Even as public healthcare teeters on a precipice, healthcare workers are not issued with adequate gloves and masks to perform their duties safely.
The coronavirus (COVID-19) outbreak in South Africa has claimed 18 lives and the number of those infected nears the 2,000 mark, community careworkers say they continue to work without personal protective equipment. Employed by various non-governmental organisations that are funded by the Department of Health, community care workers, the vast majority of whom are women, offer essential health and social services to the poorest of the poor. They work in homes and clinics and they render basic wound care, TB and HIV treatment, empathy, care and rehabilitation to those in desperate need. Over 100 healthcare workers have succumbed and died globally due to COVID-19.
Cynthia Tikwayo works for TB & HIV Care in Ndlovini in Khayelitsha and we followed her as she met with colleagues and attended to her clients. Tikwayo and her colleagues lamented the lack of security as they walk around the densely populated informal settlement tracing patients.
“One of the challenges we face when working in communities is not feeling safe. As we go from door-to-door we receive different treatment from patients; some block us from even entering their yards. As you can see, some shacks have boundary walls and gates so when we call for their attention outside some patients ignore us and close their doors. In those kinds of situations we don’t insist on coming in,” she said.
Tikwayo and her four colleagues also raised issues of the bad treatment they get from the patients. According to Nokhanyo Kili, the rudeness of patients often is related to the fact that they have not disclosed their illnesses to their families. “Most people have not yet disclosed their statuses to their families and it becomes a problem to walk in to just give them their medication in front of their families,” she said.
According to Nyameka Landzela, community careworkers are often deployed outside of their communities because the NGOs that they work for operate in demarcated areas. This has meant that Landzela has to take a taxi to work and not being familiar with a neighbourhood.she said, puts a careworker at risk of being mugged or even raped.
Coronavirus and lack of PPE
The community careworkers complained that their employer has not had a discussion with them on the coronavirus and what it means for them as they are at a high risk of contracting the virus since they attend to patients with compromised immune systems. “We don’t know whether or not we are infected with the virus. We have not been tested and we don’t have personal protective equipment. They give us one mask and tell you to use it for seven days. They give us one pair of gloves. You’re not allowed to wear the mask when walking in the community, only when you are with a patient,” said Tikwayo
The careworkers are not sure what would happen if any of them could contract the virus. “Our employer has not had any discussion with us as people who are to be working during the lockdown and coronavirus. We don’t know what will happen if any of us contract the virus; we don’t know if we will still have a job or be dismissed because you are sick,” Landzela said.
Another careworker who works as an HIV counsellor, Richman Nyangani, said that they have not received training on the coronavirus and all they know is what they have heard on TV or radio. “The only thing that we were given are permits to produce to the police and soldiers to prove that we are an essential service and that we are supposed to be working during this time. We were not trained about coronavirus,” said Nyangani.
The community careworkers said that they have not been tested for COVID-19 and yet they are made to go see patients at their houses. “The challenge around the coronavirus is that we are at high risk; we are not sure whether or not we have it, and whether the patients that we attend to in their houses have the virus or not. We are at high risk of spreading the virus because we don’t have personal protective equipment,” said Kili.
Meanwhile, the Gauteng government has indicated that it will train 9,000 community careworkers as contact tracers. Tsepho Matoko, a community careworker based in Johannesburg, said that they welcome the use of community careworkers as tracers but are worried about the lack of personal protective equipment.
Section 27’s head of its health rights programme, Sasha Stevenson, echoed Matoko’s view that the government should provide community careworkers with protective gear. “They will need to be trained to detect symptoms and to be familiar with referral pathways to ensure timeous care. They will need to be provided with protective gear to ensure they don’t contract the virus and that they don’t spread the virus as they go from home to home,” she said.
Tikwayo said that as community careworkers they would like the government and the NGOs that they work for to consult with them about their plans, especially around the coronavirus as they are the ones at the forefront of health in communities.
“The government or the Department of Health are not doing right by us as healthcare workers. I wish that in these kinds of situations, before taking official decisions, they would sit down with us and also get our views since we are the ones out here in the field and not just tell us to continue doing our jobs,” Tikwayo said.