SPOTLIGHT

What the pandemic is like for older people in poor communities

By Siyabonga Kamnqa for Spotlight 13 July 2020

Ntombizanele Jozana and Sylvia Gxabhagxabha say government should be ‘harsher’ on those who do not adhere to lockdown rules and put older people at risk. (Photo: Nasief Manief / Spotlight)

Already at an increased risk of serious Covid-19, older people in poor communities face an additional set of difficulties in staying safe and healthy. Siyabonga Kamnqa spoke to older people, experts, civil society organisations and government authorities on what can be done.

Nosipho Nkayi, 63, has become accustomed to walking about five kilometres from the Michael Mapongwana Clinic in Harare, where she collects her diabetes and high blood pressure medication, to her shack in Endlovini in Khayelitsha.

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Nkayi recently injured her knee and needs crutches to move around.

Nosipho Nkayi, 63, from Khayelitsha is one of the millions of older people in South Africa at high risk should she contract Covid-19. ( Photo: Nasief Manie / Spotlight)

On Friday 3 July Spotlight found Nkayi on her crutches on the side of the road gasping for air after having walked more than a kilometre from the clinic.

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Back in her tiny two-roomed shack, buckets of water are placed strategically on her worn-out carpets to catch rainwater leaking through the roof of her shack. There are also buckets for water that Nkayi and her daughter have to fetch from the communal tap.

Nkayi is one of the millions of older people in South Africa at high risk of developing severe symptoms or dying should she contract Covid-19.

Khayelitsha, where she lives, also happens to be one of the hardest-hit areas in Cape Town.

“Life during Covid-19 is a difficult one for me as an elderly person,” she says. “I had been suffering from chronic illnesses before and this coronavirus has exacerbated things. We are told to practise social distancing, but it is hard if you are living in an area like this. I live in fear every day.”

Nkayi says the risks of contracting Covid-19 in Endlovini are “too high”.

“You come across different people who are not wearing masks every day. And the sad part is that you cannot avoid people here. They are right in your face. You step outside your shack and there is almost a crowd of neighbours who are sitting in the sun and they want to converse with you. You can’t lock yourself in your shack all the time. I am just putting everything in the hands of God and wearing my mask,” she says.

As of 1 July, updates from the Ministry of Health showed 1,541 of 2,749 Covid-19 deaths were recorded among people of 60 and older.

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Most neglected in our society

Social distance should be redefined as physical distance when it comes to protecting the elderly during the Covid-19 pandemic, says Dr Leon Geffen from the Samson Institute for Research on the Aged.

“Social distance must mean that we take care of the elderly no matter how far we are from them. That [includes a] phone call to check how they are doing. Many elderly people are lonely and depressed around this difficult time. Plus, they need help in terms of assisting them with a lot of things such as collecting their Sassa grants, buying groceries and collecting their medication. We as the society have a role to play when it comes to these issues,” he says.

The elderly, he says, are the most neglected in our society and community groups can go a long way in alleviating their plight.

“Not only are they vulnerable to this pandemic, but they face a lot of abuse and exploitation. It would help if each and every community has a group that caters specifically to the needs of the elderly,” says Geffen.

Doing their best to stay safe

Ntombizanele Jozana, 68, from Khayelitsha, says to keep herself safe she locks her gate to control access to her house. (Photo: Nasief Manie / Spotlight)

In some cases, older people are taking charge of their own safety. Gogo Ntombizanele Jozana, 68, says before Covid-19 “came and terrorised us, [she] was quite a people’s person and everyone came and went as they pleased in [her] house”.

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“But now I am very cautious about allowing visitors because the risks are too high. In fact, I always make sure that my gate is locked all the time in order to control the flow of visitors.”

Jozana says it pains her that the elderly are the ones that are adhering to the regulations more than young people.

“These young people don’t care about Covid,” she says. “They wander the streets without wearing masks and when you rebuke them they look at you as if you’ve got leprosy. It is quite sad because most elderly people sit at home and contract the virus from their children and grandchildren. As the saying goes ‘this virus doesn’t move around but it is people who do and spread it’,” she says.

Sylvia Gxabhagxabha, left, and Ntombizanele Jozana miss the company of other older people in their seniors’ group. (Photo: Nasief Manie / Spotlight)

Joined by her wheelchair-bound friend and neighbour gogo Sylvia Gxabhagxabha, both feel it is “high time that government uses harsher measures to ensure that people follow the rules”.

“In the beginning, we were told that the army would be sent to the townships to ensure that rules were not broken, but that is not happening. If President Cyril Ramaphosa can send the army to patrol day and night, we won’t see this lawlessness ever again. People are scared of the army and they will start wearing masks and not wandering the streets,” says Gogo Jozana.

President Cyril Ramaphosa, during his address on Sunday, announced several restrictions including a curfew between 9pm and 4am, stricter regulations regarding the wearing of masks, and the reinstatement of a ban on alcohol sales.

Public transport

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For some older people, it is not always possible to keep a distance. Like many people in South Africa, older people in poorer communities depend on public transport to get around for groceries or to collect their grants.

Another Khayelitsha resident, 65-year-old Mirriam September, says she hardly leaves her house out of fear of contracting the virus and asks a neighbour to fetch her Sassa grant.

In Harare township in Khayelitsha, Mzwakhe Mlobeli is getting out of a minibus taxi when Spotlight approaches him. Wearing a mask and carrying his groceries, the 65-year-old says he has become vigilant ever since the spread of the virus in Khayelitsha.

Ramaphosa on Sunday also announced that taxis may operate at 100% capacity provided safety measures such as open windows are adhered to.

But Mlobeli says it pains him that the youth are disregarding the rules, also in taxis.

