Africa’s Hidden Victims

Healthcare Workers Struggled Through Lack of PPE, Salary Delays and Disappearing Hardship Pay

By Patrick Egwu, Linus Unah, Sally Hayden and Maurice Oniang’o

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Africa’s Hidden Victims

A three-part series on the collateral victims of a health care crisis, with reporting from four countries.

A medic sits at a checkpoint between Uganda and South Sudan, where truck drivers have their temperature taken before moving on for a coronavirus test. Uganda closed its borders in March 2020 to everyone except cargo planes and truck drivers. Photo by Sally Hayden.

It was one of the worst fears of my life. I’m still stressed, even now, and whenever I come to work. I’m scared of getting infected again.

Mpho Mokgotsi

Every morning during the coronavirus pandemic, Mpho Mokgotsi feared leaving her home for work at Hillbrow Community Health Centre in Johannesburg, a hospital and testing centre for Covid-19 in Gauteng province.

Back in April 2020, the 55-year-old nurse became infected while responding to Covid-19 patients at the hospital. Mokgotsi was transferred to Baragwanath Hospital in Soweto, Africa’s largest hospital with about 7,000 staff and 3,500 beds. Two weeks later, two of her children tested positive for the virus. 

“It was one of the worst fears of my life,” she said. 

Over the last year of pandemic, historically underfunded health systems in parts of Africa stretched to the breaking point under the strain. In many cases, frontline health workers lacked adequate protective equipment for much of the pandemic, putting their lives at risk. They faced long hours–with some working 14 days straight–without insurance or employment benefits. When they did contract Covid-19, healthcare workers complained, they were left to fend for themselves, in the absence of dedicated facilities for their treatment.

To date, the African continent has counted 5.36 million cases and 140,000 deaths, though medical workers say the real figures are likely far higher, as a dearth of tests left victims uncounted. 

A truck driver is tested for COVID-19 on the border of Uganda and South Sudan. Photo by Sally Hayden.

Kenya

In the isolation ward, we work for 14 days consecutively with no break. This is a great injustice to us.”

Dennis Cheruiyo

Dennis Cheruiyot, who works in the clinical office in Uasin Gishu District hospital in Kenya’s Rift Valley, said that early on, health workers in the isolation ward had to work 14 days without a break, deeming the conditions “a great injustice to us.”

According to Kenya’s Ministry of Health, by January, more than 3,068 healthcare workers had been infected with Covid-19 while 32 had died.

The burial of a coronavirus victim is carried out by a healthcare team wearing protective gear in Gulu, northern Uganda. Photo by Sally Hayden.

The situation was actually very terrible. Protective gear including head covers, face masks, gowns and boots were “grossly inadequate".

Dennis Cheruiyo

Robert Ugwu, head of resident doctors at the University of Abuja — Nigeria’s capital city — said that “the situation was actually very terrible” and that protective gear including head covers, face masks, gowns and boots were “grossly inadequate,” forcing many doctors to attend to patients with little protection.

Doctors, he added, see their work as a calling and “just have to do what they can do to actually save life.”

A frontline worker who handled patients in intensive care units in a large Covid-19 facility in Abuja said PPE were “heavily rationed” outside the Covid-19 facilities. The health worker spoke on condition of anonymity, citing fear of retaliation for speaking to journalists.

Dr. Robert Ugwu, head of resident doctors at the University of Abuja Teaching Hospital in Gwagwalada district. Photo by Linus Unah

We are overwhelmed, we are overwhelmed. The treatment centre is full.

Santos Okot Lapolo

Uganda’s first Covid-19 death was only confirmed in July 2020, with the number of cases staying relatively low, but the country still struggled.

Healthcare staff remained desperate for more protective gear, vehicles and fuel, thermometers, and ICU beds. Uganda had only 55 ICU beds in total, for a population of roughly 44 million people, at the beginning of the outbreak.

The situation in Gulu, a city in Uganda’s impoverished north, epitomized problems in the healthcare system. Staff there worked for months on end without salary. The government initially hospitalized both suspected and confirmed cases of Covid-19. Patients complained that hospitals lacked food and water. Some tried to escape simply to avoid starvation.

In September last year, Gulu’s hospitals ran out of space and started rejecting patients. Desperate victims of the virus “are calling me left and right,” with some threatening to commit suicide, one member of the city’s coronavirus task force wrote in their group WhatsApp at the time.

Santos Okot Lapolo, the task force chairman and the president’s representative in Gulu, called the city “the epicenter” of the crisis in September 2020, because it was receiving patients found to be positive during mandatory testing at the South Sudanese border. 

