During the crisis precipitated by Covid-19, SWOP is engaging in conversations with Community Health Workers as well as organisers and other activists working with them. These conversations are part of SWOP’s ongoing attempts to facilitate, and contribute to collective understandings of this moment and responses to its various problems and challenges.

On the 13th of May, Nicolas Dieltiens (an independent researcher based in Johannesburg) spoke to Thabo Shivalo and Patricia Petja, community health workers in Alexandra. Both are members of the National Union of Care Workers of South Africa (NUCWOSA), established in 2017. They speak about the challenges they experience in their work, their disappointed hopes of being recognised as permanent employees of the Department of Health and their continued marginalisation in the fight against the coronavirus pandemic, even while they have been thrust to its frontline.


Interview with Thabo Shivalo (TS) and Patricia Petja (PP), Wednesday 13 May at WWMP offices, Wynberg.

Interviewer: Nicolas Dieltiens

TS: My name is Thabo Shivalo working at Alexandra 8th avenue clinic. I’m a communty health worker.

PP: My name is Patrica Petja, working as a chw at 8th avenue clinic.

ND: In the midst of the coronavirus pandemic. What changes have taken place in your life and work?

TS: So much, for this year we were expecting a lot, from January, as chw. As I’m saying we were expecting a lot: we’re employed by the DoH, and we are on a community project…ward…, so DoH employed us as chw to assist the community wit health and social issues. So, they employed us from since, bach then 2014, they were supposed to… we’re supposed to be employed as permanents, and that didn’t happen. … we were expecting a lot from the year 2020. since this covid thing started, our struggle is going back, because we can’t engage as community care workers. We always come to Workers’ World to have meetings, we’ve got a union, which is NUCWOSA, we always sit and talk about the issues affecting chw all around the country. So, since this covid-19, a lot of things have changed. The government, they promised to integrate us this year. Nothing has happened. They promised to take us to schools, to do some trainings so that we can have something sustainable for chw, nothing has happened alos. Not only the covid, we were promised from this year onwards, things will be better, but nothing has happened.

TS: Even worse now, we were expecting some increase. The increase is R133, and don’t forget we’re earning R3500 per month as chw. We are part and parcel of DoH. We are doing more than what the nurses and doctors are doing, because we work in the commuity. Most of the things we’re doing, we’re assisting the nurses nad doctors. Our main problem is that we were focusing on getting permanent with the DoH. Even now, they take us from pillar to post, like nothing is happening even now. I don’t know when it’s going to change, or what’s going to happen.

ND: Day to day, what are you most busy with?

PP: For now, since this coronavirus started, we are screening, everyday. Monday to Fridays we’re doing screening. Sometimes you do workshops on maybe weekends or holidays, we are working. And what we are not happy about, is they don’t provide us with anything. We just go and work; they don’t give us more money for that day. Let me say that we are risking our lives but the \y don’t give us anything. It’s only 3.5; they don’t give us danger allowance or whatever. That thing doesn’t make us happy to be honest. And always, screening, and screening, and giving our community health talk, about all disease, about chronic disease, about everything. We aren’t just screening for coronavirus. We also give them health talk.

TS: Like these people, were not taking us serioiusly at first. We’re just ordinary workes, people who are not educated, no matric, they take us like that, you understand? But now, since this epidemic, they are using us, putting us on the frontline. With that little penny that they’re giving us, we are on the community: just imagine Alexandra, it has a lot of people, it is squatted everywhere, … Even now, when they say people must social distancing, there’s no social distancing in Alexandra. If me or Patricia can get infected there at Alexandra, to find us is going to be difficult. Some of us stay in the shacks. You can’t find me in the shacks, it’s mixed there in the shacks; my shack is in the middle, how can you find me there.

