While the vulnerability of those over 60 and with comorbidities is being addressed, healthcare workers in the private sector now need to address the challenges of running their practices as they risk infection, see fewer patients and face losing their business.
Army tent that is used as a covid-19 emergency room at Medipark 24 practice in Centurion. Healthcare facilities around the country adopted partitioning systems that separated care for the virus from the rest of the facilities. After screening any patient suspected to have covid-19 would receive care here to protect staff and patients in the main facility. Photo: Tshepo Thaela.
Upon arrival at the Medipark 24 medical practice in Centurion, one is met by the sight of about six army tents filled with all the necessary equipment to deal with covid-19 patients. Even though South Africa has passed the peak of infections, this site is still prepared for any emergency influx.
2020 has been defined by the covid-19 pandemic, and it is easy to become callous about the pandemic, but that all changes once you see the front lines in person. Seeing a patient vomit in the bushes, even though they are a good 10 meters away, quickly brings one’s mortality and vulnerability to the fore.
This vulnerability is amplified if you are considered a high-risk individual, or someone with a comorbidity, which is having multiple medical conditions, such as diabetes or hypertension. Moreover, being over the age of 60, with or without a comorbidity, increases an individual’s risk of not surviving covid-19 infection.
Co-owner of Medipark 24, Dr Clive Landman (59) is one such individual. Landman is knocking on the door of 60, and has multiple comorbidities: he is overweight, diabetic and has atrial fibrillation, which causes an irregular heartbeat.
As a high-risk healthcare worker, Landman may be put on edge by the fact that within 100 meters people are being treated for covid-19, which is especially dangerous to those with comorbidities. According to the National Institute for Occupational Health on October 10, covid-19 has taken the lives of 314 healthcare workers in South Africa. Landman, however, is as cool as a cucumber in the comfort of his wife and co-owner Dr Marié Landman’s (59) office in the Medipark 24 building.
According to allergist and immunology expert Dr Rozelda Rabie, the innate immune system, which is the body’s first line of defence against antigens, is where the issue of age risk lies. “What makes the elderly more susceptible to the disease is the waning of their innate immune system’s responses,” says Rabie in reference to covid-19 infection.
Rabie says this vulnerability is compounded by the fact that the elderly often already have comorbidities: “They often already have lung disease, heart disease, and are at risk of blood clots and other neurological complications.”
If any organs are already compromised by comorbidities such as cardiovascular disease, hypertension or diabetes, the impact of covid-19 tends to be more severe.
How did Healthcare facilities manage high-risk healthcare workers?
Although this is very much the case with Landman, he has no inkling of doubt about his safety at work. Swelling with the pride a father has for his child after a major achievement, he attributes his sense of security to the screening staff who prevent patients with symptoms from entering the practice building. “The screening staff have done such an excellent job, almost like they’re expert sniffer dogs for covid-19,” he says.
This precaution is not isolated to Medipark 24. Jacques du Plessis, managing director of Netcare’s hospital division, says screening was the first of many precautions taken by healthcare operations within the Netcare Group.
“Extensive screening, infection prevention controls including the use of UV disinfection robot technology, requirements for every person to wear a face mask, and hand hygiene compliance measures as well as scenario-specific personal protective equipment (PPE) are in place to keep everyone as safe as practically possible,” says du Plessis.
Further recommendations for healthcare workers over the age of 70 are that they “should not undertake any face-to-face work at the clinical interface within the South African health service”.
“Some of our paid staff were sent home or chose to take paid leave. This helped us because we didn’t have to worry about their safety,“
This changes the experience of doctors with comorbidities. Dr. Reardon James Zeiler (46), is a general practitioner at Medipark 24 and he has type 1 diabetes. Before the pandemic this was something he kept relatively private. Then, when his patients contracted the coronavirus and asked to see him, they were refused and Zeiler had to explain why.
“There was a twinge of feeling that my privacy was compromised at the beginning,” said Zeiler, “but I’m not an egotistical guy, so I got over it quickly and realised that maybe it’s good that people know.” He realised his confidentiality had to be breached for the sake of his own safety.
