Covid-19: Discontent among community healthcare workers on the frontlines

Healthcare workers in South Africa fear the worst as they plan to go into communities without adequate protective gear. Picture: iStock
Healthcare workers in South Africa fear the worst as they plan to go into communities without adequate protective gear. Picture: iStock

In the war against Covid-19, community healthcare workers are the foot soldiers on the frontlines. Spotlight speaks to community healthcare workers from across the country about their concerns regarding the lack of protective equipment and job insecurity.

This week Health Minister Zweli Mkhize announced details of a “Covid Home Visits Programme” that would include “mass community-based screening, referral for clinic testing, quarantine of suspected cases and appropriate care for Covid-19 patients”.

This followed President Cyril Ramaphosa’s announcement that 10 000 volunteers would be deployed in communities for tracing, screening and testing. On Thursday, Mkhize said community healthcare workers would be deployed “to the field for door-to-door household screening”.

Many of the troops the government plans to send out to the frontlines feel they are not ready to heed this call – especially without personal protective clothing

“Each province has been requested to start working on this strategy,” he said, adding that provincial healthcare workers, with appropriate personal protective equipment, would be deployed to undertake a house-to-house programme of “no-touch” screening for Covid-19 symptoms and “to refer symptomatic people to clinics for testing”.

But many of the troops the government plans to send out to the frontlines feel they are not ready to heed this call – especially without personal protective clothing.

KwaZulu-Natal

In eThekwini, *Thoko, a community healthcare worker, has only recently recovered after months of tuberculosis (TB) treatment. Thoko is one of two community healthcare workers in her group to have contracted TB while performing her healthcare worker duties in communities. These duties include tracing TB patients.

Thoko and her colleague were lucky. They got well enough to return to work.

Figures show an estimated 2 500 community healthcare workers throughout KwaZulu-Natal have died in the past 10 years because of TB and related conditions contracted on the job.

When asked to verify this number, the provincial health department did not immediately comment.

The tally of confirmed Covid-19 cases in KwaZulu-Natal on Wednesday was 186, the bulk of cases in the eThekwini area.

Thoko has only recently been well enough to return to work and, shortly thereafter, national Covid-19 battle plans were drawn up and already the country is fighting the major infectious pandemic.

In unpacking the plan, Mkhize said mobile units with health workers would be set up to go into communities where there were suspected cases or contacts. Health workers would start screening those in communities who showed symptoms.

When the call comes I am not sending my team out towards danger without protective gear. How can I?
Mbali, community healthcare team leader

“This means we will go out, look for and find patients and not wait for them to come to hospital,” Mkhize said. He emphasised that “protective gear must be available for all health workers”. He said every staff member had to be taught to look for signs of infection to prevent the spread of the virus. They also needed to protect themselves.

But in KwaZulu-Natal, Thoko’s team leader *Mbali had serious reservations.

“When the call comes I am not sending my team out towards danger without protective gear. How can I?” she told Spotlight.

“We are scared. We don’t get masks or gloves. Now nurses go to lunch with the hand sanitiser because there’s not enough to go round. There was a time I had to go through the clinic to try to steal a mask for one of my healthcare workers because she was doing TB tracing in the community.

“So, this problem is not [only] a Covid-19 problem. We have been struggling for years to get these things to protect us,” Mbali said.

She, like many other community healthcare workers Spotlight spoke to across the country, bemoaned the lack of support from the health department. She said this stemmed from long before the pandemic.

“One of my team members has been doing community healthcare work for 20 years. She’s older than 60 years and, after all these years, will go home with nothing when she retires. We risk our lives and those of our families. And when we die no one remembers. You don’t even get a memorial service.”

Mbali said her group of community healthcare workers in eThekwini was told to stay home during the lockdown and would be contacted if their services were needed.

So, now they wait.

I like working for the people, but the government doesn’t want to take responsibility for us
Grace, a community healthcare worker

Gauteng

*Grace, a community healthcare worker from Brakpan in Ekurhuleni, told Spotlight it felt like the government “doesn’t respect us”.

Grace has been doing community and healthcare work for 18 years. “I love my job. I love helping people, especially the old people who have nobody and nothing. I like working for the people, but the government doesn’t want to take responsibility for us. For them, it is only about the stats we bring back. And, when there’s a big thing – like now – then they push us forward.”

