Healthcare workers, police officers and firefighters are among the millions of essential workers putting their lives at risk on the front lines of the Covid-19 pandemic. But the shortage of personal protective equipment (PPE) during the government’s lockdown has seen many working in fear of contracting the coronavirus or passing it on to their families.
Recent outbreaks of Covid-19 at two private hospitals in KwaZulu-Natal – Netcare St Augustine’s in Berea, Durban, and Netcare Kingsway in Amanzimtoti – thrust the issue of infection protocols and health worker safety into the spotlight. An independent investigation is reportedly under way to establish how 66 people, including 48 staff members, at St Augustine’s tested positive for the virus. One patient who tested positive died at the hospital.
A 31-year-old nurse on the front lines of the Covid-19 virus, who asked for her name to be withheld because she could lose her job for speaking to the media, said her life was at risk because there wasn’t enough protective gear. “I don’t want to lie to you. As much as we pledged to do the job, there are some things that we are not protected from and we will end up getting sick.”
Netcare Kingsway Hospital on the South Coast reportedly initiated a partial closure after 10 staff members tested positive for Covid-19. St Augustine’s is now closed. The two incidents have those on the front lines fearing for their lives as they say little or no testing is being done in their workplaces.
Citing operational cracks in the healthcare system, the nurse questioned why the government has not provided transport for essential workers. Nurses are being stigmatised. “When you enter a taxi, people do not want to sit next to you because you are in uniform and you may have the virus. There is a stigma attached to us.”
The nurse comes from Port Shepstone and lives on the hospital premises. She has not been home since President Cyril Ramaphosa announced the national lockdown on 26 March. She said she felt sorry for some of her colleagues, who pay up to R100 to catch an Uber taxi to work every day.
“We have had positive cases in the hospital, although not many. The problem is that the Department of Health is testing and screening people in their communities but as the frontliners, we have not been tested.”
She feels let down by the department. “At the end of the day, if we get sick as the frontliners, the entire healthcare system in the country is going to collapse. People will die because we also have other patients who are sick.”
The mother of one, who has worked in the isolation ward where patients are tested and wait for their results, said: “The kitchen staff do not bring the food, the nurse must go to the kitchen and fetch the food for the patient. There is not a single cleaner who wants to go in there and clean, and you as the nurse need to make a plan for the patient.”
She said she feels the government does not value her life, despite healthcare workers being important to the healthcare system.
“We soldier on not knowing what we could contract every day. What is painful is that I am only 31, I am building our family home. If I died today, what would happen to my family and my unfinished house?”
Sitting alone, she sometimes regrets pursuing her chosen vocation. “But I stayed because I love nursing.”
Her cousin who is also a nurse is among the health workers who have contracted the coronavirus. “It’s really scary,” she said.
Policing the lockdown
A 30-year-old police officer with 10 years of service said he knew that his immediate challenge was going to be getting people to abide by the law. “They are failing miserably,” he said of citizens and social distancing.
“My work as a police officer has been easier with a very large drop in violent crimes, most likely as a result of the restrictions on liquor,” said the officer, who recently became a father. Ramaphosa has rejected calls to lift the government’s lockdown ban on the sale of alcohol. The officer added that support from management within the police service has made going to work worth it.
Labour law attorney Michael Maeso said that although essential service workers are compelled to go to work, employers have the responsibility to comply with stringent safety measures to ensure that they maintain a safe work environment. “All things being equal, the employees should not be compromised because of having to work. There should be protective gear and sanitisers available, and there are strict regulations on how people should operate.”
But he added that doctors, nurses and healthcare workers are working on the front lines of the Covid-19 pandemic and most likely to become infected. “They are dealing with this face to face. You’d expect them to be infected. Sure, you can give them protective gear, but that does not guarantee not being infected. PPE just prevents the possibility of being infected.”
Maeso said that in cases where there is a shortage, workers have the right to down tools until such time as the employer provides them with adequate protective equipment. “Nehawu [the National Education, Health and Allied Workers’ Union] took the department to court claiming that hospitals were not providing PPE and then they could not back up their argument and then they lost the application.”
Labour lawyer Dunstan Farrell agreed with Maeso, saying employers had an obligation in terms of the Occupational Health and Safety Act to protect employees from on-the-job hazards. “As an employer, I have an obligation to provide you masks and gloves as a minimum requirement in response to Covid-19.”
Farrell also said that if workers feel unsafe, they are within their rights to refuse to work. It might result in being dismissed, but this could be challenged in court. However, he cautioned prospective litigants to take care, citing the same judgment to which Maeso referred.
In April, Nehawu received a judicial caution for launching an urgent application against the state in respect of PPE. Labour Court Judge Benita Whitcher’s caution berated the union for its actions, which she said were “misconceived in fact and law”.
