Nurses on Front Lines of COVID-19 Fight in Rural South Africa

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Months before COVID-19 emerged, the World Health Organization (WHO) announced that 2020 would be the Year of the Nurse. The title couldn’t be more appropriate.

Around the globe, nurses battle COVID-19 daily and bear the brunt of strained health care networks, staffing deficits and personal protective equipment (PPE) shortages.

Nowhere are the front lines as challenging as in remote, rural and exurban communities such as those of South Africa, the most severely affected country on the continent with 694,537 cases, according to the Africa Centres for Disease Control and Prevention’s October 13 statistics.

“Each and every day, you put on your uniform and take care of your patients,” Kedibone Mdolo, acting provincial secretary of the union Democratic Nursing Organisation of South Africa (DENOSA), told Reuters. “You are the light, especially in this time of COVID. When people are dying from loneliness in the wards, nurses are there by their side.”

In Taung District Hospital in South Africa’s North West province, red, yellow and white candles — for DENOSA’s colors — burned in honor of the nurses who risk exposure nearly every day. One of their own, a nurse named Dudu who worked about 70 kilometers west in a tiny cattle town called Reivilo, died in July.

With about 28 million nurses in the world, the WHO estimates 6 million more are needed, and 90% of the shortfall occurs in low- and middle-income nations such as South Africa.

When Dudu died, her nursing colleagues in Reivilo had to work longer hours beyond their 12-hour shifts.

Conditions across South Africa took a harsh toll on nurses, as the country slogged to an August peak of 12,000 cases a day. Inadequate facilities, sporadic pay and widespread lack of personal protective equipment forced nurses to frequently reuse or go without, leading to protests around the continent.

Patients often have it worse.

Vicky Shikwambana works at Taung hospital and manages the only COVID-19 ward in a municipality of about 200,000 people. If patients’ symptoms worsen, they must be moved 250 kilometers for treatment at Klerksdorp Hospital.

“We only have one ventilator in the whole hospital,” Shikwambana told Reuters. “What can we do?”

Rural South Africa presents a host of challenges, according to Dr. Liesbet Ohler of Medecins Sans Frontieres (Doctors Without Borders), who worked in the town of Eshowe near the east coast.

“Strategies that worked in cities are not necessarily a good fit,” she said on her organization’s website. “The distances between clinics are greater, there are fewer health resources and governance systems are often multilayered, to name just a few of the challenges.”

DENOSA General Secretary Cassim Lekhoathi complained in April about inadequate training on handling patients suspected of having COVID-19. The organization also sounded alarms over equipment shortages. That led to a court case that spurred the government’s ministers of health and labor to buy more equipment at a time when global prices were soaring.

“We cannot go open-faced into the war zone,” Lekhoathi told South African online newspaper The Daily Maverick. “They will go to work but will not put themselves in a position to be exposed to COVID-19. I will not get it past my conscience to send our medical workers to their death.”

Help has come in the form of organizations like the Rural Health Advocacy Project, which reports shortages of equipment and medicine, as well as international donations. The U.S. ambassador to South Africa in August announced more than $350,000 worth of equipment donations.

For first responders in rural South Africa, perseverance is key.

“We have to keep working because this is a pandemic,” Shikwambana said, “My family are nervous about me working here, but they are also proud.”