“When it comes to winter I always have this pain in my lung,” said Malcolm Adams, a 56-year-old carpenter. The problems with his lung began years ago, after a case of pleural effusion. This year he felt a sensation of pressure on his chest and had difficulty breathing. When the asthma pumps he used did not alleviate his symptoms, he began to suspect this was not his usual winter problem. On the advice of his doctor, he went to False Bay Hospital, where he was tested for Covid-19. Four days later he got a phone call confirming he had been infected with the virus.
“When the sister called I broke down,” said Adams. “It felt like my life was turning upside down.” Like thousands of South Africans, Adams was not able to safely isolate himself at home without posing an infection risk to his family. He was offered the option of recovering at the Lagoon Beach Hotel quarantine and isolation (QI) facility, and accepted.
Instead of being taken to the Lagoon Beach Hotel, however, Adams found himself being dropped off at the Old Mutual Conference Centre and Clubhouse in Pinelands. As he stood outside the building, he felt as though he had hit another roadblock. “I had never seen or heard of this place. I know of Old Mutual because I have friends working there, but … when I came here it looked a bit rough. People were walking around aimlessly,” said Adams.
Quarantine and isolation
By June, four months into the pandemic, most people had heard about QI facilities such as the Lagoon Beach Hotel in Milnerton, where residents were confined to a hotel room for the duration of their stay. Group-isolation facilities, however, were less well known.
The three-storey Old Mutual Clubhouse and Conference Centre was converted into the Pinelands Isolation Facility. Each of the floors was converted into a 100-bed isolation facility that was run by its own team of health professionals. The conference rooms had been converted into dining halls and shared bedrooms. As all the residents were confirmed to be Covid-19 positive, they were allowed to interact with each other on the floor to which they were assigned.
In the last week of May, Suhair Solomon and Sheila McCloen of the Department of Health’s Khayelitsha Eastern Substructure (Kess) were instructed to set up the third 100-bed isolation facility on the top floor of the facility.
They assembled a dedicated team consisting of occupational therapists, who would be the site managers; nurses for clinical observation; and community health workers, who would be responsible for daily screening and providing additional care.
While Solomon and McCloen had no experience with running quarantine and isolation facilities, they had done case management for four months, since the start of the pandemic, which gave them insight into the patient journey. “We didn’t know what people’s experience of the health system was like before they got to us. And they had a range of different experiences. But what we could [influence] was how they experienced the system while with us,” said Solomon.
Contrary to Adams’ first impression of the group-isolation facility, the welcome he received from both the staff and his fellow residents left him feeling amazed. “I came with a heaviness. Once they told me I was positive, I felt like, ‘Now I’m really sick,’” said Adams, who had recently lost a friend to Covid-19. Being away from his family did not make things easier either, but he soon discovered he had access to a support system in the form of the men on his floor.
“The guys [who] stayed with me … were my age and older, and they made me feel at home. And that was the difference,” Adams reflected. “Everybody shared their stories, and it made me feel better.” During the course of his stay at the Pinelands Isolation Facility, Adams would find himself having to work hard to maintain a positive mental attitude. When he was admitted, he felt relatively fine except for the heaviness on his lung but three days into his stay, he began to develop typical Covid-19 symptoms. His throat became scratchy, and the difficulty with breathing returned.
The symptoms subsided with the use of medication, but ultimately for Adams, it was hearing the stories of men who had been more severely affected – some of whom had been on ventilators – and seeing them discharged that gave him hope and helped him keep mentally strong.
Building a supportive environment
“We knew that people had very different symptomatic experiences of Covid. We knew that for some they had quite traumatic experiences in hearing the news, and we knew that people experience stigma across their care pathway from family [and] from community. Maybe they felt very isolated in hospital. So we had all of these insights, and we wanted to be intentional about using that information to influence a supportive environment in the isolation facility,” said Solomon.
