Leadership, Lockdowns and Livelihoods in the time of Corona
by Rehad Desai in South Africa
Saturday 10th April 10, 2020
President Cyril Ramaphosa addressed on Thursday night and many of us heaved a sigh of relief as he seemed to be saying all the right things in statesman fashion. Like many others around the world, he informed us about what was best for ourselves based on the science and went onto to instruct the nation what must happen, unpacking, explaining but an invitation to question any of the advice was markedly absent. He played the role of the family patriarch very well.
It left me feeling better about the grim prospects we face ahead but he and his command centre continue to refuse to acknowledge the critically important role of community and neighbourhood based efforts in containing this epidemic to ensure that food is getting through to people, folks who ae slipping through the cracks.
Something is missing and maybe it is an unwillingness to accept that only if everybody is united in purpose do we have a chance to stop the pandemic overrunning our health sector and losing unnecessarily lives as well as maintaining livliehoods, that hang precariously in the balance for hundreds of millions of people in the global south..
We are not equally affected by COVID 19
So, while the numbers on the surface tell an encouraging story, the lock down strategy has slowed down the rate of infection, certainly among the economic elites who frequently engage in international travel. This is where testing has been concentrated to date for valid reasons.
Testing is at present the most critical issue. Yes, we are now doing more testing than the UK was managing to do at this specific stage of the infection rate, but quite frankly the UK has been so shit poor that is nothing to boast about
The top medical advisors now admit that he testing criteria should have been widened out much earlier into the lockdown, so to allow us by now to begin to get a picture of community transmission. Where the hot spots exist so efforts to contain can be focused.
It is clear that the most vulnerable sections of our population concentrated in the townships and informal settlements that also converge with significant underlying health conditions among our people that in turn heighten chance of COVID 19 killing you.
In the USA you are four times more likely to be killed by COVID 19 if you are black, given that the vast majority of black Americans are working class in a country where public health care is barely existent.
Test test test PPE test test …
The 30, 000 tests conducted by the South African state to date are abysmally low, and the problem is more wide ranging than the testing criteria. Government led testing is run by the National Health Lab Services (NHLS) with a solid national footprint and an annual budget of 1.5 Billion. It has significant capacity and reputable health professionals in the know believe it can manage to undertake 30, 000 tests per day by the end of April.
The government is operating on the assumption that it will be able to access this amount of testing kits by this time. The NHLS has been caught with its pants down as it failed to stockpile testing kits for emergency situations, so there is shortage of kits. The C19 coalition have been crystal clear on the issue of shortages, produce locally and immediately through compulsory licensing and we understand this is what is now happening, and we will monitor progress in this regard.
What is clear is that President Ramaphosa failed to mention the shambles that exists in many of our provincial health departments. This means the CHWs that are leading the screening process are under resourced, inadequately trained and are currently experiencing a severe shortage of Personal Protective Equipment (PPE), never mind the fact they are underpaid. It needs to be made clear to the population that a section of our community, our CHWs are going from door to door insisting people answer questions, determining who needs to go to the testing centre, because we do not have testing kits for everybody.
If we had a fully functional national health system in place that had made contingency plans for outbreaks of infectious diseases, we could have contained this disease without a lockdown. A coherent Suppression strategy requires first and foremost capacity inside the health system to cope with the outbreaks of infectious disease. The lockdown has been required because this is not in place and health systems worldwide now have to attempt to catch up.
The lockdown punishes the working poor very severely and is a consequence of our government’s unpreparedness, a consequence of their refusal to spend money in the face of an ecological crisis. Yes, COVID 19 like many diseases that proceeded it is a consequence of deforestation and the advent of large industrial agriculture. Governments around the world have been warned for many years now to be prepared for an outbreak of a global pandemic.
We have 50, 000 Community Health Workers (CHWs) in place across all our provinces. This is in line with our stated formal commitment to the progressive primary health care approach. Most if not all of the CHWs will now be diverted towards screening of those communities deemed to be at high risk of being infected, the criteria for targeting these communities remains unclear, we need clarity if we are to encourage people to cooperate, failure on this score will lead to social instability
It is only testing that will provide the data that required to be able to measure the success and failures of the strategy that hovers somewhere between suppression and mitigation at the moment. Such a line of attack necessarily involves severe emotional, spiritual and economic pain and more so for the urban working poor who live in cramped housing conditions. Transparency and accountability will be critical in the process, which means government must release all the stats in relation to testing and deaths,
We need to protect and treasure our front-line responders now.
Each of the nine provincial health departments not only require shaking up by the Presidency and that it also needs to also outline clear and transparent plans to integrate the private health sector into the national health service. There is scant evidence that this is happening or that any contingency planning is in place to ensure that thousands of extra high care beds are put into place at the necessary time.
Our Nurses and Doctors also face shortages of PPE and like CHWs most of whom have no adequate place to self-isolate after work. Open the hotels and bed and breakfast so they can keep their families safe.
Lockdown yes but only if it is socially just
The SASSA hotline for food parcel cannot be accessed by everyone I speak to. Food that is being delivered by ward councilors is not being done so in a transparent manner giving rise to very real suspicions that the political elite distribution systems are self- serving. The Solidarity Fund need to roll up their sleeves and not simply confine the efforts to business rescue, the right to food security must be prioritized.
There are many mechanisms to ensure people are supported, so they are able to feed themselves and those in need are delivered food parcels.
Ensuring our health sector and aligned public services are capable of the mammoth tasks ahead of them must receive equal priority. It is abundantly clear to us that we now need a state that can act together with wider society to ensure food security needs are met. Failure to do so now will simply deepen the horrendous inequality that COVID 19 has exposed for all of us to see. A socially unjust lockdown will in all probability lead to mass rioting and understandably so.
A workable lockdown requires total buy in from society, particularly those most deeply affected, now critical given the recently announced extension. Social safety mechanisms that can be swiftly and easily accessed have now become critical. Cash has to be transferred in various forms to the 16 million people who are income insecure and dependent on the informal sector. This is a non-negotiable.
Fifteen days into the lockdown, hunger is already widespread. If unattended this will heighten existing malnutrition and lead tens of thousands of premature deaths, possibly many more than would be killed without a lockdown in place.
Like the climate crisis this is planetary problem
We were heartened by your words concerning Africa, but please make our Pan African outlook concrete. No one can be left behind, including all of our migrant workers from neighbouring countries who reside within our borders. South Africa belongs to all those who live in it according to our constitution, please stop referring to the population as South Africans when addressing the nation, it is not the exclusive type of language we need to hear from our President. This economy was built on their sweat too and its continued viability remains dependent on our regional neighbours.
We have a moral and political obligation to guarantee everyone’s safety, well-being and security, to ensure that those in our region are supported in whatever manner possible to survive this plague.
Finally let’s not fool our ourselves Mr. President you are faced with hard choices as to how you are going to continue to make money available, not simply for the banks, but also for the people at their hour of need. You need to open up on this critical question, we cannot be continued to be fed nonsense that government will work within the resources that is available to it. In short no extra resources will be made available.
Credible organizations within society are saying that we must steer away from the temptation of taking loans now on offer from IMF. That we must maintain our political and economic sovereignty at all costs, and furthermore to promote and build our sovereignty at all levels. It seems that we now no other option if we are to put the needs of our people and country before that of the local and international banks.
Your strongest allies at this moment are they people whom elected you to serve as their president. They will support you if you support them.
Rehad Desai is an independent film maker from Johannesburg. Following his return from political exile Rehad worked as a health and safety/media officer for a chemical workers union and as the head of a HIV prevention unit. His films include Miners Shot Down and Everything Must Fall. Reproduced with permission.