Journalism from the health frontlines in a time of Coronavirus

30Sep 2020
The Guardian
Journalism from the health frontlines in a time of Coronavirus

If we were going to do this assignment, it had to be a well-thought-out operation. And we prepared for every eventuality we could think of. Our biggest concern in this project was ensuring that we were safe and able to control our environment at all times, thus limiting-

By Nomatter Ndebele

-the potential for possible infection. We decided beforehand that all the interviews would be conducted via phone to limit our in-person contact time with our participants.

So on a Wednesday morning, we packed our fears, anxieties and uncertainties into a camper van — which is what we opted to travel in to eliminate the stress of having to find safe places for us to stay for the duration of the assignment and with lockdown still a reality.

Our first point-of-call was full personal protective equipment. We insisted that all of our participants, as well as ourselves, had to be in full PPE for the duration of each shoot. We purchased surgical masks, gloves and shoe covers and asked our participants to wear shoe covers in instances where they had to stand on our backdrop.

Next, we insisted on only interacting with our participants outside. We visited 27 facilities and did not enter a single one. Our next priority was adhering to strict protocols of physical distancing.

My partner in crime, photographer Thom Pierce, put a lot of thought into devising an outside studio that we could build in any open space. Before we left, we spent three days practising the entire set-up to make sure we knew exactly what we needed to do in order to get the images we required without ever being at a distance of fewer than two metres from our subjects.

We meticulously measured out the distances from which Thom could take the shots. He was always aware of how far away he had to be working to maintain a safe distance.

Our final priority was to sanitise, sanitise and sanitise some more.

Because we needed all our participants to fill out consent forms for this assignment, we went the extra mile of purchasing 50 pens so that the participants could keep the pen they had used to fill out their form. We also asked our participants to put their consent forms in a sealed envelope which they then deposited into a box for collection, after which we sanitised their hands and ours. By this logic, we did not have to touch anything that our participants had touched during our shoot.

This was a well thought-out operation, and each time we concluded a shoot we asked our participants if there was anything else we could do to make our interactions even safer. One participant cautioned us to not pass the camera between ourselves during the shoot. Honestly, that was not something we had thought of. Had Thom and I not been sharing accommodation, our passing of the camera between us may well have been a way in which we put each other at risk.

The last piece of the puzzle was ensuring that we were able to get the stories out of participants.

Although we had decided that it was best to do our interviews telephonically, sometimes the interviews did not yield enough information. It isn’t easy to build a rapport with someone over the phone, especially when they have never met you. The magic of storytelling has always been that moment of connection between the writer and the interviewee. I realise now that I rely heavily on personal interactions when I am trying to tell stories. Often it is the ability to smile, nod, raise an eyebrow, laugh out loud or express confusion that allows us to draw stories out of participants.

After three interviews, I realised that if I was going to tell these stories, I needed to build some relationships before interviewing my participants. Based on that, I decided to do the telephonic interviews after we had completed our photo shoots. Those 20- to 30-minute interactions in person made a world of difference. Our participants opened up, shared anecdotes and allowed themselves to be vulnerable.

After a few days of figuring it out more practically rather than in theory, we finally found our mojo and threw ourselves completely into the assignment at hand. We committed ourselves to representing as many healthcare workers as possible, each in a different facility in the hope that, together, their stories would give our readers a picture of what was happening in each province in relation to the fight against Covid-19.

We were relieved to be leaving Joburg at a time when the number of positive cases was rising at an alarming rate.

That relief, however, was quickly dampened when I thought about what we were heading towards. I struggled to reconcile myself with the idea that at a time when everyone was being advised to stay at home and stay safe, we were willingly leaving not just our safe spaces, but our province, to go and interact with healthcare workers who were coming straight out of Covid-19 wards.

My imagination ran away with me. I imagined that upon arrival at various facilities we would be confronted with hundreds of people, starved of oxygen, clambering over each other in a desperate attempt to access healthcare services. What else can you expect when a pandemic hits a developing country whose healthcare system is already severely under-resourced and figuratively on its knees?

You expect the worst.

But what an absolute privilege it was to find the total opposite. If ever our healthcare system had a good story to tell, this is it.

In the conception of this project we all agreed that we wanted to tell positive stories. We wanted to highlight the efforts of those who often go unseen, especially at a time like this where we have been preoccupied with our “essentials”. It felt important to us that we highlighted the fact that our cadre of essentials were more than just the educated elite. At a time like this, security guards, groundsmen, morticians and cleaners are as essential as their more scholarly counterparts.

We were convinced (perhaps too naively, in retrospect) that in light of our good intentions, our colleagues in the offices of provincial health departments would welcome the opportunity to showcase their best efforts. Many of them were receptive to our requests, apart from KwaZulu-Natal. Our requests to interview doctors in the province were completely ignored. After days of following up on requests that we sent via email and text, we heard nothing. We very nearly lost out on Mpumalanga too, but at the last minute sense prevailed, and we were able to represent the province.

