 For more videos on people's struggles, please subscribe to our YouTube channel. Hello and welcome to People's Dispatch. Today we're going to be talking about the COVID-19 situation in South Africa, especially from the angle of public health and we're going to look at the health system and the current situation, the pandemic. Now, South Africa has been in the list of top five countries in terms of the number of cases, but there's also been one of the countries which has been reporting a lot of new cases and a lot of new deaths in recent times. So to talk more about this phenomenon, we have with us Dr. Lydia Kintros. She's a pop doctor with the public health service in South Africa and also a member of the People's Health Movement. Thank you so much for talking to us. Thank you very much Prasad. Yes, so to begin with, could we look at, could you talk a bit maybe about what's the situation on the ground right now because we do know that the government has been pushing for reopening and interestingly, South Africa was one of the countries which did have a very strong lockdown. So how is it that despite that the number of cases continues? Yeah, I think South Africa, we started off with the approach to the pandemic of a very strict and very hard lockdown, one of the hardest in the world for about five weeks. And during that time, there was quite slow transmission of the virus. We think that because it was mainly sort of initially a middle class inoculation into the society. And we have a very class segregated society, which is the legacy of apartheid and of capitalism. And so for some time, the lockdown worked. But the lockdown came at tremendous cost, tremendous cost to primarily the poor, the poor black majority in South Africa. And it revealed the tremendous food insecurity within the country and income insecurity. And the state was not able to rapidly move to fill those gaps. So there was a pressure to lift lockdown both from a conservative sort of a capital economy lobby, which wanted to get profit going and get factories running. But there was also a pressure from the ground from people who were starving, who actually were unable to fulfill their normal livelihoods, which was the micro economy in the townships, the informal economy, which had been decimated by the lockdown. And of course, what we had needed at that stage was a very strong social support package to come in rapidly, to support income security, to support food security, to bring to communities water and food and sanitation and money to allow them to survive the lockdown. But we were unable to make that shift. And so there was this pressure and a fairly uncoordinated opening of the economy, sort of the strongest lobby pushing would get their sector open. So one of the first areas to open was mining, which makes no sense in terms of a health and epidemiology point of view. And then kind of opening of churches and opening of big sectors of the economy that were not necessarily what we would consider to be essentials for life, you know, which is a more kind of social perspective on what do we need to survive and what can we keep closed in order to keep us safe. The other problem was that we didn't utilize the lockdown as we should have. So the lockdown time was really an opportunity to get two things going. The one is a mass popular education campaign to empower communities to understand the virus, to begin to know how when lockdown lifted, how to move safely in the presence of the virus. And that mass campaign has still not happened. And there are pockets of education happening by NGO social movement ourselves, but not nearly enough. And the other thing that needed to happen in that time was mass testing, tracing and quarantine. And our testing capacity really failed us at this time. And because we were not able to escape the logic of the capitalist system and bring together our public and private testing capacity, we still had a two system binary with private sector capacity with short turnaround times and a few hours to one day or so. And the public sector capacity was just totally overstretched by the numbers. So we got our community health workers out, they screened and they sent for testing. And within a few weeks, we overwhelmed our testing capacity. So when we started to open up the economy, we didn't have the testing capacity that we needed to be able to test and to separate out those that were sick and take care of them in that way. So here we are. Now we are number five in the world. Our peak is coming later in other countries, but it's coming. And the numbers are always contested and the deaths are contested as well. But we are seeing this in our hospitals. So we are seeing the epidemic in for a long time, our hospitals were quiet from a COVID point of view. But certainly started in the Western Cape province and now is moved to our most densely populated province in Kharting. And the hospitals are seeing the influx of patients with COVID symptoms short of break. So it's here. Right. So in this context, right now, what does what seems to be the government's approach because they have been reports of some amount of alarm within the government regarding the situation. So is there a very coordinated approach, which does take the issues of the people and the concerns of the people into account? Or is it something that's more half Assad and case by case? So it's very difficult because I suspect maybe like your country, we don't have a very transparent government. So we don't really understand fully the thinking behind many of the policies. And there's no broad based consultation. So we have a national command council that makes decisions about COVID and is supposed to integrate scientific information and medical knowledge. But we know that many of the medical scientists who are on these committees are not really consulted about the big policy decisions. It seems at the moment that the narrative is shifting very much to we can't lock down the economy. So people must take responsibility as individuals and they must behave better and be disciplined and so on. But of course, you know, this is being met by communities with a deep cynicism because we are in a situation where thousands of our schools do not have functional toilets and running water. And never mind sanitizer and other things that school children would need. So the resources needed to make the behavioral changes required for COVID like physical distancing, sanitizing, cleaning hands, it's just not available in big parts of the country. So we are seeing this call now for community responsibility, but we're not seeing the support required to make that real. So it feels very much like the attempts to contain the pandemic have largely