Another problem is this: they’re putting us on the frontline, and there is this R5-billion fund that the government has announced. CHW were not counted on that. Only equipment, which we don’t see that equipment – even now, we’re going to do screening in the community without proper PPE. They just give us mask, glass, a plastic apron, you understand, and ‘go and work’. And forgetting we go and knock on somebody’s door. What’s going to happen if i get infected and i go knocking on that door? Nothing was promised to us. It’s worse. We worked that first 21 days. Nothing happened. People, like social grants: there’s an increase in social grants, there are social grants for grannies, elderly, disability, there’s increase for children, there’s money for people who are employed, R350 (which they are going to get or not going to get, we don’t know), and which is difficult to apply also. And there’s a challenge of food parcels, which must get distributed to the people in our community. The food parcels problem is an issue, 100% an issue because people write their names. They write their names on a list, and they go send a person to go and get the names and numbers of people in the community, but nothing has happened. And even the food parcel: you can’t give a person a food parcel for one month. That food parcel doesn’t finish the whole month – it’s too small. Some of the family members in the household – some of the households have nine people in the house. Just imagine when you give them that 3kg of mealiemeal, for the nine people in the house – how many days will that grocery last? That’s the first point. As chw, we’re not working with food, we’re just there for coronavirus. When you enter into that household, they will ask, ‘where is food? We’re looking for food, we’re hungry,’ you understand. ‘You’re busy here to understand, to ask us questions, but you don’t bring food!’ That’s a challenge for us.

TS: So the government is killing us. They want to see their people dead as I see. Come winter, as this coronavirus is a friend of winter, it’s going to be a very big challenge, especially in communities like Alexandra.

ND: How were you trained to do the screening? Who did that for you and when?

PP: For now, we screen our community by asking questions. They don’t give us – what is that… – thermometer, to check temperature, or anything. We just screen them by asking questions.

TS: …questions of coughing, sore throat, shortness of breath, fever.

PP: Yes, only that. Or community, most of them want us to do screening by using something like a thermometer. So it’s not easy for us, but we are trying. As we are chw, we know how to work with community, we know how to talk to them. We know how to make them to be.

TS: We convince them actually. It’s just a little bit of training. We were trained by our team leaders. They just showed us: here’s a form, they give us a form. That form, I must go to the community, take name of the person of the house, contact number, date of birth then I screen with questions: do you cough? Do you have shortness of breath, sore throat or fever? If the person says no, i just write no and I submit. But if a person says maybe he’s coughing or sneezing, I’ll write it also and say ‘symptomatic’ I’ll write on that household member, I’ll write that he’s symptomatic. They’ll call. I don’t when. That’s when we’re doing screening, we don’t know when they’ll call…

ND: So who do you report to? Who do you send these forms to?

TS: We send to the team leaders, these forms, and the team leaders also send them to their makulukulu boss. That’s it.

PP: To add, they also told us that if anyone shows symptoms, maybe we have to tell them so that they can come see what to do. Maybe…we don’t know, we have yet to find someone with symptoms. Since starting screening, we didn’t find anyone with symptoms, silent (?) symptoms.

TS: …But sometimes we do, but most of the time we don’t get people with symptoms, but it doesn’t mean if you don’t have symptoms you don’t have to test, because there are people who have been tested without symptoms and they find out that they are positive. So we believe that everybody must get tested in SA, no matter symptoms or not, they must get tested. Because there are some people without symptoms really, who get tested and test positive. So we urge the government to provide more facilities. Like here in Alexandra, they’re just telling us about 4th Avenue clinic, which is far from London people, to move from London Avenue, to 8th Avenue or 1st Avenue to go to 4th Avenue at Selbourne, is far. Some people want to test but when you tell them that the testing station is near 4th Avenue, eish, to get from London to 4th Avenue, you’ll get lazy to go.

ND: And they might even be sick, right?

TS: Yes, and they can infect all the people, just imagine, the shacks are close to each other in Alexandra, and they’re talking about social distancing, but with the shacks. Just imagine, the house is dividing the other house, with just… the zinc …corrugated iron sheets, is divided by that: I cough, I sneeze, I do everything. Hey umakhelwane you are close to makhelwane, so when it needs to be spread, it can be spread easily, easily here in Alexandra. Most of us are going to get sick.

What happened in Italy, Spain, USA is also going to happen here come winter.

ND: So the people who need to get tested at the Selbourne clinic will have to walk there? Are people bothering to go get tested?

