The daily battle of rural nurses on S. Africa’s COVID-19 frontline

In the front line: Reuters

Sister Rachel Asitile (61) stands for a portrait outside the home of a patient who tested positive for COVID-19 in the community close to the Pudumong Healthcare Centre in the North West Province, South Africa, on September 4, 2020. Asitile manages the outreach team going door-to-door in the village to conduct contact tracing to keep the coronavirus numbers low. Thomson Reuters Foundation/Gulshan Khan.

TAUNG,  (Thomson Reuters Foundation)  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 km (310 miles) 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.

According to the Africa Centre for Disease Control, 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 that there are about 28 million nurses in the global workforce – 6 million less than are needed, with 90% 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 told the Thomson Reuters Foundation 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 (43 miles) away, where tests can be carried out.

On some days, no PPE was delivered to the health centre, forcing the nurses to re-use masks or go without.

Often their priority was simply stabilising 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,” Sipho Bathlaping, 29, another nurse at the Reivilo centre.

“What we need is more PPE, but also moral support,” he said.


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 (155 miles) 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 (TB) 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 the latter claiming an estimated 78,000 lives every year in the country, according to the WHO’s Global TB report.

Under-staffed, over-burdened health systems are not unique to low-income countries.

According to Nurse Heroes – a joint initiative between philanthropists, media and celebrities that supports and honors nurses, within three years the United States and Europe could lack 1 million and 1.5 million nursing staff respectively.

In Taung, Shikwambana knows that 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,” Shikwambana said, standing outside the ward.



In Pudumong, a town of 3,000 people not far from Taung hospital, a group of community healthcare workers gathered outside the clinic, adjusting their hats in the glaring sun.

“We are here to save our community,” said Kgomotso Moremedi, 43, who is 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.

About 90% of the global nursing workforce is female, even though few women occupy leadership positions in the healthcare sector, according to the WHO.

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 healthcare 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 sanitiser and photocopied assessment forms herself.

“All we can do is try by all means to protect ourselves and others.”

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