“Just in the taxi I have disembarked from, I was appalled to see that I was the only person wearing a mask. It is quite sad. People look funny at you when you are wearing a mask. When I asked one young man why he was not wearing a mask, he said ‘these things are suffocating us’. With such behaviour, this virus is going nowhere anytime soon,” says Mlobeli.

Mlobeli suffers from high blood pressure. He says the virus has “turned our lives upside down” and he is praying that a cure can be found soon.

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Mlobeli’s friend, Mhlontlo Masakala, 64, tells Spotlight the news of the virus came when he had just suffered a stroke.

“I suffer from high blood pressure and I am aware that I am at high risk of contracting and dying from this virus. Hearing that this virus has no mercy when it comes to the elderly, left me terrified. I am doing my best to stay safe, but we are surrounded by young people who don’t seem to care. They are the ones who are putting our lives at risk,” says the father of three.

Community interventions

Lockdown has affected crucial social support services to older people in poorer communities. One NGO, Ikamva Labantu, had to suspend activities temporarily.

Lulama Sigasana, Head of Ikamva Labantu Seniors Programme, says it has been difficult for the “seniors”, as she prefers to call the elderly, during Covid-19 as they had to isolate themselves from their peers, their places of worship, and their seniors’ clubs.

Sigasana says before the temporary suspension of the seniors’ programme, Ikamva Labantu was providing the elderly with a service that included the delivery of chronic medication to seniors’ clubs.

“This service is through collaboration with organisations that are part of the Chronic Dispensing Unit. We do, however, have seniors who prefer to collect their own medication from their local health facility. And these seniors have to arrange their own collection of medication,” she says.

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“Transport for seniors is a problem,” says Sigasana, “especially when they use assistive devices like wheelchairs and they are seen to move slow in a fast-moving environment. Some seniors, because of where they stay, are more compromised in terms of accessing transport as you have seen in Harare.” Sigasana says Ikamva Labantu often transports seniors to and from the seniors clubs, but funding has been a challenge.

Dr Tom Ellman, director at MSF’s (Doctors without Borders) Southern Africa Medical Unit, tells Spotlight that shielding can play a critical role in protecting the elderly. Shielding refers to protecting those at high risk from severe illness, such as older people, by minimising interaction with other people.

“With awareness of the risks, people can take measures to protect themselves better even without support. The more support that can be available from family, friends, community, and government, the more effective it will be. Shielding at home rather than moving into [care] homes will be more acceptable and more effective as well as less risky,” says Ellman.

When asked what needs to be done to warn young people about the dangers they pose to the elderly, Ellman says there are general efforts to promote awareness and clear messaging from peers highlighting the role of the young in supporting and protecting the elderly.

“Giving young people a role, potentially employment, and awareness will be needed. For those living with elderly or vulnerable relatives the dangers are personal and messages must adapt to that,” he says.

Ellman says it is unfortunate that some of the elderly continue to travel distances to seek medical attention.

“Clinics,” he says, “can give longer refills, offer alternative pickups outside the clinics, allow relatives to pick up drugs or even deliver drugs to the homes of the elderly.”

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Ellman says the government is already on board in a limited way, but the key will be solutions and ideas coming from individuals and communities.

“Support from government and community-based organisations must enable shielding by providing for the needs that cannot be met without exposing the shielded person to risk.” This includes food, income, healthcare, protection within the household, education and awareness and also supporting shielded people who may be caregivers or have other roles.

“The key for me is to ensure that individuals, families and communities are empowered with the knowledge they need and come up with solutions themselves, facilitated by community-based organisations and government support where needed,” Ellman says.

“The objective is to ensure that while up to 80% of the population may become infected in the coming months with Covid-19, the 20% who remain uninfected are those who would have been at greatest risk of severe disease or death. Shielding is focused on achieving that,” he says.

Khayelitsha ward councillor Lulekwa Jali says the issue of the elderly in impoverished areas is a sensitive one. Jali says it pains her to see the elderly living in abject poverty and having to face the Covid-19 battle.

“As councillors who see their plight daily,” she says. “We try by all means to address the issue affecting the elderly through social intervention methods. On the issue of housing, there is a backlog and, where there are desperate cases, we always try and get private donors or Good Samaritans who come and assist,” she says.

Government responds

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A spokesperson for the Department of Social Development in the Western Cape, Esther Lewis, says when it comes to the elderly the department “prioritises everyone and we are doing our best to ensure that they are taken care of during this pandemic”.

Asked how the department is addressing the challenges of the elderly, such as Gogo Nkayi who have to walk long distances to access their medication, Lewis referred Spotlight to the Department of Health — which had not responded by the time of publication.

A statement released by the Western Cape Department of Health on Friday 10 July reminded people over 55 and those with chronic conditions that they are at risk for severe Covid-19 illness and should take extra precautions to protect themselves by following steps to avoid getting the virus such as staying at home and wearing a mask when they have to go out.

According to the department, since 1 April it has through community health workers (CHWs) been able “to deliver 335,320 medication parcels to the homes of those members at high risk of contracting severe Covid-19 illness”. However, of these, “52,650 parcels were returned due to incorrect address details”. CHWs visited “943,982 members of the community in their homes (metro 720,086; rural 223,896), providing them with basic health services [so that they do] not have to leave their homes and risk contracting Covid-19”.

The department says it has implemented an action plan for diabetics with Covid-19 symptoms which includes expanding testing.

“Our current data suggests that these patients are presenting or are being admitted too late in a very sick condition, which has dire outcomes. Diabetic patients are encouraged to stay home and access the Pocket Clinic WhatsApp channel to ensure their medications are delivered to their homes. Patients are encouraged to send ‘Hi’ to 087 240 6122 to ensure we are able to deliver their medication at home,” the statement reads. DM/MC

This article was produced by Spotlight – health journalism in the public interest. Sign up for our newsletter.

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