COVID-19: Government interventions have mixed reception in communities
On the evening of 15 March 2020 President Cyril Ramaphosa declared a national state of disaster and in so doing declared ‘war’ on the COVID-19 (Coronavirus Disease 2019) pandemic.
It is now 8 days later.
It is also just hours before the President is expected to address the nation for a second time on the COVID-19 pandemic with some calling for a stricter lockdown of South African society to slow the spread of the virus.
A lot can happen in a week.
In the week following Ramaphosa’s declaration, many facets of this battle plan were unpacked by the various ministers in command of the respective portfolios – Health, Transport, Home Affairs, Cooperative Governance, International Relations and Cooperation, Defence and Police to name a few.
But it was the day before Ramaphosa’s announcement – a Saturday at the University of Cape Town’s Health Sciences Faculty during a public seminar on COVID-19 that captured the changing social dynamics and where the COVID-19 pandemic is taking our society in terms of fear, trust and how we relate to each other.
Community healthcare workers, health activists and nurses from areas like Tulbagh, Ceres, Gugulethu and Khayelitsha attended the public seminar hosted by the People’s Health Movement of South Africa (PHM-SA) to discuss the impact of the COVID-19 pandemic especially on poorer communities. There were many concerns and questions – some of which even after a series of official public announcements and bold interventions by government, still remain unanswered.
Initial Concerns, questions and no easy answers
Many of the community healthcare workers at the meeting felt they need more information and protection to serve their communities better. One community health worker (CHW) who introduced herself as Ntombethemba from Khayelitsha said CHW’s feel vulnerable. We don’t get equipment like masks and gloves. I will feel better if government can provide that. We look after very old and vulnerable people. We move from one patient’s house to the next house,” she said raising concern that both community health worker and patient is at risk. She wanted to know what the plan is for community health workers amidst the COVID-19 pandemic.
A community health activist from Tulbagh said there is very little information getting to the rural areas. Issues around late presentation, also for other diseases unrelated to COVID-19, was raised because some people will stay away from health facilities out of fear that there will be too many people. One health activist said the City of Cape Town still persists with water-cuts for non-payment and that she’s been without water for days.Other concerns related to jobs and people who can’t afford to stay at home as well as public transport especially the safety of minibus taxis many people rely on.
Dr Louis Reynolds who’s affiliated to the PHM-SA, in response to the concerns raised Saturday said this shows how behind South Africa is with improving the social determinants of health. “We are 30 years behind where we should be in terms of housing, sanitation and this pandemic will show us how important public goods are.” Reynolds said this pandemic also shows how “one combined health system can deal with something like this better than a fragmented one”.
Another woman who introduced herself as a professional nurse asked if hospitals are really ready? “I’ve worked in ICU where we need equipment but hospitals are more concerned about cost savings. There are also staff shortages, and many of the healthcare workers had no training to deal with COVID-19, she said.
But that was then…
Action plans and declarations
Since last Saturday government has taken bold and decisive steps to mitigate the threat posed by a full-blown COVID-19 epidemic in South Africa. Ramaphosa’s declaration triggered a range of measures to curb the spread of COVID-19.
Even the choice of words thereafter changed to ‘war speak’ with Health Minister Zweli Mkhize telling South Africans the spread of COVID-19 makes it time for ‘hard combat’ and that everyone is a soldier who amidst calls for social (physical) distancing should work hard at not causing their own mini-outbreak.
Mkhize in outlining preparations for government’s COVID-19-plan last Monday said health workers are trained on coronavirus and health facilities are being prepared. He assured the public that public communication will be intensified, especially on radio and through pamphlets and he said that government is engaging with local councillors, community health workers, church and community leaders and traditional leaders.
He also acknowledged: “The strain of inequality in our society is probably most visible at this point. The outbreaks we have to deal with – it always needs more resources particularly in the rural areas or poor areas. We’ve dealt in the past with cholera, we’ve dealt with malaria, and others. We just came through listeriosis so the focus on underprivileged communities is actually the thrust of why we take this route,” he explained. The minster said they will also rope in community health workers and Expanded Public Works workers to help spread information and assist in augmenting the department’s tracing teams.