“We are overwhelmed, we are overwhelmed,” he said. “The treatment center is full.” As the population of patients increased, the doctor to patient ratio ballooned.  

“We have a problem with human resources. We have a problem with financial resources,” Lapolo said. “Kampala sent us some support but it’s not reaching expectations.” 

Lapolo would later die of coronavirus himself.

An ambulance carries coronavirus patients towards Gulu Regional Referral Hospital in northern Uganda in September. Photo by Sally Hayden.

...over 38,000 healthcare workers in South Africa had tested positive for the virus

Cyril Ramaphosa

As of December 2020, over 38,000 healthcare workers in South Africa had tested positive for the virus, with more than 390 dead, according to President Cyril Ramaphosa.

Corruption has aggravated the risks for health care workers. In South Africa, politicians and companies close to the ruling party have recently been implicated in tender and contract scams linked to the supply of PPE and other medical supplies, with several suspended as a result.

Dr. Robert Ugwu, head of resident doctors at the University of Abuja Teaching Hospital in Gwagwalada district. Photo by Linus Unah.

.If the status quo remains, we will be left with no health workers at all.

Kavisha Pillay

In Kenya, 15 senior officials at the Kenya Medical Supply Authority (Kemsa), the government agency mandated with procurement and distribution of supplies to public hospitals, came under investigation over the alleged misuse of more than 7.8 billion shillings (USD $71 million) earmarked for treating Covid-19.

“It is not surprising that it happened because the system itself is very weak and vulnerable to corruption,” said Kavisha Pillay, the head of stakeholder relations and campaigns at Corruption Watch, a South African anti-corruption organization. “And our procurement systems, not just within the health sector but all sectors, are particularly vulnerable.” 

Pillay said the pandemic exacerbated the inequality within the public health system. Early on in the pandemic, Corruption Watch raised concerns that corrupt officials might exploit the pandemic to their personal advantage. 

“Definitely health workers are the ones at risk because they don’t have the proper equipment to work with or proper supplies and infrastructure,” said Pillay, who has been monitoring Covid-19-linked corruption with her team. 

Pillay’s organization also works with law enforcement agencies and the office of the auditor general to take action on corruption related to Covid-19. In July 2020, public officials and private contractors were arrested by security agents over fraud in the procurement of PPE for health workers in the frontlines of the Covid-19 pandemic.

“The issues are still here with us and it doesn’t quite seem like it’s going away anytime soon,” Pillay said. “When we talk about these things [corruption] and no one is prosecuted and made to pay, then we haven’t really done much and that’s why we have to keep looking into their activities as the pandemic goes on.”

More than one year after the outbreak of the pandemic, cases of corruption around Covid-related issues are still emerging. A report released in April by the Financial Transparency Coalition [FTC], a coalition of civil societies working to end illicit financial flows, reveals a broad lack of accountability in the use of Covid emergency funds. 

Nine countries – South Africa, Sierra Leone, Kenya, Bangladesh, India, Nepal, Honduras, Guatemala, and El Salvador – were surveyed in the report, which showed that an average of 63 percent of Covid funds went to big corporations while just 2 percent of Covid emergency funds were allocated to the informal sector, even though they make up the workforce. 

Peggy Pillay (no relation to Kavisha), convener of Johannesburg Against Injustice, whose group has led protests on Covid corruption, said frontline health workers “are sacrificing everything” to save lives and so their health and “welfare must be prioritized.” 

Those found guilty of corruption related to Covid should face prosecution and punishment, she said, adding, “Our children and the future generation deserve better.”

Nathan Onyachi, the director of Gulu Regional Referral Hospital in northern Uganda, where Covid-19 patients went on strike over poor conditions. Photo by Sally Hayden.

We put our lives on the line when people are at home with their families. We are here to save lives and it looks as if nobody cares about us.

Mokgotsi

South Africans are growing frustrated with the unchecked corruption, and are increasingly disillusioned. “And now with the pandemic raging, what we have seen is that corruption is increasing,” she said.

The corruption and perilous working conditions that led health and trade unions in the country to walk out in October last year have not abated.

The pandemic exacerbated chronic understaffing in the health sector, said Khaya Xaba, the national spokesman of the medical workers union in South Africa. Healthcare workers “are losing their lives and getting infected by the virus on a daily basis,” he said.

While Mokgotsi and her colleagues have seen improved welfare packages, including the payment of their hazard allowances and provision of PPE at the hospital they work in, unions representing health care workers in Limpopo, the northernmost part of South Africa, were only able to fend off government budget cuts to the region’s health budget by threatening to strike.

