HAJI MOHAMED DAWJEE: The COVID-19 curse and informal settlements


In South Africa so far, COVID-19 has mostly been a middle-class disease. We don’t know who these people are, we don’t know their names or their faces and rightly so, but we do know they travel to Europe.

The internet is rife with jokes about this, and there is no shortage of comparison between the “white carrier” of disease now and back in colonial times. Thus far, of the confirmed cases, most have contracted the virus due to travel, mostly in Italy. Even international news outlets are dumbstruck at the lack of spread, or rather slow spread, of COVID-19 in African countries.

In these instances, all confirmed cases have contained themselves and their families and the Department of Health has done an excellent job in keeping the public informed on the necessary steps taken to confirm their diagnosis as well as control it.

But little is being said about the other half of the middle-class family, the domestic worker. Is she being taken care of? Is she being self-contained? Or is she still being made to work and then being sent off home because she isn’t welcome to stay? Who knows? Who can say what measures are in place to protect those who work hardest for and with other families?

In South Africa, over 11 million people live in informal settlements. These informal settlements are notorious for being the forgotten children of municipality and government. They are dense, overpopulated, physically unsafe and contain little consideration for spatial planning – a symptom of the brutal ideology of apartheid which has never been corrected. They’re notorious for having little to zero access to health care and other medical facilities and in a lot of cases, even less access to clean water and sanitation.

Middle-class households with access to the internet, 24-hour news services, Twitter updates and other forms of information dissemination are prepped in as much as we can be. We’re aware that we need to wash our hands for 20 seconds, we’re aware that we need to self-isolate – but what happens to the millions who cannot do either of those things? Where clean water is in short supply and who live in spaces that are contained and claustrophobic. If you think of it in that context, self-containment becomes somewhat of a luxury.

And we have yet to be saturated with information about how governments are taking care of these citizens and what measures they’re putting in place to protect and care for them. This issue seems to remain startlingly absent from the mass media discourse. How are we going to mitigate the impact of COVID-19 in informal settlements when the social and health needs of these populations are so often invisible.

What happens when the domestic worker for the middle-class family isn’t tested? Or can’t afford to be tested? What happens when she travels home on public transport, and sits with her family in very close quarters with her neighbours who have close contact with hundreds of others in their community because self-isolation is not an option? Is government and the employer doing anything to assist?

According to the Centre for Disease Control, COVID-19 is mainly spread from person to person who are in close contact with each other and through the spread of respiratory droplets that are produced when an infected person sneezes or coughs. These droplets can land in the mouths or noses of people who are nearby and then possibly inhaled into the lungs.

If the family in KZN who have self-contained because they have been diagnosed have been in close contact with a domestic worker in their employ, that’s one person. It’s a complicated situation. If there is no regard for this person’s life, or if she hasn’t been properly informed, she goes home where the number of close contacts in informal settlements in South Africa are 40% higher, according to the American Journal of Epidemiology, than any other industrialised area in the world.

Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, says that while we should not forget to wash our hands, we’ve got to get people to understand that, “if you don't want to get infected, you can't be in crowds. Social distancing is the most effective tool we have right now".

In an American Journal of Epidemiology paper titled 'Social Mixing Patterns Within a South African Township Community: Implications for Respiratory Disease Transmission and Control', it was found that physical contact in South African informal settlements has a marked influence on the spread of acute infectious respiratory diseases and that in order to control these, distancing strategies and interventions within those communities need to be put in place for control.

One of those strategies, and the cheapest and most simple of them, is of course education and information dissemination. Other than Twitter (which is a middle-class medium in South Africa) and press releases, the South African government could look to the PR rollout happening elsewhere in the world to help assist and inform communities.

In New York, for example, the city has taken dissemination into its own hands by going around to apartment buildings and sticking up the general information about COVID-19. What to do, how it spreads and what to avoid etc.

This seems like a fairly simple way for municipalities to share information in high-density areas where people don’t have access to the internet or aren’t at liberty to turn on community radio stations and listen to public service announcements all day. What’s more, these posters, printed in plain text on cheap A4 paper, can be printed in all 11 languages and because they’re government issued, they reduce the risk of false information spreading and make sure the facts are verified and coming from a single source. I called one of those Khayelitsha clinics and no such public information exists as yet.

Health Minister Dr Zweli Mkhize has done an outstanding job of putting contingency measures in place, like screenings at ports of entry into South Africa, for example. The National Health Laboratory Service will offer 24-hour lab services for virus detection and the National Institute for Communicable Diseases have set up an operation centre to deal with detected cases.

But again, none of these plans involve responses to the spread and potential spread of COVID-19 in densely populated areas where access to tests, health services, support, clean water, information and self-isolation are a risk on an ordinary day, never mind a day that calls for dealing with a potential crisis.

There are 20 listed health clinics in Khayelitsha, one of them the Khayelitsha hospital. These facilities are inadequately equipped to deal with the community on a regular day, so in instances where there is a danger of diseases with epidemic potential, the health structures which already are only fit to represent a concentrated number of patients become hotbeds for further transmission.

The CDC notes that a lack of resources and an increase in infected citizens creates an increase in the potential for hospital-associated infection spread. Twenty under-equipped clinics simply cannot accommodate an area of this concentration and it is worrying that we have yet to hear what strategies and interventions are in place to make this a priority pre-emptively.

All lives matter.

Haji Mohamed Dawjee is a South African columnist, disruptor of the peace and the author of 'Sorry, Not Sorry: Experiences of a brown woman in a white South Africa'. Follow her on Twitter.