On the ground
Since then the tally for confirmed COVID-19 cases has risen to 402 (on 23 March). It is not clear how many of these were local transmissions or imported cases.
Mkhize last week warned that as internal transmission sets in and once this infection starts spreading in taxis and buses, it will create a new dynamic. “When this outbreak starts to affect our poor communities where families do not have enough rooms or spaces to quarantine those infected, we will experience a crisis,” the Minister said. “Therefore, it is important for us to start preparing accommodation for such an eventuality. This means that patients who do not necessarily require to be admitted in hospital, they will be placed in those quarantine facilities identified by government. We are appealing to provinces to start preparing possible quarantine sites.” Local government is also roped into this effort to identify possible quarantine sites.
Transport Minister Fikile Mbalula urged taxi associations to take necessary precautions. He also announced random screening at taxi ranks. The national taxi-association Santaco had since then introduced its own infection control guidelines for taxi ranks, taxi drivers and commuters that will be rolled out to all provinces. The Corona Prevention protocol, as it is referred to, include guidelines that taxis in every province must comply with. Santaco spokesperson Thabiso Molekwane told Spotlight last week Santaco sees its taxi drivers as ‘ambassadors’ for prevention. “We are providing our drivers with gloves and hand sanitisers. He said KwaZulu-Natal, Western Cape and Gauteng is starting to implement this but other provinces have been slower.
Molekwane said Santaco is also following up weekly to monitor progress. When asked how Santaco deals with drivers who do not comply, Molekwane said: “This pandemic is bigger than any punitive measures we can take. The idea is to rather inculcate that sense of responsibility and understanding with our drivers. We need taxi drivers, commuters, rank managers – all of them to work together. We need all hands on deck for this to work.” He also invited commuters to feel free to contact Santaco’s provincial offices with concerns.
In the Western Cape, Alan Winde, premier of the province, on Wednesday said busses are disinfected every 24 hours and people were urged to not use overcrowded busses.
On the farms
Community activist working among farmworkers Wendy Pekeur told Spotlight on farms in the Winelands and Boland area there are mixed feelings about the pandemic. Pekeur told Spotlight last week she found on one farm in Ceres, where there were more than 200 workers working in a pack house, the farm management provided safety measures like hand sanitisers and taps have been put in place. “They also provided farm workers with information about the virus, but their (farm workers’) concern is the fact that they are still so many workers working in close proximity. The workers want to know given the President’s address especially on the size of gatherings, where these workplaces fit in.”
One farmworker from Stellenbosch, Sara Claassen said she still has many questions about the virus. “But testing for fever happened yesterday and today on the farm. Tourists still visit the farm, but it had been quiet.” Pekeur said in some other farming communities like Klapmuts there have not yet been programmes or interventions. According to her, there was a mobile clinic in Elsenburg who provided masks to farm workers in that area. “The problem is that most people get their information from social media. The Department of Agriculture does not seem to have a proactive programme ensuring farm workers and owners take precautionary measures.”
According to Pekeur some farms have closed down some operations, especially after a tourist who visited a wine farm tested positive. “On one of these farms workers were told they can stay at home using some of their sick leave. But for other farms it is business as usual. Stricter measures must be put in place to protect workers whose jobs are already insecure. There are still too few wine tasting facilities that are closed. Many others are still in operation. There is no ban or proactive testing of all tourists which put all efforts to mitigate the spread at risk.” She also urged government to consult these communities as ideas must be generated from people in these communities on how to better protect vulnerable communities.
Meanwhile a group of community activists from Khayelitsha is gearing up for a protest over water cuts at the sub council offices of the City of Cape Town in Khayelitsha tomorrow (Tuesday). Qaba Mbola, a community activist, told Spotlight an estimated 1 000 households are affected by water cuts. By Friday last week, the City of Cape Town sent out a notice that water cuts will be suspended amidst the COVID-19 pandemic. However, according to Mbola there’s been water cuts of 100 non-paying households per day running up to the time of the notice and the water supply has not been restored in full. “How can they put money before people’s health? And they have not just been disconnecting water in Khayelitsha – there’s been reports of cuts in Tafelsig, Mitchells Plain too,” Mbola said. “It’s like being sent to the guillotine. Without water they’re sentencing us to death.”
