Often on my morning commute to Baragwanth Hospital (Sowetos’s largest) I pass by the billowing smoke and watch the pink hues of the morning sun reflect on the corrugated iron homes. This almost becomes a monotonous morning motion picture through my vehicle windows. It took a lockdown for me to seriously consider the plight of the informal settlement residents – large families confined to a small space, with no proper heating or amenities for a prolonged period. It can’t be an easy life. A far cry from being confined to a large suburban house for weeks.
On my return home, traffic lights are marked by the often familiar sight of a beggar. Tattered clothes, disheveled and covered in a holey grey blanket. “Bosa, money for some bread please”. I nervously draw my window closed and cautiously adjust my laptop bag on the passenger seat to hide it out of view. A smash and grab defence mechanism. During the lockdown a similar incident with the phrase :”Anything, my stomach is empty,” strikes a cord. The news was a-flood with stories of South African’s going hungry. I have read about South Africa having a Gini coefficient (inequality index) of 63.0 which is phenomenally high but this was just a figure which I failed to interrogate. The lockdown brought the recognition that this degree of inequality is not sustainable.
A BBC report video was doing the social media rounds of a Bergamo Emergency Room flooded with endless stretchers and patients gasping for breath through plastic ventilators reminiscent of diving helmets. The background track was the beeps of ICU machinery. It didn’t shake me with fear. This is not an unseen phenomenon in South African hospitals pre Covid-19. The medical admissions ward at Baragwanth hospital is almost always at full occupancy. You are working at full speed, skipping meals but still falling behind. There are patients on stretchers and chairs, some confused and bound by bandage restraints, others fighting for air. Except, we don’t always have the luxury of ventilators. There literally, isn’t at times room to walk while examining patients. The ward is often so full, patients need to share bays, so there are no curtains to shield the patient during an examination.
Colleagues in Italy talk about having to revert to wartime protocols of triage for ventilation. Triage and prioritising which patients get ICU/ ventilation is the tough decision we are often faced within the state hospitals. Covid-19 has taught us that this isn’t the international normal. We are resource-limited county but perhaps some of the Covid funding to hospitals will help alleviate staff/icu/ ventilator shortages. This coronavirus legacy might be the first phase in ramping up the quality of state hospital care as a prelude to universal quality health coverage as part of the NHI (National Health Insurance).
On the education front, Covid-19 has taught us a lot. Students often wonder what the utility of graphs taught in high school maths is in the real world. Covid-19 is a practical lesson showing the exponential curve and graphical modelling driving government policy.
Again the inequalities in education have been made even more evident. Private schools with electronic teaching aids and tablets have been able to continue lessons unabated by the lockdown, but schools and students that lack access to data/ wifi or electronic aids have had their education ground to a halt. This could further deepen the cycle of poor education and poverty. Covid has taught us that technology should be embraced in the education sector for schools in all quintiles.
Covid is also a huge reminder that none of us is invincible. Death and sickness can visit us at any time. The young doctor often see death every day but we still discount it as the fate of the old. We counsel and advise about treatment and death but fail to recogniseour own inevitable mortality. Youth is the damaged armour we wear as a defence against the arrows of death. Lockdown has been a time of introspection. Coronavirus has afforded us the time to consider/revise wills and discuss with family advanced directives about end of life care for many of us, irrespective of age.
Fate is a funny thing. I have often wondered why Tata Madiba’s chosen successor, Cyril Ramaphosa wasn’t our second president. President Mbeki’s cabinet demonstrated the arrogance of a scientifically flawed response to a health crisis (HIV). The Zuma years were marred by corruption and state capture and a general decline in national morale. The deprivation of good leadership in recent years has brought to light the statesmanship of President Ramaphosa. He has often been cited as a political Hamlet with his tragic flaw being procrastination and endless consultation. This couldn’t have come to better use during the current crisis. Is it just fortuitous or fate that our current president had learnt consultation and compromise as a CODESA negotiator in the founding of our republic or as a trade unionist? That same skill has been used to good effect in consulting faith leaders, political opponents, business community, scientist and health experts and developing a comprehensive action plan at this juncture. Could it be serendipitous that Mr Ramaphosa temporarily left politics to became an astute businessman or that he is married to a Harvard educated public health doctor? Or could it be fate that during a crisis that presents the marriage of economics and health we are led by President Cyril Ramaphosa? He is human and by no means infallible, with the blight of the marikana massacre on his record, and perhaps it is this humanness that earns our adoration.
On the political front, state-owned enterprises (SOEs) have been failing for years and have presented a significant burden on the fiscus. They have been corrupted by nepotism and greed and have needed bottomless bailouts with complete disregard of the taxpayer’s funds. Perhaps the coronavius crisis has emboldened our leader and united a factionalised party. This accompanied by compromising unions on the economic back-foot could serve as the impetus to institute much needed structural reform in the SOEs.
On a personal note perhaps the coronavirus has taught us to live the motto carpe diem. There have been innumerable times where we have postponed meetings, coffees, sports matches, dates with our friends, elderly family, spouses with the excuse of work or simply laziness. Now that we can’t make a mence due to the lockdown we have regrets. The coronavirus/lockdown has also taught us to appreciate the simple things like social gatherings, faith meetings, congregational prayers, a jog in nature, awesome travel experience and the need for companionship. A verse from the quran repeated multiple times: “Then which of the favours of your Lord will you deny?” rings true to the times. It might be the temporary withdrawal of these privileges that will enhance genuine appreciation.
This viral pandemic presents many life lessons and an intersection of our social, economic, political, spiritual, educational and personal lives. Much similarity with the corona radiata, an area of the brain that is an intersection of many pathways from the brain cortex to final destinations. Besides the brain area the literal latin translation of corona radiata is radiating crown, and perhaps this coronavirus viral pandemic can serve as an epiphany for positive structural reforms.
Dr Imraan Kola is a medical doctor at Charlotte Maxeke Johannesburg academic hospital currently in a Covid-19 response team.