One activity the staff used to create connection between residents was to have group dialogues on certain significant days. One such dialogue took place on 16 June 2020, Youth Day, where older residents, who lived in various parts of Cape Town, shared memories about where they were on 16 June 1976. On Father’s Day, they had an open discussion about what it meant to be a father in South Africa at this time.
Other activities were suggested by residents themselves, and because of their guiding principles, the team was open to them. “One of the residents began to feel well and wanted to go outside. That led to a group exercise activity for our floor. It was incredible to witness motivated, recovering people in isolation, bonding with one another in fun and healthy ways, and taking charge of their recovery,” said Solomon.
These and other activities helped build trust between the residents and the team responsible for their care. “We had to consider that every interaction we have is a transaction of that trust. And we were presented with an opportunity to do that in a community setting,” said Solomon.
Thabisa Jucwa’s journey
In contrast to Adams who arrived at the facility to begin his recovery, Thabisa Jucwa, who lives in Khayelitsha with her 16-year-old son, was admitted to the Pinelands Isolation Facility after a more complicated journey with Covid-19.
When she first began feeling sick, she thought it was related to her sugar levels, as she is diabetic, but she soon began to experience trouble breathing. She was rushed to the nearest clinic and thereafter to Khayelitsha District Hospital, where she was treated for pneumonia and tested for the virus. When her test results came back positive, she was transferred to the Khayelitsha Field Hospital and given oxygen.
While at the field hospital, Jucwa’s body responded well to the treatment. The doctors told her there was a noticeable improvement every hour. “I was so happy, because this thing is scary. When you think of Covid-19, you think of ‘one way to heaven’,” she said. The next day, after a week between the two hospitals, she was informed she was well enough to be discharged and that she could finish her recovery at home.
Jucwa decided not to go home until she was fully recovered. The decision was partly due to the stigma around Covid-19 in the area she lived and partly out of concern for her son’s health. She requested that she be taken to an isolation facility.
Like Adams, Jucwa was told that she would be taken to a hotel but ended up at the Pinelands Isolation Facility. She had never heard of the facility but she was so relieved that she was recovering, it did not bother her.
While at the facility, Jucwa found a support system she did not expect. “It’s a network of some sort, sharing experiences and [getting to know] more people,” she said. “Because we had different experiences in catching this virus, when somebody tells you their story which differs from yours … those are the things that are interesting to hear.”
Jucwa felt that being at the Kess-run floor helped her heal physically as well as emotionally. Speaking of Solomon she said: “Suhair would talk to you. They would extend their conversation to you, and comfort you emotionally.”
In addition to dealing with Covid-19, she had been unemployed since October 2019 when she finished her articles in law. The pandemic had made it difficult for her to find work, leading to her not being able to pay rent. While she was in the isolation facility, her landlord wanted to evict her and her son, but her neighbours asked her landlord to wait until Jucwa was discharged. Even though he agreed, she had the added worry of not knowing where she was going to live when she was discharged.
The emotional support Jucwa received was invaluable.
Connection and community
Adams and Jucwa experienced the initial psychological distress that so many others do when they contract Covid-19. Having to recover from the disease while in isolation, away from their families and support systems, exposed them to additional psychosocial stressors. While Adams was in isolation, his cousin died from Covid-19, and Jucwa had to deal with her impending eviction.
Both of them managed to find the support they needed in the community they were a part of at the group-isolation facility. Had they ended up at Lagoon Beach Hotel, that would not have been the case.
At the end of June, Solomon was told that the Kess team would no longer be running the facility. They had to hand it over to a new team on 3 July. All the team members gathered on that morning to bid the residents and each other farewell. While saying goodbye to the women, Jucwa stood up and made a short speech that left the residents and staff teary-eyed. She praised the staff for the importance they attached to making sure the residents were comfortable, and the interest they showed in them as people, emphasising the fact that the staff knew their names.
“All of those things are not mandated blood pressure and glucose level checks, but it certainly had an impact on their experience while [they were] with us,” Solomon reflected, “and provided opportunities for connectedness. I think in a time when we are so isolated, the opportunity to connect with one another has really been the bonus of a group isolation.”