At Medipark 24, high-risk health workers were only allowed to work with patients who were confirmed to not be suspected of having covid-19 after they had been screened. In addition to this, high-risk individuals were also given the option to take leave.
Marié Landman told Wits Vuvuzela,that Medipark 24’s high-risk workers (doctors, nurses and administration) were given the choice to work or not during the pandemic’s peak. “Some of our paid staff were sent home or chose to take paid leave. This helped us because we didn’t have to worry about their safety,” she said.
When asked about whether the absence of these individuals put any strain on the workforce during the peak, she shook her head and answered without hesitation, “Not at all, because we didn’t see many patients.”
Livelihoods of healthcare workers in private is what is really at risk.
At first it might seem difficult to believe that private healthcare specialists have not been inundated during the pandemic, but the more you consider it, the more it becomes evident that the bulk of medical resources was dedicated to responding to covid-19.
The suspension of elective surgery illustrates this phenomenon. Simply put, elective surgery is surgery that can be scheduled in advance because it is not an emergency. As an orthopaedic surgeon at Charlotte Maxeke Hospital, Dr Anthony Robertson (60) explains, “At the beginning of the pandemic it was nice to be in orthopaedics because trauma cases declined dramatically as a result of everyone being at home.” This was due to the initial hard lockdown in order to free up beds in intensive care units for covid-19 patients who may have required these facilities.
Many private practices saw little no patients during the pandemic for various reasons such as the nationwide lockdown, patients’ fear of contracting covid-19 at hospitals and the deferral of elective surgery. Photo: Tshepo Thaela.
The dramatic decline of cases was perhaps only “nice” for Robertson because he works in a public hospital. This was definitely not the case for private practices. “Their income was slashed because they had no work… finances were not an issue for us in public [facilities] because we had salaries and we did not have to deal with overheads,” said the surgeon.
This adds an entire new level to what it means to be a high-risk healthcare worker at a private practice. In the balance between lives and livelihoods private healthcare specialists have been given little consideration, in view of the fact that not all healthcare work is related to covid-19.
Rabie, for instance, is not only an immunology expert but was reliant on her practice as an allergist as her main source of income. She had to close down her practice, which she opened 16 years ago, and now practises at Sandton Mediclinic. To put that into perspective, in the same amount of time South Africa has had three different presidents, the rand went from R6,66 to the dollar to R16,23 (at the time of writing) and the South African national rugby team had won two more world cups.
“It’s heart-breaking,” said the allergist. “You get to a point where you’re going to work every day, even during lockdown levels five, four and three. I did see a few corona-positive patients here and there, but not nearly enough to pay rent. My staff also decided to leave because they were concerned about getting the virus.”
Patients’ fear of covid-19 and tight budgets threaten private healthcare workers’ livelihoods.
“Patients that get retrenched will sometimes, willing or unwillingly, not pay for the services they received.“
While the lockdown did mean fewer people were getting illnesses like the normal flu, the main issue is that people have been too scared to visit practices during the pandemic. Landman told Wits Vuvuzela, “Patients would call in and ask not to come in, have a long discussion on the phone, get a prescription for themselves, for their wives, their dog and their neighbour. This is just as taxing as a normal day, but we didn’t see the patients, which means we didn’t charge for the consultation.”
For some patients it was more than a simple matter of fear, but also the knock-on effects of the pandemic and the lockdown. According to Business Techa team of researchers published a survey that looked at the economic impact of the coronavirus pandemic and countrywide lockdown. The survey’s key finding is that approximately three million people lost their jobs over the lockdown period.
Patients’ sudden loss of income had a knock-on effect on the Landmans’ practice as well. “Patients that get retrenched will sometimes, willing or unwillingly, not pay for the services they received,’’ said Landman. ‘‘Sometimes they lose their medical aid or [get] downgraded from A to C … which won’t cover the services they need.”
