South Africa

South Africa: Unions Insist Deadly Eastern Cape Clinics Must Close

Rather than allowing state clinics in Port Elizabeth's impoverished areas to become Covid-19 vectors, health workers have shut them down until such time they are properly equipped.

The South African Federation of Trade Unions (Saftu) says it will shut down the Port Elizabeth district office of the Department of Health after two nurses from the Zwide Clinic died and at least 11 others tested positive for the coronavirus.

"Those people who are sitting in the district office must answer for these lives that have been lost. We loved those people. We still love them. The district chose to ignore the national regulations and they must pay," said Saftu regional secretary Mzikazi Nkata, speaking at a memorial service for the second nurse outside the clinic on 18 May 2020.

In Eastern Cape clinics where Covid-19 has broken out, nurses have been forced to continue working while awaiting their test results, potentially infecting hundreds of their colleagues and patients every day. After the outbreak at the Zwide Clinic, six trade unions from different sides of the political spectrum joined forces as the "combined health unions" and forced the Zwide and KwaZakhele clinics to shut their doors until the buildings were disinfected and all health workers tested negative.

Also speaking at the memorial service, Buyisile Mabope of the National Union of Public Service and Allied Workers (Nupsaw) said: "The Department of Health is so negligent. They are people who are responsible for the death of our comrades because they neglected their authority to tell these nurses to stay home."

Mabope was referring to a standard operating procedure issued by the outbreak response team of the Nelson Mandela Bay health district office on 3 April, which says "there will be no employee self-quarantined for 14 days on bases of having a contact [sic] with a confirmed case. Covid-19 testing will only be done for symptomatic employees. If in contact with a confirmed Covid-19 the following will apply. Asymptomatic healthcare workers will continue to work, while monitoring for the symptoms and applying safety precautions."

The procedure says that health workers who are tested must self-isolate until they receive their results, but the district will only allow this for those who display coronavirus symptoms. The asymptomatic health workers who were tested after the death of the first nurse had to continue working and could therefore have infected hundreds of patients.

Siphiwo Ndunyana, provincial coordinator of the leftist Saftu-affiliated Democratic Municipal and Allied Workers Union of South Africa, called on the Eastern Cape Department of Health to act against the district health office's managers. "Those who came up with this standard operating procedure must account and be charged with misconduct. Everybody must be treated equally, irrespective of whether they are management, because they cannot expose our members to health hazards," Ndunyana said.

The procedure also flouts the national Covid-19 guidelines for health workers, which state that people who may be infected but are asymptomatic can still be quarantined for 14 days. "Quarantine keeps these people away from others so they do not unknowingly infect anyone," the guidelines say. Further guidelines for asymptomatic health workers state they must quarantine at home following exposure. "If well, test on day eight and if the result is negative consider early return to work," the guidelines state.

The Port Elizabeth township clinics all suffer from a shortage of personal protective equipment (PPE). National guidelines direct clinical staff to wear face shields or goggles, non-sterile gloves that are changed between patients, and masks that can be worn for a maximum of eight hours provided they have not been touched by unwashed hands, removed from the face or become wet. But at the time of publishing, no goggles had been supplied to state clinics in Port Elizabeth and masks and gloves were being used for days. Not one clinic had an infrared forehead thermometer, also known as a temperature gun, and health workers were unable to screen patients entering the clinics.

Despite this, Yolisa Pali, mayoral committee member for health of the Nelson Mandela Bay Metropolitan Municipality, told New Frame: "I have never heard about that. They received PPE last week in Nelson Mandela Bay metro. So what I know as I am standing in front of you is that they have got PPE."

Demanding action and protection

Hundreds of patients usually attend the Zwide and KwaZakhele clinics in Port Elizabeth, which are currently closed. After the first Zwide Clinic nurse died, "the staff demanded that everyone be tested for Covid-19 and that the entire clinic be deep-cleaned. However, the cleaning company only cleaned the room that the deceased nurse had been working in, which was the pharmacy. They did not clean the entire building," said Nkata.

The rest of the Zwide clinic health workers were only tested three days after the death of their colleague but were told to keep working until their results came in. This prompted the combined health unions to protest outside the clinic on 11 May and shut it down.

At the protest, the nurses repurposed the popular struggle song "Sizo xola kanjani... (How can we be peaceful when... )" to bemoan the lack of PPE and sanitisers: "Sizo nursa kanjani i corona (How can we nurse coronavirus patients [when we need nursing ourselves])?"

Counterproductive procedures

The protest on 11 May resulted in an agreement with the district health office that Zwide Clinic would be closed until thermal infrared thermometers and PPE had been provided, and that union leaders would also be called in to verify that there is enough protective equipment to create a clinically safe space for health workers and patients. But a week later, Nkata said none of this had materialised.

Pali reportedly agreed that even those nurses whose tests were negative a week ago would need retesting in case they had since been infected by their colleagues or patients. But, said Nkata, the Department of Health then told the unions they had no budget to retest the nurses. "The department has been abusing us for so long. We want Cyril Ramaphosa to explain to us where the billions are because our Department of Health claims it does not have the budget for retesting," she said.

Muddying the waters

Last week, a WhatsApp message was sent to managers and subsequently forwarded to health workers. "Kindly please note that we will no longer test asymptomatic contacts of confirmed Covid cases. Secondly, retesting will not be done after 14 days of isolation but cases will be given discharge letters", it said. The message purportedly came from "Nadiema", who health workers say is Nadiema van der Bergh, the district's manager of HIV and Aids screening and testing. She denied sending it.

