- Hospital porters routinely come into contact with patients, but the government's guidelines put them at the back of the queue for Covid-19 protective gear.
- Porters comprise as much as 10% of hospital admissions among health workers.
- Security companies in Mpumalanga fail to provide masks for guards at facilities, forcing them to get masks from already stretched hospital stock.
Hospital porters may account for up to one in 10 Covid-19 hospitalisations among healthcare workers, second only to nurses, according to the National Institute of Occupational Health (NIOH). But workers and unions say support staff like this, as well as cleaners and security guards, are last in line for the masks, gloves and gowns they need to protect them from the new coronavirus.
As of 14 June, 238 healthcare workers had been hospitalised with Covid-19, according to a NIOH report. Of the 67 cases in which workers disclosed their job titles, nurses made up 14% of admissions but hospital porters — who move patients within facilities — were close behind.
Although the health department says cleaners who develop Covid-19 are counted as healthcare workers, the NIOH's latest report does not provide a breakdown of cases among these workers. The institute does not count hospital or clinic security guards, which are largely outsourced in the public sector.
Past research from another infectious disease, tuberculosis (TB), shows that South African health workers are at a higher risk of contracting TB and developing the active disease than the general public, a 2018 research review published in BMC Health Service Research reveals. A 2014 study, published in the same journal and conducted in three KwaZulu-Natal hospitals, found that this also held true for support staff, such as porters and cleaners.
TB is an airborne disease — unlike the new coronavirus that is spread through large droplets of saliva released when infected people sneeze, cough or speak. However, the two diseases share similar risk factors, such as working in healthcare facilities or crowded poorly ventilated spaces.
National health department Covid-19 guidelines say that porters and cleaners should be provided with masks, gloves and protective aprons to varying degrees - but, in practice, some Eastern Cape porters say they are lucky to get one mask per week.
National standards also specify that security guards should be given surgical masks, but according to unions some private companies aren't stepping in to protect workers, forcing guards to rely on health facilities' already limited stock or to buy their own masks.
'Mothers, babies, corpses — wherever they need to be, we are the ones who take them there.'
Lungile Thunywa, not his real name, is a porter at a public hospital in the Eastern Cape, which accounts for about a fifth of South Africa's confirmed Covid-19 cases since the outbreak began.
Thunywa's job takes him to all corners of the facility and includes, for example, lifting patients out of a family member's car and into a wheelchair or stretcher, or carting them between wards for X-rays, and in some cases, taking deceased patients to the mortuary.
He explains: "We move a lot. Mothers, babies, corpses — wherever they need to be, we are the ones who take them there."
Thunywa does all of this with little to no protective gear. The hospital occasionally gives him two masks, but, frequently, he has to source his own. He warns: "We are not safe."
At some hospitals, it's first come, first served, for masks and gloves
National guidelines say health facilities should plan to provide all healthcare workers with at least two masks per shift and workers should be changing gloves and protective aprons every time they leave a "Covid-19 area". But that doesn't always happen, Thunywa says.
"I've used the same masks for four days at times."
And what may count as a "Covid-19 area" is hard to tell.
Shaheen Mehtar is the chair of the education working group of the Infection Control Africa Network, a professional association for specialists. She drafted the country's national PPE guidelines and says, early on in the country's response, "Covid area" would have been a designated ward. Now, as cases mount, the term "Covid area" could apply to about 60% of areas within hospitals.
In Thunywa's Eastern Cape hospital, getting PPE is a case of first come, first served, as fearful workers rush to snatch up protective gear and sanitiser for themselves and families at home.
He explains: "Just yesterday I was helping to move a patient into the facility, and afterwards I was told the person has Covid-19. I didn't have gloves."
Even in the absence of PPE, Thunywa thinks even just better communication with nurses could help to protect him: "All they have to do is tell us: 'Hey porter, we need you to move this patient, but please protect yourself, they could be a Covid-19 case', then I can make a plan."
National guidelines unclear when it comes to support staff
South Africa's national guidelines are clear: Porters should receive disposable medical masks and non-surgical gloves when they come into contact with Covid-19 patients and contaminated surfaces. These should be changed when the porter leaves the area where patients are being treated. But the document contradicts itself about whether workers such as Thunywa should also be getting protective aprons.
Mehtar admits the discrepancy is an oversight and that porters should be given disposable aprons as well.
"We'll have to revise it."
Back in the Eastern Cape, Thunywa argues that the guidelines do not consider how up-close-and-personal a porter's work can get.
"You have to be close to someone to carry them," he explains. "Sometimes we help the doctors by holding the patients, or maybe someone has fallen and we carry them. That person is touching you and your clothes, they could be coughing."
That's why he says he and his colleagues would like to have the disposable gowns that cover their arms and legs instead of smaller, plastic aprons. These are typically reserved for doctors and nurses.
The health department recommends plastic gowns only in cases where workers could come into contact with patients' spit droplets. Mostly, the department says, healthcare workers should be given cotton gowns and a plastic apron.
But the World Health Organisation, however, argues disposable gowns should also be used by cleaners who enter the rooms of Covid-19 patients and by any staff that help transport possible coronavirus patients into the facility. This is missing from local stipulations.
The international health agency warns that a global shortage of gowns is likely and that plastic aprons can be used in cases where water-resistant gowns are not available.
In South Africa, Mehtar says there are simply not enough disposable gowns to go around, which is why gowns are not provided to all workers.
As a result, the department instead emphasises handwashing and masks to protect health workers' faces, where the virus is most likely to enter the body.
Mehtar concludes: "We are in very, very, very, short supply."
Companies fail outsourced security guards working at health facilities
Although cleaners in South Africa should get more protective gear than porters in theory, unions say PPE shortages mean they often go without. The country's guidelines stipulate cleaners must be given masks, aprons, goggles, and long gloves, but it stops short of providing gowns.
The shortages have already impacted some facilities.
Earlier in June, cleaners, cooks, porters and laundry workers at Port Elizabeth's Livingstone Hospital downed tools in a now resolved dispute over unpaid overtime and a shortage of protective gear, the general secretary for the National Education, Health and Allied Workers' Union, (Nehawu) Zola Sapetha said in a statement.
According to a Gauteng health department spokesperson, Philani Mhlungu, provincial health departments largely outsource security to private companies.
Staff working for at least three such companies in Mpumalanga say they are buying their own masks for work, according to the head of security for the South African Transport and Allied Workers Union (Satawu), Philemon Bhembe.
"Some of the guards are getting their PPE from the hospitals or clinics where they work, but the facilities are also complaining of a shortage of supply," he says. "Some of these companies are disregarding PPE protocols completely."
In contrast, the firm Servest confirmed it is providing its guards at health facilities with gloves, hand sanitiser, face shields and protective goggles if they are working close to areas with Covid-19 cases, testing activities or mortuaries.
Nine Servest guards have tested positive for the virus across the country. The company has not recorded any deaths.
In the Eastern Cape, Thunywa is continuing to work, but he says it pains him to see his colleagues in full protective gear, while he remains fearful for his health.
He explains: "I walk around seeing people walking around with full PPE and then I think – 'what about me, am I made of steel or what?' We are not respected like nurses."