Incensed by a rise in deaths among healthcare workers, lack of protective gear and the absence of insurance to cover frontline health workers, nurses and clinical officers in Kenya downed their tools in early December 2020. Doctors also joined other healthcare workers on strike two weeks after their attempt in negotiation with the government failed. After 70-days of protest, the workers called off the strike in February.

The government had promised allowances to healthcare workers during the pandemic period. But healthcare workers have faulted the criteria used to give the allowances, which were only disbursed for three months.

The danger is hardly over, as South African braces for a threatened  third wave of the pandemic.  Just 2.23 million people, under four percent of the population, have received at least one dose of vaccine, but the government prioritized health care workers as it rolled out the vaccine.

At least now, Mokgotsi said, “you can be confident and assured while leaving your home for work.”

However, Mokgotsi has lost several colleagues to COVID-19.

“We put our lives on the line when people are at home with their families,” she said. “We are here to save lives and it looks as if nobody cares about us.

“If we are really essential workers, they should treat us that way,” she said.

Top photo: The burial of a coronavirus victim is carried out by a healthcare team wearing protective gear in Gulu, northern Uganda. Photo by Sally Hayden.

 

Africa’s Hidden Victims was produced and co-published in collaboration with Journalists for Transparency, a project of Transparency International, and co-published with Africa.com.

 
Patrick Egwu

Patrick Egwu

Patrick Egwu is a South African-based Nigerian journalist and an Open Society Foundation fellow on Investigative Reporting at the University of Witwatersrand. He can be reached via Twitter @PatrickEgwu6.
Linus Unah

Linus Unah

Linus Unah is a journalist based in Nigeria, who has reported on global health, conflict, development and conservation for many outlets, including The Guardian, Al Jazeera, NPR, Mongabay and The New Humanitarian.
Sally Hayden

Sally Hayden

Sally Hayden is a journalist working in Uganda and Sierra Leone. Her work focuses on migration, conflict and humanitarian crises. She has reported for outlets including BBC, the Guardian, the Irish Times, Newsweek and TIME, and was listed on the 2019 Forbes '30 Under 30' list for Media in Europe. She won the best 'foreign coverage' award at the Newsbrands Irish Journalism Awards in 2018 and 2019, for her reporting on refugee issues.
Maurice Oniang'o

Maurice Oniang'o

Maurice Oniang'o is a freelance multimedia journalist based in Nairobi. He has produced content for National Geographic, Al Jazeera (AJ+), and InsideOver, and he has written and produced for highly regarded television programs such as Project Green, NTV Wild, Giving Nature a Voice, and Tazama. He has won various awards including Development Reporter of the year TV-AJEA 2021, Environmental Reporter of the year TV- AJEA 2015, Thomson Reuters Foundation Young Journalist of the Year (FPA-London).
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“K.”, 39, Sierra Leone
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Jorge, 25, Guinea-Bissau
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Abu, 37, Senegal
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Ibrahim, 41, Senegal
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Guaianazes street, downtown Sao Paulo

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Santa Efigenia neighbourhood
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“H”, 42, Angola
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Lalingé restaurant, Sao Paulo
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Scalabrinian Mission, Canindé neighbourhood
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Clement Kamano, 24, Guinea-Conakry
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Around the table are two Syrians who fled the war, one Cameroonian who says he wanted to escape the Anglo-French conflict in his homeland, two Afghans, one a former top-ranking police officer, an Egyptian and a Sri Lankan who wanted to go anywhere where he could make enough money to help his family. Migrants who arrive in Ecuador from Africa, Asia and the Middle East face a steep learning curve: it might be relatively easy to enter the country, thanks to Ecuador’s liberal open-border policy, but finding work here and learning Spanish can be difficult. Today their teacher is translating between Arabic, Spanish and English. “Market”? asks one. “Souk” replies another member of the group, while a fellow student does a quick translation into Pashtu.

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A little piece of Nigeria, in Quito
As the night closes in, Grace, a 25-year-old law graduate from Cameroon, dashes between a barbeque out on the street and the kitchen in the small Nigerian restaurant where she is working the night shift, as a television showing an African football league plays in the background. She wears a dark top, and her hair pulled back, as she fans the tilapia grilling on the coals. When she was denied a Canadian visa, despite having a scholarship, she decided she still wanted to leave Cameroon, where she complains of a lack of jobs and opportunities for the country’s English-speaking minority. With three friends, she bought a ticket heading west for Ecuador where she heard she could enter with her invitation to study at a language school. She soon converted to a missionary visa, and now works here and sings in the choir at a church up the hill, teaching Sunday school at the weekends. Like many of her customers, she also wants to travel north to the US or Canada, but only with the correct papers. “If you go without papers and through the jungle, you might be lost. Then my family is lost as well.”

