Children line up for their health checks at the Kopana School in Ntabethemba. (Photo: Sue Segar / Spotlight) 
In the small Eastern Cape town of Bizana, hundreds of children stream into a large hall at the Oliver and Adelaide Tambo Regional Hospital on a brisk Tuesday morning in May. There’s a festive but orderly vibrancy in the air – the scene made all the more colourful by different school uniforms and young voices from tiny six-year-olds to pupils in their late teens.
They’ll be assessed, and helped by doctors from Keready, an organisation offering mobile health services in many far-flung communities lacking healthcare services.
For weeks leading up to today, outreach teams from Keready’s mobile clinic operation have gone from school to school, asking teachers to identify children with eye problems. Today they arrived on various forms of transport – some on the back of a bakkie – from deeply rural communities as far as 100km away. Most of the children have little access to health services, particularly eye care, so the response is substantial.
I have travelled here with three doctors and an admin assistant from Keready’s East London office. They join other healthcare staff, including from the health department, for this two-day mega outreach in partnership with the Umbono Eye Project.
“Over the past three months school educators identified 492 learners from 26 schools who have impaired vision,” says Ewan Harris, a pharmacist and consultant by training and a former deputy director-general of education in the Eastern Cape, who heads up Keready’s Eastern Cape team. “We will attend to these learners and if necessary provide them with prescription spectacles and meds.”
Ntombizedumo Bhekizulu, a teacher at Mhlabuvelile Senior Primary School at Ludeke Mission, has come with 16 children, “the ones who struggle to see what we write on the chalkboard”.
A child being signed in for a health check at Bizana. (Photo: Sue Segar / Spotlight)
Bulelwa Mqhayi from Nomathebe Primary School in Isithukutezi adds: “It’s great that they can help these kids. Most of the parents are unemployed and on social grants and don’t have the money to take the kids to specialists. The clinics don’t help us with eye problems.”
The youngsters will also have a range of other health checks and will be sent to see one of the doctors on site if necessary. The health department has deployed a mobile dental unit, an audiologist, as well as a medic to provide advice on family planning and reproductive health.
Before arriving at the registration desk, the children have already been given deworming tablets and a vitamin A supplement, provided by the health department, while each group is given a health talk on age-dependent topics ranging from hand hygiene, to TB and HIV.
After handing in their registration and consent forms, the children have basic vision screening tests with a team of “eye care ambassadors” – young people supported with job opportunities through the Social Employment Fund, which is managed by the Industrial Development Corporation.
Pupils who fail the eye test are sent to optometrist Johan van der Merwe.
In between patients, he tells Spotlight he’s already found a number of “low-vision candidates” and one who might need to be placed in a special school. “I’ve just done a full refraction on one child… It’s clear that he has a lens defect,” says Van der Merwe. Placing his hand on the head of another small boy, he continues: “This little one has been very quiet… he’s struggling to communicate. He needs thick lenses, or an operation by a specialist.”
Van der Merwe, who has been an optometrist for 22 years, joined the Umbono Eye Project permanently almost two years ago after volunteering once a week. “Before I joined I was working in a mall in East London. I never saw sunlight.” He adds: “It has been very rewarding to make a difference to these children.”
At another mobile site, health department dentist, Dr Unathi Mponco, has been busy with youngsters suffering from a range of dental ailments. “There were sore teeth, rotten teeth, mobile teeth, and some children had very swollen gums… Whatever I can treat on the mobile truck, I deal with here – otherwise if they need X-rays or the cases are more serious, I refer them to the hospital’s dental unit for a comprehensive exam.”
In a mobile van outside the hall, health department medic Siyabonga Chonco has been consulting teenage girls all day, offering family planning services. “The Alfred Nzo district has the highest rate of teen pregnancies in the Eastern Cape. We are trying hard to curb teenage pregnancy,” he says.
Optometrist Johan van der Merwe assesses a child at Bizana. (Photo: Sue Segar / Spotlight)
The teens are invited to ask any questions and to say whether they are sexually active and ready to take contraceptives. Chonco says that in almost every case he senses great relief from the pupils to speak to an impartial young person. “They tell me that, at the clinics, the older nurses can be quite harsh… They open up to me, especially with questions about contraceptives.”
Broadly, young people are interested in long-term contraceptives, he says. “They don’t want to have to go to clinics all the time.” Some will walk away with a contraceptive implant – a flexible plastic rod about the size of a matchstick that is placed under the skin of the upper arm to prevent pregnancy over three years – while others choose injectables or pills.
At the end of two days in Bizana, the team has seen nearly 750 youngsters from about 40 schools, with 432 having had their eyes screened and 52 eligible for spectacles. For six of them the specs will be life-changing, says Van der Merwe.
Apart from a few “high” prescriptions that might have to be ordered from overseas, a member of the team will deliver the specs personally to each pupil – a highlight for the team. “When we first put the glasses on their faces, you just see smiles. The parents are so thankful. It makes this so worthwhile,” says Van der Merwe.
Keready is working closely with the provincial departments of health and education. The NGO recently received the Eastern Cape’s Batho Pele Award for enhancing healthcare in the province.
“We could never reach all these children as government,” says TD Mafumbatha, mayor of the Winnie Madikizela-Mandela municipality, adding that “this is what collaboration looks like”.
Where did it all begin?
Keready, loosely translated as “We are ready”, was set up in February 2022 to encourage young people to vaccinate against Covid-19.
One of the people behind Keready is Harris, who was working as a consultant for the Fort Hare Institute of Health when he was asked to help design the Eastern Cape’s Covid vaccine roll-out strategy.