TS: People are free to get tested actually. When you go for our screening, you can find out from people, you know just talking, [they’ll say] ‘it’s better’. Afraid of that thing in your nose [swab], no, no. I’ve heard there’s a new testing method now, new testing kits that are called rapid testing. Me, myself, I’ve tested, three weeks back. I’ve tested; they said they’d call if I test positive. And they have not called.

So you if they don’t call you must assume…

TS: Yes, to assume isn’t good.

Doesn’t give you confidence, no.

TS: They let me go home. That one is a big challenge.

ND: Why did you get tested? Were you feeling ill?

TS: I just wanted to test; I had no symptomsm nothing, but I said, let me test because people are testing, let me test. That’s why I say, everybody must test, with or without symptoms. Everybody must get tested, know your status.

ND: You spoke earlier about the issue of food. What other issues do people speak to you about? 19:06 PP: It’s only food. And they also want to go to work but the way this coronavirus is [being fought], only nurses, police and whatever, we have to go to work, but the thing is we will be happpy if they try their best to give our community food. More things that are going to take over a month, that’ll be better.

TS: To add on that, on this food distribution thing, the government is losing a task somewhere. They’ve got people like us, who know their community, who are working in their communities, everyday you understand. Like now for doing a list for food, they say the list is done by the councillors, the ward councillors. We ask ourselves: How is the ward councillor doing this, because the councillor doesn’t have time? The ward councillor also doesn’t know his people. Like me, in my ward, my councillor is, she is somebody that is I don’t know, she’s got her own people. So, the government – it’s just a suggestion, you understand – maybe, they can consider CHW. We do door-to-door; we know our community. We know a lot of people who are struggling. Yes, food parcels are being distributed, but not to everyone. You’ll find that maybe I’m the one who’s responsible for the distribution, they give me maybe 50 food parcels. You’ll find they’ve got their friend Patricia, my friend Nic, my friend Simon – I’ll start with my friends, forgetting that people are struggling, people who don’t have anything to eat.

TS: Jobs, people don’t work, people have stopped working because of this lockdown. They don’t have food in the house, they have nothing, no income, no food. That 350, they can get it, but it’s not going to help a household; it’s too small. I can’t buy food for… And when is that 350 coming out? Food parcels: most people who are suffering don’t get their food parcels. I just heard a rumour in Alexandra that some people are selling those parcels. You’ll find in one household there are three food parcels, while next door, there are people who are suffering, no money, no nothing. And remember here in Alexandra, we have foreigners – they are people also. We go see those people as CHW. If she’s pregnant, has no passport or ID – she must get booked for antenatal care; she must book and I have to help, you understand. Because she’s a foreigner, if she goes to the clinic alone, they’ll tell her to go back. ‘You don’t have an ID, you don’t have a passport, you go back’. That person must be helped. AS CHW, we know that person must get help, but you’ll find that even in the clinic where you’re working, they’ll chase her back – go back! – when she comes to book. So, you must not forget those people, they are also people. They are our African people, you understand.

TS: So, the government – I’m going back now. As I’ve said, it’s a suggestion; they’ve got people who could do food distribution, we can also do this thing of taking people’s names who aren’t working, apply for SASSA grants (it’s not open for them, you understand). The Dept of Soc Development can give us forms and we can go to the community with those forms. That’s the best job we can do now. But not forgetting our main job which is taking care of people… healthwise, social-wise. …

TS: This thing of food parcels, and this thing of grants, I think we as CHWs, we can do better that the way it’s happening right now. People aren’t sure when they’re going to get that 350. People have applied on the phone for groceries. Even today… People have applied for that 350, they’re not sure what’s going to happen or what. It’s a challenge for the community.

ND: So it’s only food. What are your regular patients, like the ones living with HIV or diabetes, saying? Do they have issues?

