Listening is so important

By Susan Goldstein, Johannesburg, South Africa

Working from home here in a lockdown, in South Africa … it’s very strange and worrying given the number of people who are starving. It’s really hard to understand the COVID-19 epidemic and response given that so many people are continuing to die from HIV and TB in the country (63,000 from TB alone in 2018).

In South Africa, the danger of a measles outbreak is high. TB testing is going down (by 50%, says one national expert) because they are using the Genexpert machine for COVID 19 tests. And we don't know how people with chronic illnesses are being affected.

One issue about which we have been racking our brains is to how to get quality information from poor communities without breaking lockdown. We don’t know how the situation is affecting people, and what people are thinking. What is staying in a one or two-roomed home with three other people like, for more than a few hours, never mind weeks?

The framing of the pandemic as a war (in many countries) has echos of HIV, where the enemy is then identified as the infected person, not the virus. This has already played out in some areas in South Africa, with people being forced out of neighborhoods. Similarly, some provincial Ministers of Health are threatening (and enforcing) forced isolation for those who test positive–it happened to two young doctors in Limpopo. The states of emergency/disaster are enabling huge human rights violations.

In terms of who complies, in many instances, the choice is between COVID-19 and starvation. I would definitely take my chances against COVID, even though I am in a high-risk group.

On the plus side, there has been around a 70% decrease in hospital admissions for trauma–alcohol use and a decrease in movement both playing a big part.

I am very concerned about funding being redirected from HIV and TB. In our context, 81 people die every day from TB! I am concerned about the lack of access to sexual and reproductive health, especially contraception and legal abortion. I am concerned about the shifting of focus away from immunizations that protect children from numerous diseases, especially measles, but pneumonia and rotavirus, too.

I am also concerned that the way the government is trying to change social and behavior norms is through the army and enforcement: how long can that go on?

What we need is a sustained social change model that is thought through and funded. As usual, social and behavior change is thought of last and brought in as a desperate attempt at control, despite what we should have learned from numerous other epidemics–especially Ebola.