María Molefi is on leave, but she cannot afford to rest. This is April 30, the third day of confinement in South Africa after the government order has ordered citizens to stay home in an attempt to stop the spread of the new coronavirus, a pathogen that, according to the World Organization of the Health, on May 3, it had killed more than 245,000 people worldwide.
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The atmosphere is not exactly party. Molefi is a local health facility. His is one of the essential professions that have continued to work during the national strike. In a few days he will join a new position at the Nompulelo Clinic in Midrand, after serving for several years in Tshwane. Her new destiny terrifies her. In June last year, she developed active tuberculosis after contracting the bacteria from one of her patients. "I was very, very sick," she recalls. "I was in treatment for six months, but I still don't feel well at all."
Soon, she will appear at the new clinic to work as a coronavirus tracker. Your task will be to keep track of possible patients or people who may have been in contact with someone infected. As with tuberculosis, patients with covid-19, the disease caused by coronavirus, are highly transmitting. But, unlike the first one, this one has no treatment.
Last month, a study published in the Journal of Travel Medicine has found that the rate of reproduction of covid-19 - that is, how many people an infected person can infect - is usually no fewer than three. Molefi reflects for a moment as we speak on the phone from her Midrand home, takes a deep breath and confesses: "I don't want to lie to you. I am very scared."
Just before midnight: call to action
It's 10:30 at night when Thabisa Mviko, a neighborhood health worker from Carletonville, west of Johannesburg, receives a text message: She has been selected to be one of the province's coronavirus trackers. The first thing you will do is participate in a training session that will take place the next day in the morning. "Can he be there at 07.30?" Asks the message from the Carletonville clinic medical coordinator.
A week earlier, Mviko had seen Bandile Masuku, a member of the Gauteng Executive Health Committee, announce on television that the province was going to prepare 1,000 neighborhood health workers to trace the close contacts of coronavirus patients. Then Mviko thought it was the first news she had about it.
Gauteng is the second epicenter of the coronavirus outbreak in South Africa after the Western Cape. According to the most recent data from the Ministry of Health, on May 3 they totaled 1,598 of a total of 6,336. In South Africa, the sick are already over 6,300.
When Mviko arrived at the training session the next morning, she hoped to meet quite a few colleagues ready to learn how to track down the virus. But when he hurried into the room, somewhat belatedly, there were only two people in front of the instructor at the National Institute of Communicable Diseases (NICD). He recognized one of the women, who also worked in a clinic in Merafong Township.
The plan, explained the NICD monitor, was that if a case of coronavirus was confirmed in the area assigned to a tracker, the tracker had to personally go to town to identify anyone with whom the patient might have had contact. Then the trackers, like Mviko and her two companions, had to give these "contacts" the information they needed to protect themselves and others, direct them to a center for testing, and tell people to stop. Isolate yourself until you had the results.
If these were positive, and whenever possible, the person should remain isolated until two other tests carried out over two days were positive. Then the tracking process would start again from the beginning. But there was a trick: the utilities would not only be responsible for tracing all the contacts in their respective areas, but also for training any member of the clinic they managed to recruit to help.
Fear and frustration: "They only gave us gloves, no masks"
When Maria Molefi fell ill with tuberculosis, she worked as an infection tracker in Tshwane. His task was to go to town to locate possible patients or people who might have been in contact with someone who had tuberculosis.
According to the guidelines of the World Health Organization, one of the ways that health workers have to protect themselves against infection with the tuberculosis bacillus is to use a special mask, known as a respirator or N-95 mask. These masks filter the air that healthcare workers breathe. But the clinic where Molefi worked did not have that equipment. "They only gave us gloves, no masks," he denounces.
When Molefi reached the center of Midrand to which she had been assigned, the conditions were not very different. A week before her first day on the job, the clinic had already run out of masks. As with tuberculosis, respirators are a critical piece of equipment that healthcare providers around the world use to protect themselves from the spread of the coronavirus. But currently they are difficult to find, like the rest of the items, such as aprons and visors, that they would need to fully protect themselves. Due to the high demand for personal protective equipment (PPE), they are in short supply worldwide.
The shortage is such that the Business for South Africa Public Health Task Force, a group that works closely with the Government's Personal Protective Equipment department, has urged all companies, particularly those that have stopped operating. , to "urgently derive their PPE reserves for use in the public health sector". "The teams are crucial to protect the doctors and sanitarians who are on the front line, and to ensure their health in their fight against the pandemic," the group said in a statement to the press.
