising awareness of elder abuse, seniors’ rights and health education.

While the challenges are many, and geriatric medicine and gerontology still in its infancy in South Africa, we are confident we will find solutions that will place the issues of ageing on the national agenda. In this way, we will ensure the right of our old to age with dignity.

Valentia Kadalie is manager, aged care services, at the City Mission, GH Starck centre and Rehoboth age exchange, Cape Town.

Background

• South Africa is 1,219,912 sq km (nearly five times the size of the UK) and has a population of 43.6 million.
• The life expectancy of the population is just over 45 years old (78 in the UK). 
• Ethnic groups: African 75.2 per cent, white 13.6 per cent, coloured 8.6 per cent, Asian 2.6 per cent
• Hanover Park was established in the early 1970s after the forced removal of 66,000 coloured people from District Six. Some 93 per cent of householders do not own their homes; 78 per cent of households live in high-density, three-storey flats; 81 per cent of households have a monthly income of less than £100.