'I've seen the worst of Aids, TB, but nothing compares to Covid' - a community health worker's story

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  • Buyelwa Lavisa has been a community health worker in the Eastern Cape for many years
  • She says she has seen the worst of the Aids pandemic, TB - but Covid-19 is the worst
  • Community health workers are still fighting to get permanently employed 

South Africa is rolling out phase one of the Covid-19 vaccination programme. This phase is focused on getting healthcare workers inoculated. 

On Sunday, the national department of health said that more than 10 000 health workers had received the vaccine so far.

But community healthcare worker, Buyelwa Lavisa, who is part of this phase, is having doubts about the jab.

“We have not received any training or education from the department about the vaccine,” she tells Health24.

Need for education

Lavisa has been a community health worker for 19 years in the Eastern Cape

“I have seen the worst of the Aids pandemic. I have seen the worst of TB in our community. But Covid-19 is the worst of them all. Nothing compares to it,” she says.

According to a 2020 study published in Oxford’s Health Policy and Planning, community health workers in South Africa have a broad scope of work that supports various health programmes including “health promotion and illness prevention, registering health needs at the household level, providing psychosocial support, management of minor health issues, coordination with other health providers, providing adherence support and counselling for chronic conditions and tracing of patients who have missed HIV and TB service visits or who need referring back to the clinic.”

With the arrival of the vaccine, she has doubts because she has received more "anti-vaxxer" chain messages than reliable information on the jab.

“I take the flu vaccine every year because I understand it. It was something that we were taught. But no one has explained to me as a community health worker what the Covid-19 vaccine is and what it does to my body,” she explains.

She works at the local clinic. She knows the community in and out. Part of her job is to provide the community with health literacy. A task she says will be hard if the department of health does not provide education and training from either the national or provincial departments of health.

But the spokesperson for the Eastern Cape department of health, Siyanda Manana, says that the department has provided training.

“We have trained all health workers inclusive of community health workers,” Manana tells Health24.

The national department of health did not respond to Health 24’s query.

Fighting Covid-19 with few resources

Lavisa loves her job and the impact it has in delivering healthcare to her community, but she feels that the government does not take her work seriously. 

She remembers that the main personal protective equipment (PPE) she needed to test patients for HIV was gloves, but now with Covid-19, she needs more than just gloves. 

With the event of the coronavirus pandemic, Lavisa’s job meant that she was the first person patients saw when they came to the clinic where she conducts Covid-19 screenings.

“As community health workers, we are the first people to attend to patients, but we don’t have proper PPE. We are only given masks. Sometimes when we're screening patients, they cough and the saliva lands on our clothes and we have the virus on our clothes. We are frontline workers too,” she says.

As a result, Lavisa was infected with the virus last December when the country was going through its second wave.

“I was very sick. I was hospitalised. I had never been that sick in my life,” she says.

But the fight of community health workers is not only limited to PPE or education, and she says that they lack the basics to do their jobs.

“We do not have uniforms for the community to recognise us when we go to their homes. Uniforms help the community trust us and give us an identity,” Lavisa says.

She adds that they are not supplied with hand sanitisers for their outreach work.

"Sometimes you visit a patient at their home and you find that they are in a difficult position and you need to touch them to help them. But it's hard without sanitising," she adds.

Vaccine registration not easily accessible

The government has created an online process for health workers to register for inoculation.

In a statement, the national health department stated: “There is a clear process for vaccine rollout to healthcare workers. To receive the vaccine, healthcare workers must: (1) register on the South Africa Electronic Vaccination Data System, (2) respond to an SMS invitation, and (3) provide informed consent to take part. Healthcare workers will receive a vaccination voucher and communication once a vaccination centre is open to render the service.”

But for health workers like Lavisa who are technologically challenged, the registration process is hard.

“I am old,” she says, “I don't know how to register online.”

Lavisa adds that no one came to manually register her. 

The fight for permanent positions

Lavisa says that as community health workers they do outreach programmes and home visits in all areas that need clinic services. But it comes at a cost of their safety.

“We go into communities; sometimes it's dangerous places and many of us are mugged,” she says.

According to the Oxford study, which interviewed 65 community health workers, community health workers reported “lack of respect and recognition from some in the community and from facility staff; issues of a low wage; absence of a uniform; burdensome paperwork; lack of permanent employment; and a lack of opportunity for professional growth”.

Despite risking their lives, community health workers have been fighting for permanent positions for decades. Many of the country’s community health workers are not permanently employment, a promise that government made, but is yet to deliver.

“I want the government to permanently hire us this year. We also need to have a proper salary and benefits like everyone else who works for the department of health,” Lavina says.

Manana tells Health24 that the permanent employment of community health workers is not in the hands of the provincial health department.

“The employment of CHWs is what the National Department of health is seized with right now,” [sic] he says.

The national department of health did not respond to Health24’s enquiry on the issue.

Meanwhile, last week in the Buffalo City Metropolitan Municipality, community health care workers shut down at least six clinics as part of protest action to get permanent employment.

They say that they were promised that they would be permanently employed from 1 July 2020.

The provincial government did not respond to Health24’s query on the protest action.

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