This has put an immense financial strain on the practice, which has incurred more expenses because of the pandemic. “On top of having under 20 percent of 2013’s patient turnover, we incurred more costs. None of our staff got pay cuts, we had more expenses from buying the army tents we use as our covid consultation rooms outside, and we increased our staff complement by employing extra people to do screenings,” said Marié Landman.
These financial burdens are not without repercussions on staff. Zeiler, for example, needed to extend his working hours in a bid to compensate for the little turnover from the lack of patients. Some staff even succumbed to emotional breakdowns because of the financial strain. “In the past month we had three staff members have mental breakdowns, two of whom needed to be admitted,” said Marié Landman.
Rabie told Wits Vuvuzela about healthcare workers who suffered through the pandemic: “I know many doctors who suffered through this. I know that many of the older practitioners had to close down their practices and have retired. There have been a lot of mental issues and I even know some colleagues who committed suicide.”
As serious as these issues are, Marié Landman looks back at a time when public sentiment towards doctors was very positive. “At the beginning of the pandemic people were praying for us, sending us cookies, and churches even brought us coffee, but now they’ve forgotten about us,” she says as a joke.
At-risk healthcare workers have shown an enduring spirit during the pandemic. They have had to overcome risks to their lives and livelihoods. Things are not all good for all healthcare practitioners and this begs the question, what will South Africa’s healthcare workforce look like in the medium- to long-term aftermath of the pandemic? Despite the many challenges the Landmans have gone through in adapting their practice during the covid-19 pandemic to keep their staff and patients safe, Clive Landman earnestly mentions his gratitude for still having some work, saying, “Even though there was no money flowing, I am glad we still had patients that gave us a cause.”
FEATURED IMAGE:
Army tent that is used as a covid-19 emergency room at Medipark 24 practice in Centurion. Healthcare facilities around the country adopted partitioning systems that separated care for the virus from the rest of the facilities. After screening any patient suspected to have covid-19 would receive care here to protect staff and patients in the main facility. Photo: Tshepo Thaela.
Foundation phase teachers in South Africa have been left reeling after new teaching and learning adjustments, varying from school to school, were made as a consequence of the covid-19 pandemic and nationwide lockdown.
Embattled teachers have found themselves under fire in the front line of a unique crisis – andin general they have individually risen to the challenge by finding ways and means to win the battle for the welfare and education of their learners.
“Since the beginning of the lockdown, I always say, ‘I have survived depression’. It was a lot,” said Reabetsoe Motsoaledi,a grade three teacher at SPARK Theresa Park, an independent school in Pretoria North.
Foundation phase teachers, who teach grades R to three, were left on unstable footing after the covid-19 pandemic forced a national lockdown,and closure of primary schools across South Africa, in late March.
“I had submissionsevery day. I found myself crying out of nowhere because I was just so drained. I even lost weight from all the stress. It really put a strain on me,” said Motsoaledi as she sat at a desk in her empty classroom, her face mask pulled down to her chin.
A toll on their mental wellbeing
The South African Federation for Mental Health (SAFMH), a non-governmental organisation that advocates for accessible mental health care, stated in an articlepublished in October:“One in four people will be affected by a mental health disorder at some point in their lives.”
Lloyd Ripley-Evans, a psychologist based in Johannesburg, explained to Wits Vuvuzelathat the covid-19 pandemic would naturally have an impact on an individual’s mental health.
“This [covid-19] has been a prolonged trauma that the world has experienced and it has created so many knock-on effects,” said Ripley-Evans. “Pandemic aside, if somebody is going through something difficult on a personal level, it’s going to affect them in a work space because it can be quite consuming. Their capacity to be present can be impacted.”
Foundation phase teachers are no less at risk than other frontline workers of having their mental wellbeing compromised. According to Ripley-Evans, this could also influence their relationship with their learners.
“I think it has been significantly harder for foundation phase teachers to engage with their students effectively,’’ he said. ‘’Their ability to engage and connect with their students to the same level as before has significantly been impacted.”
Motsoaledi explained that adjusting to a new way of teaching online, at the start of the lockdown,came with some unforeseen anxiety.
