Pain of rural front-line nurses

Ruth Seikaneng, a nurse in the North West, 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 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 500km west of 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, SA has about 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. There are only two nurses on shift at any given time in Reivilo.

Assistant Nurses Agnes Lencwe (37) and Kgomotso Mlanyede (30) stand for a portrait outside the COVID-19 ward in the Taung Hospital in Taung, the North West Province, South Africa, on September 4, 2020. Currently they are looking after four patients, a number they are trying to keep low as the hospital has only one ventilator. Thomson Reuters Foundation/Gulshan Khan

The World Health Organisation (WHO) estimates that there are about 28 million nurses in the global workforce – six million less than are needed, with 90% of theshortfall concentrated in low- and middle-income countries such as SA. 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 – 70km away – where tests can be carried out.

On some days, no equipment was delivered to the health centre, forcing the nurses to reuse 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,” said Sipho Bathlaping, 29, another nurse at the Reivilo centre. “What we need is more PPE, but also moral support.”

The only two Nurses on duty, Sipho Wilson Batlhaping (29) and Ruth Seikaneng (64) walk through a corridor of the Reivilo Health Centre in Reivilo, a town an hour away from Taung, North West Province, South Africa, on September 3, 2020. “My biggest fear is that people don’t take this virus seriously or realise how dangerous it is,” said Seikaneng. Thomson Reuters Foundation/Gulshan Khan

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, about 250km 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 TB, with the latter claiming an estimated 78,000 lives every year in the country, according to the WHO’s Global TB report.

Understaffed, overburdened health systems are not unique to low-income countries. According to Nurse Heroes – a joint initiative between philanthropists, media and celebrities that supports and honours nurses – within three years the United States and Europe could lack one million and 1.5 million nursing staff, respectively.

Article courtesy of the Thomson Reuters Foundation.

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