She told Spotlight many community healthcare workers often risked life and limb going into communities.

“About two years ago a dog bit me as I was doing my rounds,” she said. Grace was doing TB tracing at the time. “I think the man got tired of us keeping coming back and had the dog ready to scare us off.”

Grace and another community healthcare worker were bitten and had to be treated. “The sister [who was in charge of the community healthcare workers] only asked when the dog had bitten us and, after that, we heard nothing from the department.”

By Wednesday this week Gauteng had 645 confirmed cases of Covid-19.

Grace is still tending to her patients in their homes during the lockdown.

“I’m scared,” she said, “but what can I do? I have to do what I need to provide for my family.”

She has two children, one of whom is still in school.

“I’m scared. They say there is not a vaccine for this corona. I really cannot afford to put myself at risk. I have to survive,” she said, “for my children.”

The day Spotlight spoke to Grace this week, some of the community healthcare workers received masks. At the time Grace and other community healthcare workers were on their way to campaign for more protective gear.

In Soweto, another community healthcare worker, *Thumi, told Spotlight some community healthcare workers received training to identify Covid-19 symptoms but many were still confused over their role and how they would be protected while performing their duties.

Thumi said the training was a “crash course” on what Covid-19 is.

“It’s the same as what we can learn from the TV.” Thumi raised similar concerns over the lack of masks and other protective equipment.

“They give us a mask, then we have to use it for two or three days. You can’t do that.”

She said whenever they raised these issues, “it’s always just the response there’s no money”.

“They just want the stats – that’s all they care about,” Thumi said.

Community healthcare workers in her group had already been working on spreading awareness about Covid-19 in communities.

Bandile Masuku, Gauteng’s health MEC, said the province would train 1 000 community healthcare workers to help in the fight against the pandemic.

Kwara Kekana, spokesperson for the Gauteng health department, told Spotlight there were 8 790 community healthcare workers in the department and he was not aware of any concerns about the training.

“The training is based on standard content developed by the relevant institutions – the National Institute for Occupational Health and the National Institute for Communicable Diseases. Most importantly, training in any work environment is always ongoing,” she said.

Kekana acknowledged that personal protective gear was important but “for all staff and not just community healthcare workers”.

“The department is continually procuring protective equipment, stock comes in and then it is delivered to various facilities.”

She did not respond to community healthcare workers’ concerns of exposure to the virus and said they would be “part of the contact tracing teams”.

“The community healthcare workers can perform any of the functions in a team except for swabbing because that is not yet in their scope of work.”

I’ll just have to take my own precautionary measures to make myself safe because what use am I if I bring the virus to my patients or back to my family?
Rachel, also a community healthcare worker

Northern Cape

In Kimberley *Rachel, also a community healthcare worker, decided to stay home this week. Some of the community healthcare workers refused to work without protective gear. There’s been too much confusion especially around training and protective gear, she said.

“And nobody is telling us anything. They let us work without protection.”

So, Rachel decided to stay home to see how the situation unfolds. “But I’ll go back on Monday. My conscience is killing me. I have to go to work. My patients depend on me. So, I’ll just have to take my own precautionary measures to make myself safe because what use am I if I bring the virus to my patients or back to my family?”

There were seven confirmed cases in the Northern Cape by Wednesday.

Free State and Limpopo

Community healthcare workers in Bloemfontein in the Free State and the Vhembe district in Limpopo raised similar concerns and were just as confused about their role in the pandemic.

Western Cape

Keith Cloete, the head of the provincial health department, said on Thursday that the department had worked with community healthcare workers through non-profit organisations and they would be roped in to help screen and test community members. This was expected to begin on Monday.

Cloete said the department had an “existing relationship with more than 3 600 community healthcare workers” in the province.

“We will ask them to help ask questions to screen members of the community. We normally do campaigns like this so it’s not unusual. They will ask standard questions and, based on the answers, that will determine whether somebody should be tested or not.”

The first fieldworkers – 5 400 of them – would be deployed in Alexandra township, Khayelitsha and Diepsloot

Cloete said: “If any of the healthcare workers have dealings with someone who is Covid-positive, we need to provide them with a medical mask. We are not asking the community healthcare workers to come into physical contact with anyone who’s a potential or known Covid-19 case.