been given up in terms of large scale policies. And now we're just expecting people to do their best and to wash their hands, which is not going to be very effective in the current situation. Absolutely. It's interesting you mentioned that because that's something that is characterized other big three countries also, India, Brazil and the US, where everywhere sometimes it's somehow on the people to take care of themselves and do that. But in this context, one interesting question that has also come up in many other countries is how the structural issues in the health system themselves have actually led to the situation today. So across the world, we have seen, for instance, the push for privatization. We've seen an absolute lack of investment in the sector itself, a lack of clear thought in training and education. So could you look at some of these issues in the context of South Africa also? Yes. So as we have said in some of our writings, COVID didn't break the system in South Africa, it unmasked the broken system in our health care. And we have, despite 25 years of democracy, we've actually seen progressive strengthening of the private sector within health. And South Africa has one of the numbers that we have the highest of is we have the biggest private to public sector proportion of expenditure through private intermediaries versus public health. So our public sector covers 85% of the population with about 48% of the money spent on health. Most of our health workers are in the private sector, not in the public sector. And then within the public sector, we have major disparities between urban and rural and between provinces, which are historical, which date way back to apartheid times. And many of those have not been addressed. So that now that the COVID pandemic has arrived, it has, we have not been able to bring those two systems together into an integrated health response. So still today, your ability to survive this pandemic and the quality of treatment that you get depends on whether you have medical insurance or not, and also depends on which province you live in and which city. So some parts of our public health system function quite well. Other parts are very weak, and you would have seen some of those reports in the news about some of our weaker provinces, really heartbreaking stories of sort of dysfunction at the management level, some corruption, and then just decades of neglect of infrastructure. So simple things like getting our oxygen reticulation system sorted out is resulting in deaths. We're not talking here about needing the ventilators. It's the basic things that are not there, which is a legacy of privatization and the legacy of historical inequalities. So in this context also, what could you talk a bit about what has been the role and the thinking of public health policy, for instance, on the issue of investment itself as a part of the budget and how that functions also? Yeah. So, so from as progressive health activists, what we have been arguing for during this time is sustainable investment in public health infrastructure. First of all, to pool the resources of the two systems. If we cannot at this time in the middle of this global pandemic, where there's this massive focus on health, bring those two systems together, there's the philosophical justification and there should be the political will, and there is even on the ground sufficient goodwill from clinicians to bring that together. But there has really been a failure of that bringing together of the two systems. But failing that the next steps that we could be doing within the public health system is to resource and capacitate at the primary healthcare level. So the community health workers in South Africa remain some of the most exploited and underpaid workers in the country and certainly within the state sector. So they remain on mainly stipends on insecure contracts and yet they are being put forward and lauded as the true frontline of this pandemic. So for us right now, we could bring our community health workers in train, adequate remuneration and recognition for community health workers and of course expand that pool. And then it's also an opportunity for us to take the funds that are being mobilized for COVID and put in sustainable infrastructure within the public health system. Many, many private doctors are out of work at this time. If there was will, we could open posts in the public sector and we could bring health workers back into the public system. So we could really use this as a reset button for us to strengthen the public aspect of our health service if there was the political will. And you know, we still hopeful that that shift will take place and that is what we're advocating for. So not sort of short term bursts of money that get put into project that will disappear after COVID but sustainable investment in human resources as well as infrastructure. Right, absolutely. And finally, this is also something you've written about. Could you talk maybe a bit about the impact on non-COVID patients also? So especially because a number of cases, the focus is entirely on this, but what has been the impact of those suffering from other diseases, those, for instance, homemade surgery, which you've written about? Yeah, so I'm a surgeon by profession and I can tell you that our surgical patients that normally wait many months for their operations have now waited another six months. And those are the people in the system. So there are, there's the unmet need of patients who have not presented for fear. They have not come to institutions with their symptoms. And then there are the many, many, many patients on chronic medications whose care has been disrupted. And in South Africa, as you know, we have HIV and tuberculosis burden, which is huge. Then some reports are saying up to 11,000 patients have not collected their antiretroviral medication regularly. We know that there has been disruption of diabetic care and hypertension as well as vaccination of children. This did not need to happen with COVID. We could have set up systems to strengthen and to encourage people to come to facilities and to balance the fear against the access and also make sure that facilities don't close because many facilities closed completely. But I think part of the post COVID reality is going to be an epidemic really of the non COVID illnesses, which have been neglected during this time, almost a second wave of illness and death that will follow this, even more reason to strengthen our public health system to, to anticipate and manage that when it comes. Absolutely. Thank you so much, Dr. Lydia for talking to us. Thank you very much. That's all we have time for today. Keep watching People's Dispatch.