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“Health workers know that they are valued and, to whatever extent possible, they will be protected.”

Green Masks
By Pierre Barker, MD

Cape Town
South Africa

I am based for now in South Africa, where I found myself two weeks ago deciding whether to get on the “last plane” back to the US, or to hunker down for an indeterminate period to ride out the epidemic here in Cape Town. I decided to stay, primarily to be close to my 95-year-old mother-in-law who lives in a retirement community and has no remaining relatives in South Africa, but also out of a sense of wanting to contribute directly to the South African COVID-19 response and to be closer in time zone to the Institute for Healthcare Improvement’s (IHI) global teams at this time of uncertainty and need.

This means that I am observing from a distance the tragedies unfolding in the US and in Europe, and fretting about the seemingly inevitable epidemic path that South Africa and the rest of Africa and other low- and middle-income countries are about to follow. Since I don’t have a TV, I am spared a visual feed of the horrors of the US epidemic. But I am reading the stories of health workers and other essential workers who are being exposed to and dying from the virus at a disproportionate rate. Health care workers are at extremely high risk of getting COVID-19 from the very sick patients they are taking care of.

As a physician, I feel frustration and anger that the US, the world’s most advanced economy, is unable to provide doctors and nurses with the essential protection they need. Two days ago I heard Governor Baker of Massachusetts describe at a press conference how a shipment of personal protective equipment (PPE) destined for the state’s struggling hospitals was impounded and confiscated by federal agents, forcing Baker’s team to send the [NFL team, New England] Patriot’s plane to China to pick up crates of PPE to protect doctors and nurses. The world is watching the US live through the consequences of decades of devaluation of central planning and rejection of the concept of the commons and the common good.

In South Africa there is a real fear that limited hospital resources will quickly be overwhelmed. A large hospital in my home town of Durban has been shut down temporarily after 13 health workers became infected while caring for one of the first cases of COVID-19. The lessons of this unnecessary breach of health worker safety are quickly being learned. In an extraordinary collaboration between professional groups, the national health system and industry, a set of stringent policies has been issued to protect workers, ethical guidelines are in place that protect health care workers in the event of a lack of PPE, and industry has swung into action to manufacture an array of PPE ahead of the expected surge of sick patients.

South Africa may yet be overwhelmed by the virus, but the country has come tightly together, with scientists, academics, policy makers, physicians, activists, communities all collaborating to mobilize talent, resources, and good will. We have a very uncertain path ahead, but the health workers know that they are valued and, to whatever extent possible, they will be protected.

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