OPINION | From trauma to hope: The return of primary healthcare in a co-Covid world

Photo by Gallo Images/Sharon Seretlo

With Covid, we've had the time to prepare, to isolate, to be angry, to grieve, to accept. But the old attritional war on poverty grinds on, and we're losing that battle badly. We cannot treat Covid in isolation much longer, while the other pathologies that haunt and impoverish our society rage on, writes Andrea Mendelsohn.

A young Somali girl rushes her mother into the Covid clinic in a wheelchair.

Breathing fast and confused, she hasn't been able to stand or eat for a week, drinking only milk and now muttering about her daughter wanting to poison her. Oxygen and antibiotics given, "Your mother is very ill; we need to admit her to hospital to figure out what is wrong".

The daughter's eyes well with tears - "I can't go with her?" - visibly strained by the idea of abandoning her mother to an unknown, alone. "You can phone. The nurses will give you an update." Trying to reassure her, but only half convinced that she will get through to the right person. The daughter says nothing.

We've had five months of similar conversations. Hospitals have re-organised into engines of infection control, isolating and alienating even to the staff who have grown used to the new routines.

The sick too were put off. Stories leaked out, whispers of lonesome deaths in sterile wards. Many instead have quietly died at home. Fearful patients continue to stay away, even when they are ill. 

The news reports burning tyres on the M5. The stitches of our social fabric are giving way. Food parcels haven't arrived. Soup kitchens are fatigued. Work is scarce. And every day in my clinic, I hear the same question, "Doctor, is Sassa open yet? I need help".

A thirty-year-old female patient quit tik through God. HIV positive, prior TB meningitis, still haunted by the voices chattering in her head, she cannot focus long enough to work at a checkout counter.

But she is clean. And she takes care of her 6-year-old. Her disability grant pays for the food, the rent, and supports her mother and brother, also unemployed. It expires this month.

"Can I renew?"

A 42 year-old-man with HIV and recurrent TB. He is so short of breath and fatigued that he cannot look for the odd jobs he used to get last year. He used his disability grant for food, and Kimbies, and taxi fair to the clinic. But it ran out in December. "How will I swallow my tablets if I don't have food?" 

"Doctor, can't I apply for a disability grant to help?"

"I’m so sorry. Sassa hasn't re-started new disability grant appointments yet." 

"When will they start?" he asks.

"Hopefully soon. You can apply for the Covid grant? It's only R350/month but it's something?"

"I tried. I got a message that I was rejected." 

"Why?" I ask.

"I don't know."

He exhales, "What will I do?"

We’ve gotten better at coping with Covid. Steroids, less intubation. We've learnt. Cases are going down, and people are recovering. Our clinics have separated into Covid and non-Covid entrances, screening for symptoms at the gate.

We have patients wait outside and enter five at a time, distanced two metres apart. We deliver chronic medication directly to our patients' doors, saving them a visit to the clinic and keeping away unnecessary crowds.

Everybody wears masks. You can come to the clinic without fear of catching Covid. We're winning. With Covid, we've had the time to prepare, to isolate, to be angry, to grieve, to accept.

But the old attritional war on poverty grinds on, and we're losing that battle badly. We cannot treat Covid in isolation much longer, while the other pathologies that haunt and impoverish our society rage on. In our community health centre, we're doing our small part, but we want to do more.

We continued essential services throughout lockdown - immunisations, HIV and TB tests, family planning, antenatal care, emergency care, but many patients did not come. People were afraid. The message was confusing. Stay home, except if your baby is well. Then please do not skip your vaccines. We all need to catch up now, lest we pay an even steeper price in future measles outbreaks and lost TB cases.

We want and need to bring everything back - elective surgeries, physiotherapy, routine blood pressure checks, and those disability grant appointments that are a lifeline to so many because, like the fire on the M5, patients cannot wait much longer.

Things might change even more, hopefully bestowing some small gains from the sacrifices of the past few months. Covid has forced us to think how we can deliver healthcare better; how we can make it easier for patients to access clinics quickly and efficiently so that we can do both - provide a full package of healthcare services without sacrificing quality or infection control.

We plan to stagger visits, so that everyone doesn't crush together in the morning and then sit idle for hours. We plan to continue home delivery of medication to make it easier for patients to adhere to treatment plans. And hopefully soon, hospitals will allow in visitors, masked up, one person at a time so we can all find a way to move past the trauma of locked-down healthcare.

Physical distancing might continue for a while, but social isolation is not sustainable. Vulnerable patients also need both, top notch medical care and family support. The president spoke to the nation - Level 2!

The Hospital of Hope closed its doors with a dance of exaltation, Jerusalema! These are our rallying cries. At the Community Health Centre we are also dancing, shouting a message of hope: Don't be afraid. We want to help you. Things are changing. Welcome Back! It is going to be okay.

- Andrea Mendelsohn is a Senior Medical Officer at a public community health centre in Cape Town. She writes in her personal capacity.

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