When Spotlight approached the City of Cape Town last week for comment on this and other issues, Xanthea Limberg, mayoral committee member for water and waste services, just replied: “In cases where water supply is limited due to non-payment, non-indigent customers will receive an allocation of 200 litres per day through their meter. Customers who qualify as indigent receive 350 litres per day for free.”
Evictions and community agency
The organisation Abahlali baseMjondolo in a statement also called for an end to evictions and water- and other services cuts during this time and that water and sanitation must be provided to all shack settlements as ‘an urgent priority’. Secretary-General of the nursing union Denosa, Cassiem Lekoathi said union members in clinics in the North West and KwaZulu-Natal are reporting some clinics have no running water. Denosa called on provincial governments to ensure that municipalities connect or deliver clean water to communities and clinics in areas under their governance.
Vainola Makan, co-founder of the Sisterhood Movement shared her observations with Spotlight. She said at the moment there is not a coherent strategy to provide information to all communities which leaves a lot of confusion. “Information that comes through comes from a top-down perspective. There is very little consultation with communities and health care workers on the ground and they are the closest to communities.” Makan told Spotlight there has been cases in rural areas like Vredendal where people go to the hospital but are shown away without proper advice on self-quarantine. She said the women are now trying to create a platform for “the agency of women and community voices to come through”. “We will do a participatory community-centred fact finding process that will aim at solidarity action and community-centred solutions with popular education sessions based on an integration of scientifically verified information,” she explained. “Hopefully, a different model of working with communities in these crisis times will emerge that can be shared with others as learnings and good practice.”
Joyce Malebo, a member of the Gugulethu Health Committee told Spotlight she has been doing some of these visits to facilities in her area. “People still go to clinics to get their chronic medication but some people have also been advised to go to other pick-up points like civic halls and churches to pick up their medicine. I saw they do get hand sanitiser and masks before they enter the facilities.” Malebo will be monitoring the facilities every week, she said. According to her the community health workers are still doing house visits, and as far as she saw, they were provided with masks and gloves for their visits. She did, however, raise concern over water cuts.
The official line
Mayoral Committee Member for Health in the City of Cape Town Zahid Badroodien in a response to Spotlight’s questions said at present primary care clinics are not testing clients for COVID-19. “However, training is underway to increase this capacity,” he said. “Anyone who presents at a facility is screened and appropriately referred if need be. In the meantime,” he said, “we ask that residents first call one of the hotlines that have been established to assist persons who have reason to believe that they may have contracted the virus.”
In response to a question on infection control in informal settlements in the city, Badroodien said the City is part of an established outbreak response team together with Provincial Government, the National Institute for Communicable Diseases (NICD) and National Health Department. “City Health will also increase its health and hygiene drives in all vulnerable communities, where we share information on preventing contamination so that residents can assist in the containment of COVID-19.” But when prodded about water cuts and how this impact the drive for personal hygiene he only said: “The City provides standpipes in informal settlements in line with national standards. However, City Health has, in addition, been promoting the use of the tippy tap for several years now. It is part of a national health strategy aimed at promoting hand hygiene. The tippy-tap is very effective at ensuring hand hygiene, and can be made at home.” The tippy-tap is made with a plastic bottle and filled with soapy water.
Dr Keith Cloete who will be taking over the reins as Head of the Western Cape Health Department from April, during a press briefing last week announced some of the province’s interventions. This includes providing extra capacity for contact tracing and these teams are placed in all communities, especially poorer communities. Cloete said the department is also working through community structures like the community police forums and community health workers to get the message out.
Doing it for themselves
Meanwhile in some areas communities have started to mobilise themselves and initiated their own interventions. A community activist in Tafelsig, Mitchells Plain Toni Fredericks told Spotlight they created the Community Action Group for Mitchells Plain. Part of their initiatives now is to collect soaps, wipes and other hygiene essentials for the Beaconvale Frailcare Centre of 200 people including the care givers.
Ramaphosa is expected to address the nation on Monday night after a series of meetings with various stakeholders.