Gauteng

Cotlands Johannesburg Cotlands – Johannesburg:
Contact number:+27 11 683 7200
Fax number: +27 1 683 6688
Postal address: PO Box 74042, Turffontein, 2140
Physical address: 134 Stanton Street, Turffontein
E-mail address: info@cotlands.org
Directions to Cotlands Gauteng

Cotlands is a long-serving South African 'non-profit' agency that continues to meet the ever-changing needs of children impacted by HIV/AIDS in our country.

South Africa has been identified as the country with the greatest number of HIV/AIDS-infected people in the world. Recent reports reveal that more than five million South Africans are currently living with the impact of HIV/AIDS, while some of Cotlands’ programme focus areas (e.g. Cotlands' Hlabisa Home Base Care project) have estimated infection rates of more than 40% of the total population.

While this information is not new, the impact of these figures is becoming clearer to our communities, our government and the global community in which we live.

'AIDS orphans' (children orphaned by the HIV/AIDS related death of their parents), 'child-headed households' (homes managed by elder siblings often as young as 11) and similar terms are now commonplace in South Africa, yet support for these individuals is still lagging behind growing awareness of the challenges we face.

Our Proud History

Founded in 1936, Cotlands was originally established as a care centre for unwed mothers and their infants, but in the last decade the organisation has evolved into a shelter for abused, abandoned and HIV-positive terminally ill children from birth to nine years of age.

With headquarters in Johannesburg, South Africa, our responsibility has changed in response to the needs of our society and has increased in both the quality and quantity of services we provide.

In the early 90's, Cotlands identified the increasing need to care for children directly impacted by HIV/AIDS, including the development of a paediatric AIDS hospice, the first of its kind in South Africa (1996), offering specialised paediatric palliative care 24 hours a day.

At present, Cotlands is servicing five regions (Johannesburg South and Soweto, Hlabisa, East London, Helderberg and Lydenburg) impacting more than 4200 families either directly (home based care) or indirectly (outreach and counselling).

Expanding services include Home Based Care, community development and capacity-building services in the field of HIV/AIDS on a national basis.

In the past few years, Cotlands has been expanding its services to adapt to the ever-changing socio-economic fallout from HIV/AIDS in our country. Our need-driven evolution has included such innovations as:

A Johannesburg-based AIDS hospice (1996)
Orphan Care (2000)
HIV education for children (2000)
NGO/CBO capacity building (2003)
Helderberg-based paediatric AIDS hospice (2004)

With a staff complement of 208 full-time employees, including an administrative staff of 24 dedicated professionals, Cotlands is constantly adapting to the growing needs of our communities through the efficient allocation of scarce resources.

At present, Cotlands is seeking assistance with funding for the provision of care within our sphere of influence. We are also currently in the process of meeting the needs of the jobless sector through identifying appropriate poverty-alleviation opportunities for persons with minimal skills.

As the world has come to understand, unemployment and poverty are two of the most significant contributing factors to the rapid expansion of HIV/AIDS in Sub-Saharan Africa. Through the increased participation of donor partners, Cotlands intends to effectively manage and grow our services to meet existing and future challenges.

Projects

Proposals

Introduction

Founded in 1936, Cotlands was originally created as a care centre for unwed mothers and their infants, and over the years has evolved into a shelter for abused, abandoned, HIV-positive, orphaned and terminally ill children from birth to fourteen years of age.

With headquarters in Johannesburg, South Africa, our activities have reflected the changing needs of our society and we have increased both the quality and quantity of services we provide. In the early 1990’s, Cotlands identified an urgent need to care for children directly impacted by HIV/AIDS. This focus included the establishment of a paediatric AIDS hospice, the first of its kind in South Africa at that time (1996), offering specialised paediatric palliative care 24 hours a day.

At present, Cotlands is servicing five regions (Johannesburg South, and Soweto in Gauteng, Hlabisa in KwaZulu/Natal, East London in Eastern Cape, Helderberg in the Western Cape and Lydenburg in Mpumalanga)  impacting more than 3 000 families either directly (through home based care and residential care) or indirectly (via outreach, capacity building and counselling).

