COVID'S RURAL FRONT LINE
Nurses in South Africa fight virus as best they can
South African nurse Ruth Seikaneng did not have time to mourn her colleague Dudu, who died from COVID-19 in one quick, painful week in July.
In the town of Reivilo in the country's North West Province where Seikaneng works, patients were waiting for a diagnosis, personal protective equipment (PPE) had to be ordered, and a full week of 12-hour shifts lay ahead.
“We miss Dudu. That loss, it was so bad. But we had to come straight back to work to make sure no one else got sick,” Seikaneng said between consultations.
Seikaneng, 64, is one of 11 nurses in the town about 500 kilometres west of the country's biggest city, Johannesburg, fighting the spread of the coronavirus in a nation with the highest numbers of confirmed cases on the continent.
The Africa Centre for Disease Control says South Africa has some 681,200 COVID-19 cases. About 16,976 people have died from the disease.
Seikaneng's experience in this former mining town of roughly 4,000 people is echoed by nurses across the country who have spoken out in recent months about their working conditions, with protests erupting over pay, short-staffing and a lack of PPE.
The World Health Organization (WHO) estimates there are about 28 million nurses in the global workforce — six million fewer than are needed, with 90 per cent of the shortfall concentrated in low- and middle-income countries such as South Africa.
For Seikaneng and her colleagues, minimal PPE and staff shortages have forced them to innovate and adapt to prevent more lives being lost to COVID-19.
“We're doing the best we can with the little we have,” she said from an office in Reivilo Health Centre where she works.
It has meant working longer hours when a colleague has to quarantine and carefully assessing patients' symptoms to decide whether to call for an ambulance from the nearest hospital, 70 km away, where tests can be carried out.
On some days, no PPE was delivered to the health centre, forcing the nurses to reuse masks or go without.
Often their priority was simply stabilizing patients until the ambulance arrived to take them to Taung hospital, which has the municipality's only COVID-19 ward.
“We're in a rural area far from supporting health services,” said Sipho Bathlaping, 29, another nurse at the Reivilo centre.
“What we need is more PPE,” he said, “but also moral support.”
At Taung hospital, COVID-19 ward manager Vicky Shikwambana receives patients from surrounding towns including Reivilo, dividing them between rooms for suspected or confirmed cases.
If a patient's condition worsens, they have to be moved to Klerksdorp hospital, some 250 km away.
“We only have one ventilator in the whole hospital. What can we do? We have to keep working because this is a pandemic,” Shikwambana said.
Like many nurses, Shikwambana has had to adapt to plug the gaps during the coronavirus crisis.
The COVID-19 ward used to be for tuberculosis patients, who were moved elsewhere in the hospital as the pandemic gathered pace.
Coronavirus has piled pressure on a health system already dealing with HIV/AIDS and tuberculosis, with TB claiming an estimated 78,000 lives every year in the country, the WHO Global TB report says.
Under-staffed, overburdened health systems are not unique to low-income countries.
Nurse Heroes — a joint initiative between philanthropists, media and celebrities that supports and honours nurses — says within three years the United States and Europe could lack one million and 1.5 million nursing staff, respectively.
In Taung, Shikwambana knows even minor adjustments can preserve PPE, and possibly help his small team save lives.
Shikwambana and the other nurses sometimes speak to patients through the window, cutting down on the need for PPE and preserving precious supplies.
“My family are nervous about me working here, but they are also proud,” said Shikwambana, standing outside the ward.
In Pudumong, a town of 3,000 people not far from Taung hospital, community health-care workers gathered outside the clinic, adjusting their hats in the glaring sun.
“We are here to save our community,” said Kgomotso Moremedi, 43, one of 26 members of an outreach team doing door-to-door contact tracing to stem the virus's spread.
Gontlafetse Leinane, 45, sprayed the last drops of hand sanitizer onto her colleagues' open palms.
“This is all the sanitizer we have today,” she said, as the mostly women team members rubbed their hands and adjusted their face masks before heading out on their rounds.
With no thermometer, they use a verbal assessment form to ask quarantining residents who they last saw and whether their symptoms are better or worse.
At their first stop, nurse and team manager Rachel Asitile accompanied three outreach team members to the house of Thuso Kalanyane, a 49-year-old teacher with COVID-19 who had been self-isolating for a week.
“We're relieved and happy to see the health-care workers,” said his wife, Mapuledi, who had been isolating with him. “Now we feel someone is there for us, that we're not alone in this.”
Asitile said the climate of fear and uncertainty was palpable in the town, which lies near the border with Botswana.
“We cannot be afraid or it will affect us psychologically” said Asitile, adding that when funds were low she paid for sanitizer and photocopied assessment forms herself.
“All we can do is try by all means to protect ourselves and others.”