“You have to keep in mind that parents are going to be in your video and watching you,” explained Motsoaledi. “Now you get even more nervous because you need to make sure everything is correct and you have to be the teacher that doesn’t make mistakes. But that’s not fair, because teachers do make mistakes.”
“I found myself crying out of nowhere because I was just so drained. I even lost weight from all the stress. It really put a strain on me“
SPARK schools have made use of an online programme, known as AskNelson, throughout the covid-19 pandemic. AskNelson is an Employee Assistance Programme (EAP), free of charge to the teachers anddesigned to provide them with immediate emotional support. Teachers can rate how they are feeling on any given day and are put in touch with a local counsellor if they needhelp.
The teachers at SPARK schools are able to use the programme at their own discretion and do not have to disclose its use tothe school, confirmed SPARK Theresa Park assistant principal, Tshegofatso Diale.
Motsoaledi said she had found alternative ways of dealing with her mental health instead of usingthe AskNelson programme. “I have always just tried to be strong and move on. Besides just praying, just talking to someone because we’re all going through the same thing as educators. And venting to family members or partners. I’ve never taken any bigger steps to deal with what I’m going through,” she said.
Although being a foundation phase teacher is demanding, Motsoaledi said she loves her job and teaching is something she has always wanted to do. “I wanted to make a change to a child’s life, to develop a child, to be in the upbringing of that child.I wanted to make a difference,” she addedpositively.
Protecting themselves and their loved ones
Mental health struggleshave not been the only fallout of the covid-19 pandemic experienced by foundation phase teachers in South Africa.
Odel David, a grade R teacher at Shari Crest Primary School in Lenasia, said she found it really tough to balancethe need to stay at home with the demand to be at school, as a substitute teacher, for the grade seven learners.
“It really has been concerning mentally, because at home I am concerned about my family, but being at a government school, you also need to be available to the students. It is stressful when your emotions are weighed like that. You don’t know what’s going to happen and you are just preparing yourself for the worst situation,” said David.
Odel David shows Wits Vuvuzela a photograph of her son, who has a comorbidity and is at risk of serious illness if he contracts the coronavirus. Photo: Laura Hunter.
Shesaidshe felt the pressure to adjust her teaching style to match the demands of an older grade:“Although I am a foundation phase teacher, I still have to fill in that gap. It is rather stressful because I am so used to the foundation phase and now I have to go teach the intermediate phase.”
Before showing Wits Vuvuzela around the dust-laden grounds of Shari Crest Primary School, with its colourful walls and palpable loving atmosphere, David mentioned that after a group of teachers at the school contracted covid-19, she felt pressured to remain at home. She has a 12-year old son who has a comorbidity, and is at high risk of contracting the coronavirus.
“Being a mom of a special needs child, I know it’s very easy for him to contract covid. The beginning [of lockdown] was quite challenging because I wanted to be at home, because of the safety of my son, but then I was also thinking of the safety of my learners. It was better for us to be away from one another,” said a torn David.
Navigating the digital divide
At Vuleka St Marks, an independent church school of the Anglican Church of Southern Africa in Randburg, teachers and learners have their hands sanitised and temperatures checked before making their way past the modest church and onto theplayground.
Before the teachers of Vuleka St Marksreturned to school,they faced another challenge brought on by the covid-19 pandemic – trying to successfully teach learners online while some learners had little to no access to the internet at home.
Danielle Lang, a grade one teacher at Vuleka St Marks, said her biggest fear was the effect the pandemic had on the learners’ access to information, and whether the sudden interruption would cause them to fall behind.
Danielle Lang sits at her desk marking her learners’ work. Lang noticed that some of her learners’ reading and writing skills had declined over the lockdown period. Photo: Laura Hunter.
“We moved to [Microsoft] Teams in April, but we first started with ClassDojo (an online learning platform) and sent out slides. It was difficult because many kids at our school are underprivileged, so they don’t have access to any computers or phones,” she said.
