People’s Health Movement, Observatory, Cape Town. Saturday, 14 March 2020
The COVID-19 coronavirus pandemic will have its major impact on working class people in crowded periurban settlements where public health measures to slow it down and “flatten the curve” are difficult to practice, and where the public health system is already unable to cope effectively with the existing disease burden. What are the key issues facing community-health workers and general members of the communities as they prepare for the outbreak that will inevitably come?
The People’s Health Movement, South Africa (PHM) sensed that it was urgent for members of the broader community to share experiences and concerns relating to the pandemic before public meetings and transport became impossible due to viral spread.
Accordingly, on Saturday 14 March 2020 PHM convened a public meeting where about 45 health care workers, health professionals, school learners, academics, members of civil society organisations from Cape Flats communities and outlying areas as far as Ceres and Tulbagh, met to discuss the impact of COVID-19 on the health of their communities.
Before entering the room PHM members insisted that participants should not shake hands or hug, and wash their hands with soap and water. Seats were spaced at least a meter apart, and everyone was given tissues in case they had to cough or sneeze.
We report some of the key issues that emerged from the meeting.
Home-based care services
Community health workers know that they are highly vulnerable to contracting COVID-1 in the course of their work. They need protective equipment not only for themselves but also for their patients.
CHWs who work with the elderly and the sick in their homes in formal and informal settlements reported that they had not been given enough information and training in protocols for caring for the sick and vulnerable, including some who had cancer.
They requested clear information and pamphlets to distribute to those who did not have access to information. They also said that they wanted medical supplies to protect themselves and their patients from spreading the virus.
Social concerns: Housing, mass gatherings and public transport
Many people living in informal settlements have poor access to running water making frequent hand washing very difficult. In addition, crowded living conditions make social distancing impossible. Participants know that these 2 factors make rapid transmission of COVID-19 inevitable.
Furthermore, churches, taverns and shops were not promoting social distancing and other safety measures to protect the community. This concern applied to public meetings and schools. Learners suggested that they had no information on how to protect themselves. Children need awareness programmes.
Participants highlighted a lack of safe transport options. Taxis are a core means of transport in the absence of reliable bus and train services. Because of the absolute need not to miss work there is no option but to use taxis. But there is very little that can be done to prevent over-crowding and contact with infected surfaces inside the vehicles. Participants said that government must speak to the taxi industry about how to protect their clients.
Social media and the problem of misinformation
There is a great need for information on the modes of transmission of COVID-19, as well as practical measures and guidelines to prevent and reduce spread and to protect yourself. Government must disseminate accurate, consistent and up-to-date information in simple language.
Hard to reach communities must be included, including farm workers and rural dwellers, the aged and the ill who are isolated at home. These groups often know very little about COVID-19, and few have access to television or radio networks.
We should use social media to spread accurate information for the benefit of society. But social media is awash with contradictory messages, and it is hard to decide which information to trust. It is everyone’s responsibility to use it constructively without spreading fake news and causing panic.
The health system and budgeting
Participants feel that the health system is not ready for the COVID-19 outbreak; that it will not be able to cope. They pointed out that TB kills more people every day in South Africa than COVID-19 currently in Europe. Therefore it It has been dangerous to visit crowded health facilities even in the absence of coronavirus.
Participants pointed out that, especially in times of trouble, people seek alternative means of healing and comfort and these practices need to be respected and brought into wider strategic discussions. There is a place for alternative approaches to healing such as those used by traditional healers. They should not be ignored or dismissed. It is essential to respect cultural differences whether foreign or South African.
The participants feel more should be done to prevent importation of the virus from Europe and other affected areas. People entering South Africa must quarantine themselves for an appropriate time.
Since this meeting the number of confirmed COVID-19 cases in South Africa has increased to 61, and person-to-person spread has started. This will probably change the rate of spread and the distribution of the virus from privileged international travellers to those living in peri-urban informal settlements where access to the social determinants of health is often lacking.
These community voices show how the corona virus, a formidable problem in its own right, exposes long-standing deep underlying problems such as our enormous inequality, failure to deliver key services essential for good health, and our failing health system. They highlight key problems that face community health workers, fundamental to primary health care and universal health coverage. They provide clear testimony of how lack of adequate housing, poor access to water, working conditions and unsafe public transport make it virtually impossible for thousands of people to use simple recommended public health measures such as frequent hand washing and social distancing to slow down the viral spread and flatten the curve.
This will put added pressure on the public health system on which they depend. And, as they clearly point out, the system is already battling to cope with the pre-corona virus burden of disease with crowded waiting rooms, where all forms of communicable diseases tend to spread.
It is too soon to evaluate President Ramaphosa’s declaration of national state of disaster with a range of far-reaching but, under the circumstances, seemingly reasonable measures to control the epidemic. Some of the measures address issues raised by community members, but more information is needed, including the composition of the proposed Command Council and briefings by ministers of other sectors.
The key to progress lies in concerted action by the state, labour, the private sector, and a mobilised civil society—the people. As a nation we must ensure that this critical period leads to social solidarity, action to address the social determinants of health, and an equitable unitary health system that truly meets the health needs of all.