“We are asking them to maintain the distance and observe hygiene, just like we ask everybody else.”

But some community healthcare workers, such as *Lihle in Khayelitsha, are not happy especially about the lack of protective equipment.

Lihle said in her area the community healthcare workers got masks which they had to re-use. She nothing much had changed in recent weeks.

Lihle said she had to carry a two-litre bottle of water with her to wash her hands because some of the dwellings did not have water.

“They say we have to drop off medicine, we should not be in touch with patients but these people have many questions and many we can’t answer.” Lihle said the health department should provide danger allowances to community healthcare workers.

“We are exposing ourselves to high risk,” she said. “How can we know if someone is Covid-positive when we visit the house?”

By Thursday there were two confirmed cases in Khayelitsha and seven in Mitchells Plain – areas Cloete referred to as “vulnerable”.

The total confirmed cases in the province at the time was 393.

Mkhize said the deployment of the fieldworkers would be phased in and the aim was to accomplish screening at 10 households an hour. The first fieldworkers – 5 400 of them – would be deployed in Alexandra township, Khayelitsha and Diepsloot.

No worker in the field will be without the necessary protection
Health Minister Zweli Mkhize

‘We have heard the concerns’

Mkhize offered some reassurance.

“The fieldworkers, frontline workers and all workers coming into contact with Covid-19-positive patients –and those with other infectious diseases – will be given adequate personal protective equipment and no worker in the field will be without the necessary protection,” he said.

“Although we know there is a global crisis of a shortage of protective equipment, we have been working hard, as a department and as a global community, partnering with business to secure the availability of equipment in this time of need. We have heard the concerns of our healthcare workers.”

Tinashe Njanji, coordinator at the People’s Health Movement, told Spotlight that community workers had long been frontline providers of healthcare, especially in areas where there are minimal or no health services. He said community healthcare workers were “well-positioned to take on the role of tracing people who have symptoms of Covid-19, as well as contacts of those who have tested positive, and referring them to testing sites”.

“However,” said Njanji, “although some are being trained, the training, as reported by community healthcare workers, has been minimal and they have not been given protective gear to safeguard them when they go into houses.”

Njanji said the issue of a lack of protective gear “is not a new story”.

“For years community health workers have been working without protective face masks, gloves and other basic materials. In engaging with them we have come across some heart-breaking stories of community care workers using plastic bags for gloves and homemade clothes for dressings,” he said.

“In addition to this, in their present employment, although placed and employed by the departments of health or social development, they have casual labour status and do not have worker’s compensation if they were to contract the virus in the course of duty.”

Njanji said community healthcare workers did not need only protective clothing – they also need better training and workers’ compensation, as well as possibly being escorted while conducting home visits because it could be dangerous.

Many [healthcare workers] have lost their lives serving their communities. Many have nothing to leave their families
Tshepo Matoko, secretary of the Gauteng Community Health Care Forum

Tshepo Matoko, secretary of the Gauteng Community Health Care Forum, which represents the majority of community healthcare workers in the province, wrote a letter to the MEC describing community healthcare workers as “courageous foot soldiers who will put their lives on the line to save their community from this pandemic”.

In the letter, the forum asked that community healthcare workers be recognised as permanent employees of the department so that they would be entitled to benefits like other employees. The forum also called for proper training and equipment.

Matoko told Spotlight the healthcare workers were not using the crisis in an opportunistic way.

“These are people who have put their health and that of their families at risk time and again. They are on the frontline in the fight against HIV/Aids and TB. Many have lost their lives serving their communities. Many have nothing to leave their families.

“Now they are asked to again prove their value during this Covid-19 pandemic. And we will, because it is our job and we believe that we have a role to play in this crisis. But the government needs to recognise us as public servants in the employ of the state. We need to move forward from here.”

Masuku, in response to the letter, said the department and community healthcare workers agreed last year on a process that included establishing a MEC advisory committee which had been working on a framework and details on the integration and formalisation of community healthcare workers in Gauteng.

He said a formal meeting would be arranged after the lockdown with the unions and bodies representing community healthcare workers.

*Names have been changed to protect identities because community healthcare workers said they feared victimisation.

This article was produced by Spotlight – health journalism in the public interest



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