The situation has caused great fear to Molefi. "I don't want to get the virus working," he explains. "I already got tuberculosis from my profession." This mother in her early 40s is not the only Gauteng Health Department coronavirus tracker who is scared. Thepo Matoko is the general secretary of the Gauteng Community Healthcare Forum. When Matoko paid a visit to a clinic last week, she discovered that the team of 48 local health workers had not received masks to protect themselves. They had only been given a 750 milliliter bottle of hand sanitizer to share. Matoko cautions, "You can't expect these people to go on the trail of someone with unprotected coronaviruses right now."
Also, trackers aren't the only ones at risk. Proximity health workers will be on the front line, whether or not they have been trained as trackers. "If there is a suspected case of covid-19 in the monitoring area that corresponds to me as a proximity toilet," explains Matoko, "it is I who must go out and show the trackers where that person lives."
Gauteng had begun teaching all of his neighborhood toilets how to protect themselves against the coronavirus and how to educate their patients about the disease, but even in those sessions workers were told that the supply of protective equipment was "in crisis," he says. Neo Maleka, one of the people who attended one of the Merafong municipal workshops. "What if I have been visiting a house without protective equipment, not knowing that someone with covid-19 lived in it?"
A cruel comparison
In countries that have contained the epidemic, tracing contacts has played a key role in slowing down the spread of the virus
About 400 miles from Carletonville, the picture is very different. The South African Red Cross has deployed a team of nearly 20 trackers to identify people who have had close contact with sick people who tested positive at one of the Bloemfontein Church of Divine Restoration worship centers in the province of the Free State.
The trackers received five days of training several weeks before the pandemic also struck the country's shores, far more than the three-hour crash course offered to Mviko and the other neighborhood toilets. In Bloemfontein church only five people tested positive for coronavirus, but that group gave the Red Cross staff in charge of the monitoring a lot of work. "There were 1,032 names on the list," says Claudia Mangwepape, head of the section of the humanitarian organization in the Free State.
Although Mangwepape and his team worked over 12 hours to get in touch with everyone on the list as quickly as possible, they were comforted in having full protective gear, including special respirator-type masks designed to prevent the spread of sanitary and surgical gloves. The contrast is enormous. Gauteng health department trackers are almost entirely equipmentless. "The Department has again failed its local toilets," denounces Tshepo Matoko.
On April 21, there were 76 infected toilets in South Africa. However, at the end of March, when there were only five, the Ministry of Health stated that the majority were not infected through their patients, but, more likely, from their relatives or during a trip abroad. Back home, in her living room, María Molefi feels uneasy. He clicks his tongue and says, "It's not fair."
New virus, old wounds
The Gauteng Community Healthcare Forum and the province's Department of Health have long been at odds. In 2016, five forum workers brought the department to court after it advertised several toilet vacancies without notice. Despite winning the case and the statement by former Health Minister Aaron Motsoaledi, in which he stated that in 2018 public squares would be created again, little has changed for Mviko and his colleagues.
So when he relays the news, the other workers at the Carletonville clinic find it outrageous. "It is too much," they protest. Mviko explains: "We are risking our lives in this job. I like what I do and I have the necessary patience, but I don't have protection, and they don't pay us well."
Currently, the country's proximity health workers have a one-year contract with the Department of Health, Matoko explains. "That means we receive a monthly salary, but not the same benefits as other healthcare workers, such as healthcare or retirement." Also, salaries are very low. Only 3,500 rand (170 euros).
In various emails addressed to Masuku, Matoko requested that local health workers be recruited into the Health Department staff, and that equipment be provided to protect them from the coronavirus. Masuku promised them that on April 1 they would be given a fixed place, Matoko says, but so far nothing indicates that this will happen.
This was the worker's request: "It is not the first time that community health workers have been tasked with caring for workers to prevent the spread of an infectious pandemic. Community health workers were at the forefront of the fight against AIDS and tuberculosis. Many lost their lives serving their neighbors. " The prime minister's office did not respond to requests for comment from this outlet.
In her house in Midrand, María Molefi takes a deep breath between sentences. The stress of talking about what awaits her in the coming weeks brings out her feelings. "The government keeps saying that community health workers do a great job, but when it comes to money, what happens? What are they having trouble letting go of." Molefi sighs. "I don't know what else to say. We risk our lives to save others. I really like my job, but I need protection against the coronavirus and I deserve to be paid well. We do more than our share."
This article was originally published in English by Bhekisisa, a South African health publication. The Bhekisisa Center for Health Journalism newsletter can be viewed here
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