The union claimed its members were not being provided with PPE at hospitals across the country. The judge said the court acknowledged that health workers were on the front line – “heroically so” – and entitled to PPE. But while there was a national shortage, the specific hospitals the union had identified either had no shortage or if they did, this could be solved by placing additional orders or shifting resources.
The judge granted a costs order against the union, saying she was adjusting the standard of what constituted frivolous and vexatious conduct in litigation. Under the circumstances of national disaster, she said, “everyone is called upon, for the good of society as a whole, to cooperate in bringing the pandemic under control”.
“In short, a new value system on what constitutes acceptable behaviour has been thrust upon us all … those who elect to pursue obviously untenable legal points, use the court process as part of other power plays, unnecessarily consume the resources of their opponents, or make allegations they cannot substantiate, know that they run the risk of a cost order thereby should they lose.”
‘A don’t-care attitude’
A 47-year-old firefighter with 25 years of experience said he knew before Ramaphosa’s announcement that he would be needed at work. “My concern was getting infected and bringing infection home,” he said.
During the lockdown, the man and his team attend to fires and accidents. “Our gripe is that we are not provided with the correct personal protective equipment when we are going for standby. They give us a pair of gloves and one mask to use for four days. We are responding to calls with six personnel sitting in one fire engine and that means there is no distancing. We also do not have temperature-testing equipment.”
When the men and women on the front line ask their superiors, they are threatened into complying or they will “face repercussions”. “So guys are frightened to refuse to go on standby. The problem is that we cannot work around the protective gear issue, it is a must-have for essential service workers. We all fear getting the virus at work, especially with no or minimal PPE.”
When he gets home from work, his son hands him disinfectant. He strips down to his underwear and sprays his entire body, uniform and lunchbox, then heads straight for the shower. His clothes are placed in the washing machine to be washed immediately.
“This happens every day I go to work. On my off days at home, it is wonderful. I feel a sense of safety and security. When we go to work, that’s where it becomes scary and worse because there is no help and there is generally a don’t-care attitude from our chief and deputy chief, who sit at home.”
Mask or not
A court interpreter in KwaZulu-Natal said that while he had been issued with a mask, he still felt unsafe. “We have close contact with prisoners and the risk of disease spreading among them is high. All I can do is keep my distance. I refuse to go down to the cells. I also bought myself a quality mask that is comfortable and is safe.”
A supermarket cashier in Durban said she opted not to wear a mask. “Seriously, I can’t breathe with that thing. If I get it, I get it. I’m just happy I have a job. One of our customers was in just now, she’s a single mom and she can’t work because of the lockdown. So now she has no income.”
Democratic Nursing Organisation of South Africa provincial secretary Mandla Shabangu lambasted the Netcare group for placing the lives of workers at its St Augustine’s and Kingsway hospitals at risk. Shabangu said Netcare and the department needed to be held accountable for the outbreaks.
The union called on the provincial health department to take stringent measures against noncompliant employers. When asked how members were coping mentally, Shabangu said it was an “extremely daunting” time for health practitioners and essential workers countrywide.
“Our nurses are confident and they have been trained in dealing with all infectious diseases. The problem is when you don’t get the necessary support from management. It is difficult to do your job with confidence. Nurses are coping well under the circumstances, except for those instances where management is not playing its part and not giving emotional support.”
The most important thing, said Shabangu, is to have professionals who are passionate about infectious diseases. “Those are the frontliners who are voluntarily confronting Covid-19 head-on. They are passionate about infection control. But you do find a situation where an ordinary nurse is afraid to deal with infection control.”
Durban psychologist Lindelwa Mkize finds herself in a catch-22 situation. She is an essential worker but because she has a private practice, she is forced to stay at home. “I would give anything to go back to work. I know and can hear that my counterparts in public service are frustrated with having to wake up and go to work and offer their services.”
Mkize, who recently became self-employed, said she was not earning an income and that was causing her anxiety. “The white psychotherapists are offering services remotely from home via Skype and Zoom whereas as a black psychologist, I have not really bought into that. My brother asked me why I’m not following suit and I said because my black clientele has not called to ask for a Skype session or over the phone.”
Mkize said she felt useless. “I know full well that I am essential services and that people are going through a lot of trauma right now, a lot of depression and a lot of anxiety, and these are things I am experiencing myself. I am thinking about everything they may be dealing with.”
KwaZulu-Natal premier Sihle Zikalala has expressed concern over the high number of Covid-19 cases recorded in the province. In late April, Zikalala said that of the 52 deaths recorded around the country, 21 were from KwaZulu-Natal and it was clear that eThekwini had become the epicentre of the virus in the province.