Care now extends through the whole continuum – from identifying vulnerable children in the community to end stage hospice care for children dying of AIDS. Expanded services include home based care, community development and capacity-building services in the field of HIV/AIDS on a national basis. Cotlands presently offers the following services:

Cotlands Residential Care Programmes

Sanctuary (Gauteng and Western Cape)

Place of Safety(Western Cape)

Hospices (Gauteng and Western Cape)

Children’s Home (Gauteng and Western Cape)

ECDC (Gauteng)

Cotlands Outreach Programmes

Home Based Care (Gauteng and KwaZulu/Natal)

Chris Hani Baragwanath Hospital Counselling Project (Gauteng)

Nutrition Project (Eastern Cape)

Orphan Care (KwaZulu/Natal)

ECDC (Mpumalanga)

HIV/AIDS Outreach Clinic (Gauteng and KZN)

Food Gardens (Gauteng, KwaZulu/Natal, Mpumalanga, Eastern Cape and Western Cape)

Support groups (Gauteng and KwaZulu/Natal)

Income generating projects (Gauteng)

Business Plan Cotlands Chris Hani Baragwanath Counselling Project

Background

It is estimated that some six-million South Africans are currently infected with HIV and more than 200 000 children are living with HIV/AIDS. The latest HIV survey indicates a 29% HIV prevalence rate among pregnant women in 2005, up from 27% in 2003. KwaZulu-Natal tops the list at 49% HIV prevalence among pregnant women, followed by Gauteng at 31%.

Cotlands is able to provide the full continuum of care to vulnerable children with services ranging from home based care of HIV-positive children through to end stage palliative care for children with AIDS. Emphasis is placed on supporting children and their families in the community through various outreach programmes, which include home based care, orphan care, counselling services, and nutrition programmes.

At present in South Africa today, care and support services for children living with HIV/AIDS are somewhat fragmented and uncoordinated. Often in a clinical environment the focus is purely on providing medical treatment and indeed, during the research phase of this project, Chris Hani Baragwanath Hospital’s (CHBH) management identified psychosocial support of the caregivers of children living with HIV/AIDS, in particular, as being an important inadequacy in the services provided by the hospital’s paediatric department. CHBH’s professional staff members are overburdened and unable to provide services over and above their primary responsibilities.

Therefore, the overall aim of the counselling project at CHBH is to complete the spectrum of care services offered to children living with AIDS, as well as their families, by attending not only to their medical needs, but also to their psychosocial, emotional and material needs.

Many South African families have suffered the death of a parent as a result of AIDS, which has impacted negatively on their emotional and financial security. Children in these circumstances often become vulnerable to neglect, malnutrition and abuse. Stigma and discrimination against people living with HIV/AIDS remains a reality in South African communities and this can result in infected children being hidden from the public eye, often suffering in desperate circumstances

Project description

Together with the CHBH and with sponsorship from the private sector, Cotlands has recruited, screened and trained support counsellors, who provide ongoing support to families by counselling caregivers during clinic visits and during hospitalisation of the children. Clinic defaulters and families are followed-up telephonically and through house visits.

Material relief in the form of milk formula and clothing is also channelled wherever possible to the families being counselled, since most of these families are impoverished  living in conditions of lack which are conducive to serious illness.

The establishment of this counselling initiative has relieved the burden on the hospital’s nursing staff significantly in terms of pre- and post-HIV test counselling and improved the support available to mothers of terminally ill children. In the past, many of these mothers sat for long hours next to their child’s bedside with no-one to talk to or support them. CHBH’s medical and nursing teams have acknowledged that they have come to rely increasingly on this counselling service and requested that Cotlands employ an additional three counsellors during 2007. At present, Cotlands employs 9 (nine) counsellors at CHBH.

Home Based Care

Background

Cotlands’ Home Based Care (HBC) project began as a research project initiated by Cotlands on behalf of the National Department of Health in 1999. The Department commissioned Cotlands to develop palliative care guidelines for children living with HIV/AIDS. HBC was a component of this exercise, using Soweto, Alexandra and Thembisa as our urban sites and Hlabisa, a remote district in Kwa- Zulu/Natal, as our rural site. After the research was completed, Cotlands management felt it could not simply extract this critically needed service from the community and decided to continue with the HBC programme as a long term organisational project.

It is estimated that some six-million South Africans are currently infected with HIV and more than 250 000 children are living with HIV/AIDS. The latest HIV survey indicates a 29% HIV prevalence rate among pregnant women in 2006, up from 27.9% in 2003. KwaZulu-Natal tops the list at 49% HIV prevalence among pregnant women, followed by Gauteng at 31%.

Project Description

Our Soweto-based HBC programmes prove that these statistics are a reality in this community, which is struggling to cope with the challenges brought about by the AIDS epidemic. In an attempt to address these challenges, Cotlands has continually added new, value-added components to the original programme.

Although palliative care services for children infected with HIV remain a core focus, we have realised these services alone are not enough to help children holistically. In addition, an increasing number of orphans, not all of them HIV positive, were being referred to our programme, requiring the project to adjust to meet the specific needs of two distinct groups of vulnerable children – those infected with HIV and those orphaned as a result of the disease.

