“A year of trauma” – community careworkers

Community healthcare workers have been absorbed as permanent employees of the department of health only in Gauteng and work in the other provinces under the most precarious conditions. Archive photo by Lilita Gcwabe

Community health workers keep on delivering services to communities against many odds, while burdened by the loss of colleagues to Covid-19.

Community careworkers who have been on the frontline in the fight against Covid-19 since the lockdown began a year ago have described the situation as ‘a year of trauma’. Some tested positive and recovered, while others passed away.

In an interview with Elitsha this week, several community careworkers working in different communities in the Western Cape, Eastern Cape and Gauteng say their working conditions have not changed amid the pandemic.

Ntombethemba Maduna works at Nonkqubela clinic in Khayelitsha and has been working as a community healthcare worker for thirteen years. She said the past twelve months have been horrific. “Some of my colleagues contracted the coronavirus and recovered, and some have died along the way but I kept on moving because of God’s grace.”

Maduna said she had no choice but to retain her job so as to put food on the table. The emergence of Covid-19 meant that their job descriptions had to be twisted and responsibilities had to expand. Despite this, she said, their stipend of R3,500 remained unchanged.

“We had to conduct Covid-19 screenings and also performed contact tracing for those patients who tested and did not come back to the clinic for their results,” she added.

Moreover, careworkers according to Maduna are now providing health education on the vaccine to the community to counter misinformation as part of the vaccination roll-out programme.

In November 2020, community careworkers in the Western Cape marched for a minimum wage of R12,500. Archive photo by Lilita Gcwabe

In the Eastern Cape, community healthcare workers are employed by the department of health on short-term contract basis but the working conditions and challenges are no different from their permanently employed peers.

Thobeka Faltein of Nahoon works at Drake Road clinic. In her ten years of service she has been exposed to TB and HIV positive patients. Despite such experience in the field, she is afraid of the deadly coronavirus and has always been worried of the risk she takes of exposing her family to disease.

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Faltein is heart-broken having lost more than ten co-workers to the virus. She wishes that government could respect the work they do and pay them more than R3,500, which she says is never enough for her household expenses.

Nomashiya Mthintsilana who works at Mgcwe clinic in Ngqamakwe, is concerned about the increased workload during the Covid-19 period. This includes assisting in receiving of medication and assisting in the lab. Mthintsilana said some responsibilities which do not fall under her scope of job description has been pushed onto her.

“My never enough R3,500 wage could have been increased because I was doing other people’s work, but this did not happen,” she added. She said screening someone who you see does show symptoms of Covid-19 was a traumatising experience. She did contract the coronavirus during the second wave and is fully recovered.

The community careworkers say that their work conditions have not changed even though the workload has increased during the pandemic. Photo supplied

Last year in June, Gauteng’s Health MEC announced that the province’s community health workers would be made level-two public servants. This meant that they would be paid about R8,500 per month and receive benefits.

Yvonne Lekoloana, who is based in Laudium clinic in Tshwane has been permanently employed by the provincial department of health at a level-two salary scale with pension fund, housing allowance and medical aid benefits. She has more than 15 years experience and feels that a level-two salary scale is not enough compensation for her suffering in that time. “The Gauteng Department of Health has abused us,” she said. Lekoloana takes home R7.200 after deductions, which she said it not enough for her living.

The clinic-based care worker said they always work under risk to their health and now the coronavirus has made things worse. She said dealing with patients who manifest Covid-19 symptoms on a daily basis was a scary encounter.

In August 2020, Eastern Cape community health workers demonstrated outside the Health Department offices in Bisho demanding permanent positions. Archive Photo by Nombulelo Damba-Hendrik.

Cynthia Tikwayo who serves at Michael Mapongwana clinic in Khayelitsha, Cape Town, said that they did not get personal protective equipment (PPE) in the beginning and put their lives in danger.

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Vuyani Shwane, the acting provincial office manager of the National Union of Public Servants and Allied Workers (NUPSAW) in the Western Cape,  echoed the same challenge of getting PPE:

“All the NGOs were dependent on the department of health for the PPEs. We had NGOs that would issue one mask for the whole week. The community health workers were not given surgical masks but given cloth masks. That is the reason we demanded that they be included on the ‘danger allowance’ because of the risks that they are exposed to,” he said.

In November last year, NUPSAW together with other civil society organisations marched to the Premier’s Office to demand the standardisation of the terms and conditions of community health work.

In relation to the demand that community health workers must be integrated in the Western Cape Department of Health, Shwane said they were told the department is not responsible for community care workers as they are not employed by them.

“Unlike other provinces, Western Cape seems like the only province that is outsourcing primary healthcare to NGOs. We are saying that outsourcing is unconstitutional as it is the constitutional mandate of government to deliver primary health care,” Shwane concluded.

The issue of outsourcing is on the agenda of the public sector bargaining council for deliberation.

Household visits involve checking on the patient’s health and well-being by determining whether they are on track with their medication, using the Catch and Match book that they travel with for this purpose. Tikwayo is seen with one of her patients, Zamubuntu Geja.

Tikwayo is a Covid-19 survivor. She quarantined at home for her recovery without any support from her employer. She had to take out from her little stipend to buy medication. “I do have hope that one day, we will enjoy the benefits of permanent employment. We call on government to stop outsourcing this service”, she said.

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