In the Northern Cape, we were unable to secure any participants at De Aar Hospital. Workers were terrified of speaking to us out of fear of losing their jobs. A political contact told us that workers were not willing to speak on record or be photographed because the response to their interactions with us could be unfair suspensions. Unfortunately, this is not the first time we have to contend with such issues at De Aar Hospital.

We are accustomed to speaking to people in confidence at that particular facility, but this time there was a big difference. This time no-one was willing to speak – not the cleaners, nurses or doctors. This was an interesting dynamic because as we made our way across the country we found that most, if not all, doctors we approached felt empowered to speak candidly about their experiences, without any fear of reprisal. So for us it follows that where even doctors are afraid to speak out, something had to be terribly wrong. We heard rumours that at least six patients had died in one weekend at the facility, but we were unable to confirm this.

It seems a great pity that we have had to tell this story without the input of the public sector in KwaZulu-Natal and De Aar Hospital.

Despite those challenges, we were heartened by the efforts of our colleagues in Limpopo, Free State and the Western Cape. Our interactions with department representatives and hospital workers were an absolute pleasure. It was encouraging that we were all on the same page.

Although we wanted this to be a positive story, we were prepared for the reality that much of what we would find would be a long list of challenges, with an even longer list of workers’ demands. We understood that responses of that nature would have been 100% warranted, especially at a time like this. What we found, though, was a cadre of workers who were less concerned about what could not be done and more focused on making plans and decisions to ensure that lives would be saved every day – even if it was just one life.

We met people who taught their patients about apps they could use at home to monitor the levels of their oxygen intake in a bid to ensure that critically ill patients could be prioritised for beds in the facility. We met people who embraced accidental activism in a bid to prioritise the lives of patients rather than worry about political scores. We met people who gave their kids over to the care of family members to ensure that they could be at work every single day. We met people who have gone door-to-door in townships, to make sure that people who are out of reach of the primary healthcare system were informed about the pandemic. We met people who refused to sit back and wait for a crisis. Where most of us allowed our fears and anxieties to steer us away from the oncoming storm, we met people who went face-first into it.

Not a single person we met referred to themselves as heroes – they were all “just doing their jobs”. Imagine working in a healthcare system that on the best day cannot provide you with the resources you need to do your job. Imagine always being in a position where you have to decide who gets oxygen and who doesn’t. Imagine having to drive patients up and down in your own car because the ambulance didn’t turn up. That is not just “doing your job”, that is commitment — it is dedication, perseverance, the conscious and deliberate act of embodying the principles of batho pele (Tswana for “people first”).

I realise now that if I had given in to my fears, I would have missed the opportunity to tell the story of a lifetime. We hope that by telling these stories of our comrades in the trenches we have given them a reason to battle on. I am so incredibly grateful that I felt the fear and pushed on to tell this story anyway. I have been privileged to see the absolute best of this country. The best has not always had a fancy car or even a degree. The best are ordinary South Africans who, when called for “country duty”, did not ask “Why me?” They didn’t sit it out; they didn’t just walk away. They refused to be defined by their fear, but rather by ubuntu; the simple idea of umuntu ngumuntu ngabantu (“I am because you are”).

This pandemic has not only tested our healthcare system. It has tested our resolve as a country, it has tested our commitment to saving lives and our commitment to hope. Where the world least expected it, South Africa came out swinging.

This project has in many ways surprised us. If there is one thing I can confirm without a single doubt it is that humans are strange creatures. We have spoken at great length about the response of healthcare workers during the pandemic, but there is something to be said about the response of ordinary people.

Given the exact same information – that there is a pandemic going on, to wear a mask, sanitise frequently, maintain physical distancing protocols – there are two responses:

  1. In the middle of nowhere, hundreds of kilometres away from any cities or towns, you will drive past a man sitting by himself on a donkey cart wearing a mask.
  2. In high-density metropolitan areas, hundreds of people rush through town centres, weaving in and around each other, without sparing a single thought for physical distancing protocols.

I can’t explain it. I don’t know if anybody ever will.

Finally, and perhaps most importantly, we would like to thank all our participants for sharing their experiences with us and being vulnerable with us. Without you this story would never have made it from pen to paper. We also cannot finish this story without mentioning all of the people who were unable to speak to us freely for fear of losing their jobs. It may not be much, but here is a line for all the groundsmen, security guards, cleaners, doctors, nurses, paramedics and anyone else who has been made to feel small or insignificant during this time: we see you. Your contributions do not and will not go unseen. When you feel like just another cog in the machine, please remember that it is you and your contributions that keep these wheels moving.

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