The first level of intervention – ensuring medical care — has also changed a great deal over the past few years with the introduction of antiretroviral treatment (ART). Our initial focus was pain and symptom management, but today we follow a more aggressive treatment programme to help children become well enough to begin ART. To facilitate this process, Cotlands has secured the services of a medical doctor to run a weekly clinic at the centre.

However, ART alone is not enough to ensure good health — proper nutrition is essential. To address this need, Cotlands has introduced material aid in the form of basic food supplies provided to families in difficulty. Without regular nutritional meals, it is impossible for children to comply with the ART regime — and compliance is critical to avoid resistance to the drugs.

Later, after discovering that many of the children were living in granny-headed or single parent households, we introduced support groups for these primary care givers. What initially started as a once a week meeting, has now evolved into support groups offered five days a week at our newly acquired community centre in Soweto. We have also opened an ECDC centre for the children who accompany their caregivers, as this is a wonderful opportunity to offer additional interventions. This development has, however, presented some logistical problems, as we have tried to group the children by age so as to maximise the input we are able to provide. A similar principle applies to the caregivers who, depending on their ages, have many different needs. Experience with our Granny Project has shown us that in separate groups with their peers, these women find far greater freedom of expression. A great deal of planning is therefore required to arrange for the children — and caregivers — of similar ages to come through on the same day.

To further assist the families – parents, grandparents, older siblings or other relatives – Cotlands has introduced income generating projects. Led by our grannies, hand sewn goods, including children’s pyjamas, bags, oven gloves and aprons, are produced under the “Philagogo” label, which means “Live Granny” and the profits made from the sale of these products are distributed among the grannies. Not only does this project provide welcome additional income, but it also provides participants with a purpose and an opportunity for social interaction, while reducing their dependency on Cotlands for material support.

In addition to physical, medical, educational and emotional support, Cotlands helps families to apply for the documentation required to receive social grants, which affords them further financial independence and ensures that orphans are legally placed with family members where required/possible.

The HBC programme strives to fulfil Cotlands’ mission – to provide exceptional models of care to children and their families by empowering them to improve their quality of life through specialised interventions and sustainability projects. However, if we can secure ongoing core funding, we would like to expand this programme to assist many more children and families living in Soweto.

Staffing

This programme is staffed by two professional nurses, one social worker, one auxiliary social worker, an ECDC practitioner, a centre coordinator and nine community caregivers. There are also some volunteers who assist with the distribution of material aid.

Statistics

Activity	Total*
Total number of children seen	200
Referred to clinic	15
Referred to hospital	5
On Antiretroviral treatment	130
Orphans	105

* Monthly average

These statistics do not reflect the full scope of services, as presently they only record the number of direct beneficiaries. However, Cotlands has identified statistics as a quality improvement issue for 2008, and from April this year we introduced a more detailed and accurate information gathering system.

Conclusion

Thank you for taking the time to read this proposal. Should it meet your corporate social investment requirements and you would like further information, the following addendums can be forwarded to you:

Addendum 1 – Activity Plan

Addendum 2 – Organisational Profile

Addendum 3 – Project Budget

On behalf of the children we have cared for, those we are caring for now – and those we are still to encounter, we thank you.

Residential Care Programs

Cotlands 134 Stanton Street Tel: (011) 683-7200

Turffontein Fax: (011) 683-2609

Johannesburg 2190

E-mail:rochelle@cotlands.org

PO Box 74042 Website: www.cotlands.org

Turffontein 2140

Banking Details: Standard Bank

Type of Account: Cheque

Branch: The Glen

Account Number: 200 045 288

Branch Code: 006 005

Fundraising Number: 01 100166 000 5

Non Profit Number: NPO 000-849

Tax Exemption: Section 18 (a)

Exemption Certificate Number: 18/11/13/2029

Auditor: Barrus and Associates

Background

Cotlands has three residential facilities in Johannesburg – our Hospice, Sanctuary and residential care project for older children. Although initially these three entities were regarded as separate units, the successful introduction of antiretroviral therapy (ART) and the associated improved health and longevity of our children, has resulted in children moving through all three units, depending on their needs at any given time. In light of this, we just refer to these units as “residential care”, as their combined services offer the children a continuum of care.

The Sanctuary is a historic unit within Cotlands, established 70 years ago. Physical and emotional restoration is provided to the 42 children being sheltered at the Cotlands Sanctuary within our Johannesburg headquarters. They are cared for in this unit until alternative placements can be arranged.