The district health office also sent letters to Covid-19 positive nurses confirming "permission to de-isolate after Covid-19 positive test" - in other words, to return to work - but these letters were sent on 16 May to nurses who only began isolating after testing positive on 10 May.

"You can never discharge a person who has coronavirus who has only been in isolation for seven days," said Nkata, adding that the combined unions insisted that all coronavirus-positive nurses be retested after 14 days.

The provincial health department spokesperson Siyanda Manana confirmed that the district health office had issued the instruction. Quoting an article in The Conversation by Australian epidemiologists Tambri Housen, Amy Parry and Meru Sheel which says the infectious period is "8-10 days but can be longer" Manana told New Frame that "after 14 days there is no need for retesting as they are not infectious even if they may test positive". However, the same article refers to recent research published in the Lancet journal and says "severe cases have much higher viral loads and many continue to test positive beyond the 10 days after symptoms start. So the more severe the illness and the higher the viral load, the longer you continue to shed the virus and are infectious".

Thabisile Sikhakhane, a member of the Young Nurses Indaba Trade Union, says other clinics in townships in Port Elizabeth have the same problems as Zwide Clinic. "There is a lot of corona in Motherwell Community Health Centre. But the management is hiding. Nurses have resigned from infection control because they [management] hide results. Some staff are being tested, some are not tested. It's just chaos.

"All these clinics should be shut down. We wear the face masks until they taste stale. But you are hired as a nurse to provide service to citizens. You are not happy. You wake up in the morning afraid. We have to get people from the gates; we are going up and down. I think the shutdown of everything will be the solution. That will make them stop running and take care of us. They disrespected us," said Sikhakhane.

Nomonde Fanele, a nurse and shop steward for the South African State and Allied Workers Union, says security guards working at clinics should be protected too. Hundreds of patients line up at the gates of clinics daily, but the guards are without PPE. "The safety of the workers starts from the gate, not from those who are doing the testing. It is the same; we are crying with the same voice."

Government's absence felt

Andile Mavela, chairperson of the Democratic Nurses Organisation of South Africa, which is affiliated to the Congress of South African Trade Unions, says the government has not met even the most basic needs at the clinics. "We want the employer to give us not only one mask for two weeks. We want gloves, we want sanitisers and soap. We are aggrieved. We are infecting more community members because without PPE we are also not safe from Covid."

The union members were delighted to see a large disinfecting truck arrive to clean Zwide Clinic. The truck's owner, Jack Carelson of Finecorp Trading, told New Frame he had come as a volunteer. The company usually deep-cleans sewers, but since lockdown it has been disinfecting buildings in which people who have tested positive for Covid-19 work. Carelson said he had heard on the news about the 11 nurses and decided to clean the building thoroughly.

"A lot of our staff live in Zwide. I couldn't let this pass. We need to keep this clinic open. We cannot have it close down for long periods and that is why we are doing our civic duty by cleaning it. I don't worry about the money [payment]," he said.

Manipulating the system

At the large and busy 223-bed public hospital in Uitenhage, nurses have spent days picketing over the same concerns during tea breaks and lunchtimes. One of them, who spoke to New Frame on condition of anonymity, said: "When this lockdown started, we were given no PPE at all. No mask, no apron, nothing. Ever since we started picketing, the hospital gave us a mask but we are forced to use it for five days.

"There is no hand sanitiser, no gloves, no liquid to wash your hand. They say everything is out of stock. They have started giving the day staff those thin aprons to wear, just so the union can see they are providing something, but there is nothing for the night staff."

She says even the health workers in the hospital's Covid-19 unit are not screened. Instead, they have been given forms by the hospital's management to sign confirming they have been screened. "They said we must just sign it and they will put in the dates. They say they will backdate the form so they can show we have been screening all along.

"A few nurses have had to resign as they are chronic asthmatics and diabetics and they are being forced [to continue working]," said the nurse, adding that these nurses had been working with so-called patients under investigation - those who have been tested but whose results are not yet known.

"The worst thing in this hospital is that people have died of coronavirus," said the nurse. "The porters needed to move the bodies to the mortuary, but they didn't have any gowns. There are no separate fridges for the corpses. The Covid-19 deceased are mixed with those who died of other illnesses."

Avoidance and ignorance

Provincial health department spokesperson Siyanda Manana said the Uitenhage hospital porters had now been issued with coveralls, gloves and masks. A separate fridge for the Covid-19 deceased patients would be delivered this week, he added.

New Frame asked Manana why the Port Elizabeth district office had insisted that Zwide clinic workers continue working while they waited for their test results, instead of isolating at home. Manana would only say, "we are dealing with it insofar as to why staff were instructed to work in violation of protocols."

"As the department we were proactive when testing them as no one presented with symptoms even the deceased staff [who] was on duty on the 30th [of April] and completed the shift," he said.

Meanwhile, President Cyril Ramaphosa had nothing but praise for the struggling province. He seemed unaware that the province had flouted the national guidelines.

"I am really impressed with the strategy you have put in place. The Eastern Cape is really awake. The plan and outlook that was outlined here is particularly pleasing. Yes, you have awoken to the danger of this [the rapid increase in cases] and you are now putting in place a clear health strategy that is going to address this challenge," Ramaphosa said.

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