The following article was written Dr Lydia Cairncross and Kelly Gillespie. It was published online by the Spotlight
During South Africa’s 21-day lockdown we have started to see worrying scenes of police and army officers beating and harassing citizens in the streets. For some this is reminiscent of the days of the State of Emergency under the Apartheid regime. The difference today is that this is a “stay at home” or 24-hour curfew implemented as a drastic health measure in the face of a global pandemic.
The lockdown is intended to help and protect us. However, there is broad non-compliance with the lockdown regulations in townships. Our communities do not trust the state, police and military enough to be persuaded that the lockdown is for the communities’ benefit. The increasing use of brute force by the army and police will not succeed here.
For the lockdown to work it needs to be implemented with belief, commitment and engagement by the vast majority of our people. This include people from our informal settlements to middle class communities, from the rural villages to corporate CEOs. This lockdown needs an extraordinary level of trust, communication and clear messaging.
What is our role as civil society leaders and activists in this time?
We should try to build understanding, trust and collective commitment to the lockdown by using the full extent of our leadership, influence and networks to spread progressive, context-appropriate public health messaging. At the same time, our role is to highlight the contradictions and inequities unmasked by this epidemic and campaign for the protection of the unemployed, the working people and vulnerable groups in our population from an explosion of disaster capitalism which will seek to exploit this crisis for profiteering.
Our other role should be to make the lockdown rules feasible, tangible and practical particularly for the millions of South Africans who live in overcrowded townships and informal settlements.
Without an acknowledgement of how vastly different lockdown is in these communities to the suburbs of South Africa, we can only expect resistance and non-adherence. We need to address the deep sense of cynicism people have when hearing about isolation and physical distancing.
This cynicism is understandable. It is a difficult matter to stay at home when you are living in a one-bedroom home or shack with many people sharing a tiny living and sleeping space.
Only by empowering communities with information about why lockdown is necessary and how it can be done in their own living context, can we expect mass endorsement and promotion of these restrictions.
How we can do physical distancing in SA
As the People’s Health Movement of South Africa (PHMSA) we believe that part of the uncertainty about lockdown and physical distancing is the impossibility of keeping distance from other people when living in small crowded spaces.
We therefore need to clarify that physical distancing is keeping out of physical contact with people who are not in your household or family. And “household” and “family” is varied in South Africa with many people not living in nuclear families or where who lives in your home is often changing due to migrant labour, different definitions of what constitutes a family and shared accommodation and subletting.
In light of this, each of us needs to define who and where our “household” is for this time of lockdown and physical distancing. We suggest that these are the people you usually live in close proximity to, in the same dwelling, sharing meals and sleeping areas. During lockdown these become the people with whom you remain close. We can continue to eat meals together, lift our children onto our laps, hold and hug our close and loved ones.
What we cannot do is extend this level of physical contact to people outside our household. This means mostly staying indoors or having outside time in an area that is part of your house and not a public space. Outside time will mean vastly different things for different people. For middle class people, it may mean you stay in your house and can sit or walk in your garden; for people living in smaller homes in townships and dense urban areas, this may mean identifying the few metres outside your home (fenced or not) that you mark as the outside space of your “household”. For those in flats it may mean identifying clear boundaries between households on balconies and remaining at a distance from other household members. Or drawing up a roster to take turns to use a shared courtyard or garden.
What is really important is not to have physical interaction with people outside of your household. This means no visiting neighbours, checking in on a cousin in the township or suburb close by and not stopping in groups to chat when out to shop for essential items.
What about going out for necessary supplies? Once we have settled in our households, we should not go outside unless there is an emergency. One person from the household should be chosen to get food and essential supplies but that should be done as infrequently as possible. We should aim for once a week or less – as each time someone leaves the home, they risk bringing the virus back. When it is necessary to make this trip to purchase essential groceries, medication or to attend a health facility for medication, this person should take great care to protect those in their household. This can be done by not interacting closely with other people (keep a distance of 1.5 m), washing hands at every opportunity, not touching their face and using the sanitiser provided at public spaces. When coming home, it is essential to protect those at home by washing hands thoroughly before touching anyone else and if possible, changing outside clothes and washing. If these precautions are taken, once home we should again feel free to be close to the people inside our households. We all need contact at this time, to hug each other and take care of each other.
How we can do isolation in SA
PHMSA agrees and supports the recent Presidential announcement on 30 March to roll out mass testing, contact tracing and isolation. However, for many in South Africa, self-isolation in a separate room with separate bathroom facilities which can allow the three-metre recommended distance, is simply impossible.
It is critical that government provides adequate, safe and well provisioned accommodation with separate bathroom facilities and availability of necessary food and supplies for our people in these circumstances. We believe that we should consider these places Health Sanctuaries where people can recover from the virus, decrease the risk of spread and protect their families and loved ones. Our cities have ample accommodation spaces for the establishment of these sanctuaries including currently empty conference centres, hotels and student hostels. There is sufficient goodwill and solidarity in our society for us to prepare these currently unused spaces for dignified accommodation of people who need to be apart from their loved ones during this time.
In the UK, people over 70 have been asked to isolate at home as they are at high risk of severe COVID-19 infection. While this is largely not feasible in South Africa, we should also consider making available COVID-free Health Sanctuaries for the elderly or those with significant medical conditions who live in crowded living conditions for the same reason.
As activists and civil society leaders, we should lead in our individual communities to make lockdown liveable for others. This could mean identifying community members who need assistance such as the elderly who need help with groceries or those with illnesses who need to access medication or visit clinics. These actions should be done safely, using virtual communication where possible and maintaining safe physical distance at all times.
Army and police should bring a spirit of support
The lockdown assumes that state emergency services will do everything but they cannot possibly achieve this. The state needs civil society to assist with this lockdown and known community leaders including social, sporting, political and religious, should be recognised and brought into the response teams for implementation and assistance. South Africa has a rich tradition of grassroots mobilization which needs to be tapped into during this time.
There are many, many well intentioned youth and other leaders who would play a positive role if supported, shown how to be safe in their actions and could serve as a valid and critical extension of the state’s attempt to make lockdown work.
We therefore call on the army and police to bring a spirit of support and service to their necessary duty of promoting compliance with lockdown restrictions. Importantly, the lockdown implementation by the state must come together with the provision of much needed food, water and health assistance which are essential to make it possible for communities to survive the lockdown period. The role of the army and police should also be to support and partner with community leaders while maintaining a visible presence as opposed to only using fear and intimidation. This different approach is essential to promote long term adherence and help build the critical levels of trust in government interventions which will be needed in the weeks and months ahead.
If we can broadcast an empathetic and practical approach to lockdown in communities where water, food and sanitation are scarce and overcrowding is a daily reality, we may build the necessary community understanding, support and implementation that can take this lockdown from one that needs the army and police in the streets to enforce it, to one where we, the people, make it happen through our creativity, our willpower and our collective belief that this is for the best for all of us in this uncertain time.
*Dr Lydia Cairncross and Kelly Gillespie are both members of the People’s Health Movement South Africa.