Spine Road off the N2 highway leading to Khayelitsha is a hive of activity. It is a sunny Friday morning and Cape Town’s biggest township is coming to life.
Women in night gowns are sitting in groups, others are hanging up washing. Further down the road, shisa nyama spots are buzzing with activity as patrons queue to get their daily supply of braai meat.
South Africa’s Covid-19 coronavirus lockdown was relaxed to level two (of five) on August 18. But even as the economy has opened up, government messaging has continued to stress the importance of measures such as hand washing and social distancing.
Yet in Khayelitsha few people are wearing masks and there is little sign of social distancing.
“Siyinqobile iCovid (We have defeated Covid-19 in Khayelitsha)”, a man tells us before he disappears into the sea of shacks next to the road.
A hard-hit township
Up until September 14 a total of 8 333 confirmed cases of Covid-19 were reported in Khayelitsha – which amounts to about 10% of Cape Town’s total cases.
As elsewhere, however, the real number of infections is probably much higher.
In a recent Covid-19 antibody survey, over 40% of public sector HIV patients and pregnant women in the township whose blood samples were tested showed Sars-CoV-2 antibodies.
Even if only 20% of Khayelitsha’s population has been infected, the real number would be multiple times higher than the official count.
The sense that an initial wave of infections, however powerful, has subsided was reinforced on August 12 when Western Cape Premier Alan Winde announced the closure of the Khayelitsha Thusong Centre (a temporary Covid-19 facility).
By Monday, September 14 there were only 45 confirmed active cases in the area.
Risk still ‘high’
Meanwhile, at the Khayelitsha Community Health Clinic, queues are still a lot shorter than before the virus first struck in Khayelitsha.
Mziwonke Dlulane (43) is waiting to be screened for Covid-19. The father of three stays in the densely populated TR informal settlement. He tells Spotlight that he believes the risk of contracting the virus is still high.
A few days ago, Dlulane attended a funeral in the Eastern Cape and says his concerned wife urged him to get tested.
“Despite telling her that I’m fine and not showing any symptoms, she insisted I come,” Dlulane says. “We live in communities where people still don’t adhere to the rules. I always wear a mask, but some of my neighbours mock me about it. They ask why are you suffocating yourself with that thing in this scorching heat?”
Another resident, Babalwa Ntoyanto (39) says she accompanied her friend who is collecting her chronic medication and then decided to get screened for Covid-19.
“I am absolutely fine because I stay indoors and avoid places where there are big crowds. Some of us are still scared of contracting this virus because we know of people who did and died from it,” says Ntoyanto.
Thokoza Mdunyelwa and Nolufefe Mbi, both community healthcare workers, say they have been doing Covid-19 screenings during lockdown, but things have slowed down since the start of level two. From screening over 100 people per day during the stricter lockdown levels, they say they now screen about 30 residents a day.
“People here in Khayelitsha think this virus is over. The fact that we are now on level two and shebeens are open makes people think we are fine. They don’t see the need to be screened, and take this virus as a joke,” says Mbi.
Mbi contracted the virus during alert level four and considers herself lucky to have survived.
“I showed some symptoms and immediately decided to go for a test on June 29. Mbi said she medicated and isolated at home after she tested positive. She says the past six months, ever since the lockdown period started, have been stressful for front line workers like her.
“Every day you live in fear of contracting the virus and infecting your family. I’ve been to hell and back, but we have to soldier on,” says Mbi.
Besides the low salaries, long hours and not feeling appreciated, Mdunyelwa says they also have to put up with bad treatment from residents now that some healthcare workers are making house visits.
She says that, because they are screening fewer people, they are once again focusing on HIV testing and TB contact and defaulter tracing.
The two women say some residents of Khayelitsha, especially the elderly, are still adhering to the rules.
“Not only because we emphasise that they are vulnerable to the virus, but they are highly disciplined. They are the ones who keep us on our toes, asking questions about the virus and ways to keep themselves safe,” Mdunyelwa says.
Winde recently noted that, three weeks into level two, with more businesses open, more people returning to work and more people moving around, there has not been an uptick in new cases.
“With the appropriate safety measures in place, we can reopen further and save jobs while also saving lives,” Winde wrote in his weekly Covid-19 update. “There are, as yet, no tools that can indicate whether we will see a resurgence in the virus, or when.”
“In the absence of a vaccine, behaviour change is the most powerful weapon that we have against Covid-19,” he says.
But is the Western Cape succeeding in its behaviour change efforts, given the apparent rejection of social distancing measures in much of Khayelitsha?
Cayla Murray from the provincial health department says their information on compliance with the mask-wearing regulation is anecdotal at present. “But it is a concern that people have become more complacent,” she tells Spotlight.