TS: Our patients, because we take care of them, during the week, we go to them. For them I can’t say… As we’re doing covid-19 like this, we don’t leave our job out. We also take care of them We have to ask. We’re now working as a group. This programme of ours is ward based – a person must work where he or she is based. So you find that now as covid-19 has started. You go as a group, you take a small portion of the community area, you understand, then we work there, we do our screening there. If we find a patient who’s got a problem… Like this old timer there by 8th avenue, he doesn’t have a family, he doesn’t have anything. He stays alone, he’s bed ridden. We’re helping; we went there yesterday, we managed to find a social worker who’s helping the guy, and the fortunate part is that his family has been found, from Soweto. Meaning, we are still busy doing our job. That’s still part of our job because he’s an elderly person. The elderly are supposed to get a pension. He doesn’t have a pension and now he’s bed-ridden. he’s staying alone in the room. The neighbours are helping him. They feed him on a daily basis, clean the house, wash the guy.

TS: So we are still doing our job, just not the way we are used to doing it. We’re now focusing on this thing that is killing people. Asmuch as there are too many cases here in our region, for a place like Alexandra when winter is approaching like this, what’s going to happen. We are scared. Come winter, they must provide us with proper PPE. At least if we can get that coat they’re wearing come winter, we need those PPEs, gloves, we need them, sanitisers, all the time. We don’t have sanitisers. The saddest part: we are two different groups, we who are helped by the Dept of Health, and the Dept of Health has partnered with Anova. Anova has hired their people, other CHWs. They’re getting paid by Anova, these people, not by the DoH like us, but we are on the same level of pay. Stipend, let me call it a stipend – it’s not a pay. it’s just a stipend. We’re on the same stipend, but it’s different people paying us. You find that Anova, they are provided with sanitisers, they are provided with masks. You see this mask. I can’t wear this mask for the whole day.

ND: This disposable mask you’re wearing?

TS: Yes. The way I know about masks, if I get into one household, after that household I must remove it. I can’t go to another household with the same mask. What if that household was contaminated and I go to the next household with the same gloves, the same mask – that’s no good for the other people. Me, myself I could infect people while working. So, PPEs is very important. We must be provided with proper PPE, gloves, masks, I must… If I find a person in the household who’s got symptoms, I don’t just say go and test at 4th Avenue. I have to take a new mask and give that person to wear so that whatever he’s got mustn’t go to other people, you understand. So, coming to PPE, we need proper PPE.

ND: So the PPE you receive now: is it just the masks and apron?

TS: Aprons and gloves.

ND: How many masks, how many gloves?

TS: One pair of gloves a day, one mask. The Anova CHWs, they’ve got hand sanitisers, but even them, sanitiser won’t prevent, because they are working on their clothes. Clothes are dangerous. As I’ve said, if I go into a house where someone’s infected, already these clothes can be infected. Some where you’ll sit, you get get that coronavirus. They say the coronavirus can stay on the surface for 9 hours. A chair can be contaminated, meaning the clothes I’m wearing when I sit are contaminated. It’s not easy to knock at someone’s house and say to that person I can’t get inside the house. Some people think that you think you’re better than them. Or sometimes, like the elderly person I spoke about who’e bed-ridden for example: I enter that household and shout ARE YOU COUGHING? DO YOU SNEEZE? Is it good like that? Everything must be confidential. Even the person who’s got symptoms – they’ll never tell you while screaming. You must get inside the house, but it’s risky for us. You can’t always stay at the door. It’s not appropriate. Our job is to get inside the household, help people inside. But iwthout proper PPE, it’s a big challenge; we’re going to get infected. And there’s no money for us. We don’t know. We’ve been promised a lot by mouth, promised from long ago…. You see, a tongue, in our language we say umlomo … which means you can talk but no action. You’re telling us but you’re not going to act. We don’t know where government is pulling us as CHWs, we don’t know. We are really scared, even now.

ND: You still don’t have recognition as permanent employees? You’re still volunteers?

TS: Yes, we’re volunteers, but the saddest part: they put us on Persal. That Persal’s got nothing; it should show that you are working, earning R3,500 monthly. That Persal number shows that you are working. Whatever you’re going to do, they’ll tell you you are on Persal, that’s a government paying form, with no benefits, with no good payment. We are nobody but they are making us people by working… taking us seriously while working, but when it comes to money, it’s bad.