The Afghan police officer
Asadullah, a former police officer, spent 31 years training new recruits and fighting terrorist groups in his country. Among the documents he smuggled out with him is a photograph of him with Robert Gates, the former US Secretary of Defence, paperwork from a training programme at the National Defence University in Washington DC, and training certificate from the George C Marshall centre in Europe, signed by the German defence minister.

His career had been high-profile and illustrious, but while that brought recognition from the Americans and their allies, it also brought him the unwelcome attention of the Taliban and other extremist groups.

For three years before he fled, he says terrorists were calling him saying he needed to end his work with the police. “Come and work with us,” they’d coax. When he refused, someone tried to throw acid on his child at school – that was when he decided to leave.

Today the family are renting a spacious flat in central Quito, with a big beige sofa and swept wood floors. A big TV is mounted on the wall behind him, and one of his children brings in sweet tea and fruits. His wife and six of his children are with him, awaiting a decision from the migration authorities on their asylum case. For the sake of his children – who all speak English – Asadullah wants to go to the US.

“I want to go to America, but it’s a process: it will take a lot of time,” he says. “We have been waiting to get an answer. I only came here because the bad people wanted to kill us. I’m just here so I’m safe.” He considered going to Europe, but considered the route there more dangerous. “Many Afghan people wanted to go to Europe, to Turkey, but many people died in the sea.”

The Artist
Mughni Sief’s paintings once made him a well-known artist in his native Syria: he taught fine art in a top university, and was invited to Lebanon to show his work. But since the war, and his decision to flee, his paintings have taken on a darker tone. One , “Even The Sea Had A Share Of Our Lives, It Was Tough” touches on the horrors so many Syrians have seen as they try to flee to safety.

“This painting is about Syrians crossing the sea to go to Europe from Turkey. I put this fish head and cut the head off to show the culture of ISIS. This here is the boat people,” he explains in his spartan apartment in Ecuador’s capital, Quito. “Syria was empty of people, and there are so many people dying in the sea.”

From the windows of his bedroom-come-studio, you can see the mountains, washing hanging in the sunshine on a neighbours balcony, beige tiles. Behind him the bed sheets – which came with the house – are adorned with images of teddy bears and the phrase “happy day.”

In the corner is a small, rolling suitcase in which he brought his wood carving tools, crayons, and charcoals from Syria: everything from his old life that he dared bring without alerting attention that he was leaving the country. In a small backpack he bought a Frederick Nietshce paperback, a birthday present from a friend, and a book he bought in Syria: “Learn Spanish in 5 days”. He didn’t bring any photos, in case his bag was searched.

Frustrated by restrictions he faced as a Syrian in Lebanon, he started to research other places where he might make a new start. He read that Ecuador was “one of the few countries that don't ask for a visa from Syrians. I had problems leaving Lebanon, and in El Dorado in Colombia but at Quito I came in no problem. The only question was: why are you coming to Ecuador, do you have money? I said nothing about asking for asylum so they just gave me a tourist visa.”

Soon after he made his asylum application, and today, he paints while he waits for a decision. “Before the war I was focused just on humans, on women, but when the war started that changed, and I began focusing on the miserable life that we live in Syria,” he says as he arranges three paintings on the bed. In one, he explains, is a woman who can’ face something in her life, so prefers to stop speaking.

Tricked
Although many of the migrants that make their way to Ecuador are able to travel more independently than those making the journey across the Mediterranean, examples abound of exploitation of some who arrive here. Mohammad, for example. He’s  a 24-year-old from Sri Lanka who first tried his luck in Malaysia, but was cheated by a travel fixer who took his money while promising him a work visa that never materialized. When he was arrested for working without the proper documents, a friend had to come and pay the police to get him out. Travelling west, to Ecuador, after religious violence broke out in his hometown, he says he paid someone he knows to help sort out his travel, unsure of how much he took as a cut. When he flew in, alongside a Sri Lankan family, the agent arranged for him to be picked up by an unknown woman who charged each of them again to take them to a hostel. He is now renting a room from a man he met at the mosque. Every day continues to be a struggle, he said.

“At home, I saw so many troubles each day. I decided to come here thinking maybe things will be good. But I did one week working in a restaurant, they treated me like a slave. For three months I was searching for work. They are good people here but I have no opportunities here. Seven months I have nothing, I’m wasting my time.”