“The Western Cape Department of Community Safety, in collaboration with the Department of Health and the University of Stellenbosch, is looking to undertake a small-scale study in the Khayelitsha and the broader eastern health subdistrict soon to determine the percentage of people wearing masks. The study will probably be conducted over a few months to measure whether the wearing of masks decreases over time with any further changes in Covid-19 levels,” says Murray.
She also notes that the province, along with the national health department and the City of Cape Town, launched an extensive media campaign aimed at behavioural change among residents in Khayelitsha to practice the five golden rules as guided by the World Health Organisation.
(According to a document on the department’s website, the rules include washing your hands, not touching your face, keeping apart, covering your cough and staying at home when sick.)
New informal settlements
Meanwhile, as authorities erect Covid-19 awareness billboards, defiant residents continue to erect shacks in open spaces in Khayelitsha, despite attempts by the City of Cape Town to demolish the shacks. Some of these new settlements are named after the buzz words of the pandemic, including Sanitiser and Corona.
“It sometimes skips our minds that we have to adhere to these rules now that we hear on the radio that the cases have dropped,” says Thobeka Ncwaba (53), a mother of seven who lives in a two-roomed shack in the newly established “Covid-19” informal settlement next to the N2 highway in Khayelitsha.
“We are living in a poor community. The one thing that occupies our minds is providing a meal for our families.”
Hailing from Idutywa in the Eastern Cape, Ncwaba says if there was something that would put a smile on her face it would be getting a decent roof over her head.
“We are dying every day here, not only from Covid-19 but from shack fires. I had to move to this open space after my shack burnt down. We have no option but to occupy these open spaces because we have no place to stay,” she says.
With shacks built close to each other, Ncwaba admits that social distancing and washing hands, as promoted in government’s Covid-19 messages, are impossible in the new informal settlements.
“That is why we, as informal settlement dwellers, are most at risk of this virus. Every day I count myself lucky that my children and I don’t show symptoms of it,” she says.
To eke out a living, Ncwaba sells second-hand clothing in Khayelitsha, but says business has been tough since Covid-19 struck.
Ncwaba says she doesn’t know how she would have survived had it not been for the R350 social relief grant from government.
She is among the thousands of beneficiaries fortunate enough to have received the grant.
Social Development Minister Lindiwe Zulu, in answer to a parliamentary question, said that by August 19 the “number of approved applications stood at 4 424 720”.
Many eligible beneficiaries, however, have not been as lucky and were either rejected or are still waiting. The Auditor-General recently flagged this grants process, stating that “some applicants could have been unfairly rejected as a result of outdated information on which assessment for eligibility was based”.
“It’s too little (the grant), but what can we say? We are starving and anything that puts food in our mouths is appreciated. During level five I was fortunate to get some food parcels from some Good Samaritan [an organisation] white people. But ever since then, nothing has been forthcoming,” Ncwaba says.
Media reports showed that large numbers of people in need and eligible for government food parcels did not get any, so civil society organisations had to step in. According to official figures by 11 May, when the distribution of food parcels ended, 146 936 of them had been distributed.
Keeping the wolf from the door
A stone’s throw from Ncwaba, 36-year-old Lubabalo Putswana, an informal trader, sells traditional herbs. He says it is with this income that his family must survive. Ever since Covid-19 struck business has been bad, Putswana says.
He sells traditional herbs such as impepho (a type of incense) and umhlonyane and says that, under the stricter lockdown regulations, he wasn’t able to sell his stock. Putswana is, however, quick to stress that umhlonyane, contrary to popular belief, does not heal Covid-19.
But many of his customers who flock to his stand, believe otherwise.
One woman, Nosakhele Vukubi (45), says she uses traditional herbs for flu symptoms because it is much cheaper for her than going to the doctor.
Putswana, however, says he always encourages his clients to follow the regulations and go for screening. The father of three was also among the beneficiaries who received the R350 government social relief grant and says that, although it is not enough, he manages to keep the wolf from the door.
Healthcare worker challenges
According to Mzwanya Ndibongo, chairperson of the Khayelitsha Health Forum, there are seven health facilities servicing the area, including clinics, day hospitals and a district hospital.
Ndibongo says that, during lockdown, they noted one of the busiest clinics in Site C, Nolungile Clinic, had 20 healthcare workers testing positive for Covid-19 and a nurse at the clinic succumbed to the virus.
“We sit in forums discussing these ongoing challenges and we hope that solutions will be found soon. Healthcare workers play a vital role in the fight against this pandemic, and everything needs to be done to ensure that their morale is high. They work under extreme conditions and we owe it to them to ensure that their working conditions are improved. These are people who put their lives at risk and they deserve better treatment,” he says.
Veronica Samuel from Makhaza in Khayelitsha, who works for the NGO TB/HIV Care, says she lost two close relatives to Covid-19 during lockdown and regrets the day the pandemic hit the country.
“We keep raising the alarm, but people don’t want to listen. Unless it kills someone close to you, then it is just a joke,” says Samuel.
*This article was produced by Spotlight – health journalism in the public interest