“The Covid programme was a success because, through advanced digitisation, we were able to map the 84,000 communities in South Africa to their nearest schools, clinics and hospitals,” he says.
Out of that awareness of the spatial distribution of healthcare needs, Keready was born.
After the Covid programme ended, Harris, as national lead for the project, was tasked with setting up Keready’s offices in four provinces, including employing provincial leads, staff and doctors and nurses. “Our vision was to give young doctors the opportunity to manage at the highest level, under our guidance.”
Implemented by the DG Murray Trust (a South African philanthropic foundation) in partnership with the National Department of Health, Keready is funded by the German government through the KfW Development Bank.
The project reached full scale late in 2023 with 46 mobile health clinics in four provinces: Eastern Cape (8), Gauteng (16), KwaZulu-Natal (13) and the Western Cape (9).
Doctors Eileen Kaba and Anda Gxolo consult with their little patients. (Photo: Sue Segar / Spotlight)
These mobile clinics move into different communities every day. At times they use a loud-hailer to attract people. Sometimes they are based at schools, other times at taxi ranks and other hubs of activity.
People of all ages who visit the clinics are provided with a range of health services, including screenings and tests for HIV, TB and diabetes, as well as family planning advice and immunisations. Medication is prescribed, and, where possible, dispensed on the spot.
Keready also runs a WhatsApp line where young people can ask young doctors and nurses any health-related questions and get straightforward, non-judgemental answers.
When learning about Keready during a walkthrough of exhibition stands set up at the Birchwood Hotel in Boksburg during the 2023 Presidential Health Summit, President Cyril Ramaphosa described the movement as “NHI on Wheels” because of its efforts in addressing universal health coverage.
From Bizana to Whittlesea
Two weeks later, I am again travelling with the same Keready team – this time to Whittlesea, outside Queenstown. Over two days we visit the Ekuphumleni Community Hall and Kopana School in Ntabethemba. A highlight of this outreach is that teenage girls will be supplied with sanitary pads, thanks to a collaboration with pharmaceutical company Johnson & Johnson.
On day one, hundreds more pupils than anticipated arrive. Principals were overenthusiastic in spreading the word of the outreach, resulting in taxi-loads of pupils from unexpected schools arriving. Irate teachers try to negotiate a way for their pupils to be seen.
Teacher Nolitha Tuta tells me many of the children she has brought are from child-headed households and some have had little to no access to healthcare services.
While waiting in the queue, the mother of a child from Bhongolethu Primary School describes how she walked for hours to bring her child for an eye test.
Despite having waited until the end of the day, students from Zweledinga High end up being driven back home at sunset without being helped.
After two days in Whittlesea, nearly 1,200 pupils from 36 schools have arrived. Nine schools were turned away. Nearly 700 pupils have been screened for eye conditions, with 88 eligible for specs and four referred to an ophthalmologist.
The doctors look exhausted. Dr Anda Gxolo says that over the past two days numerous children presented with ear problems. There were also long lines for dental care this time.
Despite the long hours, Dr Phumelele Sambumbu, who manages five of the eight Keready mobile clinics in the Eastern Cape, says she loves her work. “I come from these parts – from a village between Cofimvaba and Tsomo. My old grandmother is bedridden. I know first-hand how difficult it is to have access to care when you’re from a village like that and when you suffer from ailments like that. The idea of bringing health services to people who would otherwise struggle to access them is what drives me,” she says.
Mapping the need
Based on its relationship with the health department, Keready has ambitious plans to expand its grassroots outreach programmes to help narrow the gaps in healthcare nationally.
A map on the wall of Keready’s office shows the number of government clinics in the Eastern Cape relative to schools. There are about 700 clinics in the province, but more than 5,000 schools (which works out to more than seven schools per clinic). Nationally there are about 3,400 clinics and 25,000 schools.
It’s no surprise then that, according to Harris, staff on Keready’s 46 mobile clinics in the four provinces where it operates cannot keep up with demand for their services.
“Based on our mapping of the national population, we know there are 2,500 communities that don’t have reasonable access to a clinic. Just to deal with the gaps we need 2,500 mobile clinics. We can tell you exactly where in the country to put them,” Harris says.
Children line up for their health checks at the Kopana School in Ntabethemba. (Photo: Sue Segar / Spotlight)
To reach people who are ill but don’t know it, Keready aimed for nurse-supervised ambassadors to do door-to-door visits in communities to check who had TB, HIV and hypertension. “We have digitised every street and every house by satellite. Each house would be marked off; if TB is picked up, it is mapped.”
Plans for the door-to-door programme were well under way. “In the Eastern Cape, Keready has partnered with the Small Projects Foundation to train 80 young people [as nurse-supervised ambassadors] from the Industrial Development Corporation’s Social Employment Fund to do health testing house to house.”
Eventually, says Harris, there could be 80 people linked to each of the 46 mobile clinics, meaning that a total of 3,680 trained people could be going from door to door.
“Going forward we’d want to find the disease before the disease finds us – TB, HIV, hypertension, diabetes and general growth issues [in children] are the core areas we will address in this programme.”
But the extent to which Keready can deliver on its ambitious expansion plans will depend on funding and to what extent the government continues to implement services using mobile clinic outreach programmes. The German financial contribution to the Keready project will end in September. “We are working day and night to get more funding,” Harris says, adding that they will soon be meeting potential donors. DM
Disclosure: Segar was hosted by the Keready team.
This article was first published by Spotlight – health journalism in the public interest. Sign up to the Spotlight newsletter.