The Hospice, which opened in 1996, cares for up to 20 children from birth to nine years who are HIV positive and who cannot be cared for by their own biological families, or who have been abandoned as a result of their condition. However, most of the children admitted are suffering from AIDS related illnesses.

Cotlands House, our most recent residential facility in Gauteng, was opened in 2007. Ten clinically well HIV positive children on ART and who attend formal schooling are accommodated at Cotlands House, a group home setting within the community.

All three units focus on providing holistic care to the children to ensure that all needs are met according to their individual medical, developmental and emotional status.

Project description

At present, “well” HIV positive children living at Cotlands’ residential facilities in Gauteng comprise around 70% of all the children we care for and their number is steadily increasing. Most of these children begin their lives at Cotlands in the Hospice, which cares for chronically, acutely and terminally ill children who cannot be cared for within the community. Care offered by a multidisciplinary team extends across the full spectrum to address the medical, physical, developmental and psychosocial needs of the child.

Children are referred to the hospice via state hospitals, Cotlands’ Home Based Care project, other childcare agencies and institutions, and directly by community members. The demand for this service has remained constant over the past few years, so the unit always runs at full capacity.

Since the introduction of ART, the hospice’s clinical focus has increasingly moved away from palliative care to more aggressive intervention. The prime objective is normalising the sick child. Apart from those who are seriously ill, children are encouraged to participate in daily programmes and to assist with daily chores. Older children are enrolled at Cotlands' Early Childhood Development (ECD) centre and they are included in volunteer outings and educational programmes.

Since the introduction of ART the death rate has reduced significantly, from 51 children in 2002, to only two in 2007. While this has been a very positive development in the field of childcare, it has also slowed down the bed turnover rate, resulting in less beds being available for new admissions. Cotlands presently addresses this challenge by transferring recovering children to our Sanctuary section, but because beds are not always available in this section either, the system is at times bottlenecked.

The Sanctuary, in addition to caring for recovered Hospice children, also cares for abandoned, abused, orphaned and/or HIV positive children until they can be reunited with family members, or until suitable community placements can be arranged.

While we cannot avoid the institutional overtones of having to operate the Sanctuary using four shifts of workers and a highly routined programme, by ensuring each child is allocated a personal adult carer and exposing them to many normal experiences – such as an annual holiday, trips to shopping centres, baking in the kitchen, enrolment at Cotlands' Early Childhood Development (ECD) centre, etc — we strive to tip the balances in favour of a more home-like environment.

As far as possible, Cotlands attempts to ensure that the care children receive in the Sanctuary approximates family life, in that children’s experiences are normalised as far as possible, exposing them to similar experiences as children living in the community. The focus is on limiting the impact of institutionalisation and this is accomplished by using volunteers to host children at their homes for weekends and by restricting the duration of the children’s stay in the Sanctuary as much as possible.

However, as a result of the high number of HIV positive children, community placements present a challenge, with fewer families available who feel equipped to deal with HIV positive children than those willing to take on an HIV negative child. We are therefore exploring different models of community care, particularly for the HIV positive children. One such model is Cotlands House, where we accommodate our eight to 13 year-olds who have outgrown the Hospice and Sanctuary facilities. Cotlands is reluctant to transfer these children to other institutions, mainly because ART treatment in children is still a new concept and, apart from ourselves, very few organisations have the experience to maintain the improved level of health these children now enjoy. The other model is “professional foster care”, where Cotlands plans to recruit and train foster parents specifically to care for two to three HIV positive children in there own homes, and offer these families a stipend to cover any additional costs associated with caring for a positive child.

Staffing

Residential care is the most heavily staffed programme, with the ratio of children to staff per shift ranging from four to one to ten to one, depending on the age and health of the children. As this is a 24 hour service, the labour laws and the intense nature of the work dictate that four shifts are required. This programme therefore employs 46 staff members who are either child care workers or nursing staff. In addition to this, we have two cooks, four cleaners, a stimulation coordinator, a social worker and a Department Manager, as well as relief staff to cover posts when staff members are on leave.

Also part of the team are five educare practitioners, a part time physiotherapist and a part time medical doctor. The remaining support staff comprise a hard working maintenance crew and a driver.

Statistics

The scope of this service is reflected in the statistics below:

Activity	Sanctuary*	Hospice*	Cotlands House*
Number of admissions	3	2	0
Discharges	3	3	0
Deaths	0	0	0
On ART	27	6	10
Place of Safety	15	5	0
Fostered	1	0	0
Adopted	1	0	0
Reunification with families	1	2	0