Lang reminds us that the covid-19 pandemic has accentuated the digital divide in South Africa.The latest General Household Survey by Stats SA, published in 2018, stated that onlyan alarming 10.4% of households in South Africa have access to the internet at home.
“I had two kids who had no access to Teams and their parents don’t have any smart devices. That was the biggest difficulty, because those kids didnot get any information for about two months,” explained Lang.
As soon as she was allowed to go back to the school, Lang printed resource packs for the children who did not have access to schoolwork during the lockdown. And since some of her learners had not been able to practise reading and writing every day, Lang noticed they had indeed fallen behind.
“There was a huge decrease in understanding, especially with writing and reading.That was very difficult,”she said.
Candice Barrett, a grade two teacher at Parkdene Primary School, a public school in Boksburg, said her primary concern, at the start of the lockdown, was also if her learners would have access to schoolwork while trying to learn at home.
“At first it was quite a concern because we had to adjust to a new way of teaching. The kids as well. Some didn’t have internet access or data because of the financial strains caused by covid,” explained Barrett.“We did have a platform for parents to download the work but, because of data struggles, we weren’t sure the kids were going to do the work or if the parents could assist them.”
Barrett also noted that her learners are too young to use certain online learning platforms.“We didn’t have Whatsapp groups or Zoom because the kids are only eight years old, so it was going to be a challenge to use that,” she said.
Barrett, who had a covid-19 scare after close family members tested positive for the coronavirus, said her other major concern was the physical health and safety of her learners.
“I was concerned about the learners’ health, whether some were going hungry – at school we have a feeding scheme with extra lunches kids can fetch from the kitchen – and if kids were being abused staying with relatives. That’s constantly playing on my mind,because we [the teachers] care so much about them and we don’t know what’s going on,” she said with concern in her voice.
The learners’ desks at Vuleka St Marks are divided by clear plastic shields in order to minimise the spread of the coronavirus. Photo: Laura Hunter.
Addressing demands for extra emotional support
Although the health and safety of learners weighed heavily on theminds of the foundation phase teachers,the covid-19 pandemic has also resulted in learners demanding extra emotional support from them.
David, the grade R teacher from Shari Crest Primary, noticed that some of her learners demanded more of her attention once they had returned.She said it has been tricky to provide them with support, given all the physical restrictions existing in herclassroom.
“Theyhave been seeking that emotional support, especially when it comes to physical contact. Grade Rs love hugging! And I am a teacher who loves to show love back,’’ said David. ‘‘There are certain children I have picked up on that really need that affection. You know they may not be getting that hug at home.”
Lang, whose classroom walls are covered with charmingly scraggy paper portraits, said she also noticed that her learners‘ need for emotional support increased once they returned to school.
“A lot of kids we work with are not getting that emotional support from home. It is very difficult for them, coming to school and wanting to do the same things such as hugging or sharing. When you tell them off, you can see they are very upset about it and don’t understand why. There was a lot of strain on them not being at school and not having that support from me,” Lang said sadly.
Vuleka St Marks has an on-hand social worker, Janet Gibbons, who has worked with all four Vuleka Schools in Johannesburg for nearly six years. When the pandemic hit, Gibbons transitioned her free services online to the learners, teachers and their families.
“You can’t teach a child who is emotionally suffering,” said Gibbons, who believes all learners across South Africa should have access to emotional support services at school.And, she said, theseservices should also be extended to foundation phase teachers.
“So many teachers are being stretched. Teaching is very underrated. Not many people understand that until they are in the classroom teaching,” said Gibbons.
The covid-19 pandemic may havethrown a spanner in the works for foundation phase teachers, but most of them agree this is just the new normal. Andwhether it is dealing with their own mental wellbeing, the physical and emotional safety of their learners or facing issues ofdigital access, the unexpected challenges these teachers have faced have onlybetter equipped them for teaching in the future.
FEATURED IMAGE: The covid-19 pandemic has had overarching consequences on foundation phase teachers, who have had to face many challenges inside and outside the classroom. Photo: Laura Hunter.
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