Nurse Ruth Seikaneng did not have time to mourn her colleague Dudu, who died from the Covid-19 coronavirus in one quick, painful week in July.
In the town of Reivilo, 100km south-west of Vryburg in the North West where Seikaneng works, patients were waiting for a diagnosis, personal protective equipment (PPE) had to be ordered, and a full week of 12-hour shifts lay ahead.
“We miss Dudu. That loss, it was so bad. But we had to come straight back to work [after the funeral] to make sure no one else got sick,” Seikaneng said between consultations.
Seikaneng (64) is one of 11 nurses in the town about 500km from Johannesburg, fighting the spread of Covid-19 in a nation with the highest confirmed cases in Africa.
According to the national department of health, as of Tuesday South Africa had about 682 215 Covid-19 cases and about 17 016 people had died from the virus.
Seikaneng’s experience in this former mining town of about 4 000 people is echoed by nurses across the country who have spoken out in recent months about their working conditions, with protests erupting over pay, staff shortages and a lack of PPE.
The World Health Organisation (WHO) estimates that there are about 28 million nurses in the global workforce – 6 million less than are needed – with 90% of the shortfall concentrated in low- and middle-income countries such as South Africa.
For Seikaneng and her colleagues, minimal PPE and staff shortages have forced them to innovate and adapt to prevent more lives being lost to Covid-19.
“We’re doing the best we can with the little we have,” she told the Thomson Reuters Foundation from an office in Reivilo Community Health Centre where she works.
It has meant working longer hours when a colleague has to quarantine and carefully assessing patients’ symptoms to decide whether to call for an ambulance from the nearest hospital 70km away, where tests can be carried out.
On some days, no PPE was delivered to the health centre, forcing the nurses to re-use masks or go without.
Often their priority was simply stabilising patients until the ambulance arrived to take them to Taung hospital, which has the municipality’s only Covid-19 ward.
“We’re in a rural area far from supporting health services,” said Sipho Bathlaping (29), another nurse at the Reivilo centre. “What we need is more PPE, but also moral support.”
‘We have to keep working’
At Taung hospital, Covid-19 ward manager Vicky Shikwambana receives patients from surrounding towns including Reivilo, dividing them between rooms for suspected or confirmed cases.
If a patient’s condition worsens, they have to be moved to Klerksdorp hospital, some 250km away.
“We only have one ventilator in the whole hospital. What can we do? We have to keep working because this is a pandemic,” Shikwambana said.
Like many nurses, Shikwambana has had to adapt to plug the gaps during the coronavirus crisis.
The Covid-19 ward used to be for TB patients, who were moved elsewhere in the hospital as the pandemic gathered pace.
Covid-19 has piled pressure on a health system already dealing with HIV/Aids and TB, with the latter claiming about 78 000 lives every year in the country, according to the WHO’s Global TB report.
Under-staffed, over-burdened health systems are not unique to low-income countries.
According to Nurse Heroes, a joint initiative between philanthropists, the media and celebrities that supports and honours nurses, within three years the US and Europe could lack a million and 1.5 million nursing staff, respectively.
In Taung, Shikwambana knows that even minor adjustments can preserve PPE and possibly help his small team save lives.
He and the other nurses sometimes speak to patients through the window, cutting down on the need for PPE and preserving precious supplies.
“My family are nervous about me working here, but they are also proud,” he said, standing outside the ward.
‘Save our community’
In Pudumong, a town of 3 000 people not far from the Taung District Hospital, a group of community healthcare workers gathered outside the clinic, adjusting their hats in the glaring sun.
“We are here to save our community,” said Kgomotso Moremedi (43), one of 26 members of an outreach team doing door-to-door contact tracing to stem the virus’ spread.
Gontlafetse Leinane (45) sprayed the last drops of hand sanitiser onto her colleagues’ open palms.
“This is all the sanitiser we have today,” Leinane said, as the mostly women team members rubbed their hands and adjusted their face masks before heading out on their rounds.
About 90% of the global nursing workforce are women, even though few occupy leadership positions in the healthcare sector, according to the WHO.
With no thermometer, they use a verbal assessment form to ask quarantining residents who they last saw and whether their symptoms are better or worse.
At their first stop, nurse and team manager Rachel Asitile accompanied three outreach team members to the house of Thuso Kalanyane, a 49-year-old teacher with Covid-19 who had been self-isolating for a week.
“We’re relieved and happy to see the healthcare workers,” said his wife Mapuledi, who had been isolating with him. “Now we feel someone is there for us, that we’re not alone in this.”
Asitile said the climate of fear and uncertainty was palpable in the town.
“We cannot be afraid or it will affect us psychologically,” said Asitile, adding that when funds were low she paid for sanitiser and photocopied assessment forms herself.
“All we can do is try by all means to protect ourselves and others.” – Reuters