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25 May 2020 | Story Keamogetswe Juries, Dimakatšo Veronica Masenya, Mamokoena Mokoena, and Joy Owen | Photo Photo by Magda Ehlers from Pexels

At the start of our democracy, four years into her existence, President Mbeki offered a new hopeful vision that was inclusive of our African compatriots to the north. In her rebirth, South Africa masqueraded as the land of milk and honey; a land to which the destitute, hopeless, and impoverished citizens of the rest of Africa would flee as they escaped hunger, failed states, failing healthcare systems, and certain death in the countries of their birth. In response, we treated our African neighbours variably, but most notably (and newsworthy) as pariahs of the South African state and its citizens. In short, we treated them as outsiders, akin to waste, to be erased from the South African psyche and landscape.

Yet, these African others have a history that is mired in the depths of our South African soil – they have been digging into the richness of our land, excavating diamonds, gold, and copper for decades. Mozambican. Basotho. Zimbabwean. Since the late 1970s and 1980s, Congolese, predominantly from the Democratic Republic of the Congo, first arrived in South Africa as highly educated professionals – doctors, dentists, mathematicians, and lecturers – and were employed by the South African state; then as entrepreneurs, educated refugees, and working-class asylum seekers. Soon other Africans arrived from Nigeria, Cameroon, Ghana, Liberia, Senegal, and Somalia. So too, our South Asian compatriots from Bangladesh, India, and Pakistan. 

If we are to believe headline reports over the past 15 years, acceptance of those African migrants living in South African townships has been predominantly negative, with widespread xenophobic attacks against particularly working-class black African ‘foreigners’. They have been maimed, killed, and robbed of their dignity in various ways, because their citizenship was not secured within the foothills of South African soil. They have been harangued, harassed, and brutalised, because they could not speak a South African language (or so we are led to believe); they have been questioned, humiliated, and shot at by police in random raids or random searches in the streets of Johannesburg. They have been harassed in hair salons and threatened with kidnapping; they have been thrown from moving trains, necklaced and killed in Bloemfontein, Masiphumelele, Bellville, Pretoria, Philippi, Katlehong and elsewhere in South Africa. The horror of these events, these experiences, should lead to outcries. Provide a moment of pause. And yet, they have not. 

Some commentators argue that the violence meted out against our African brothers and sisters is indicative of a violent South Africa. Xenophobia is thus subsumed under the aberrant reality of a violent South African population, as embodied and expressed through a virulent, oppressive, and toxic hyper-masculinity. To subsume xenophobic or Afrophobic violence in this way ironically captures African nationals as part of the contemporary South African story, enmeshed within our collective present of high unemployment, and continuing racial, gendered, and deep social inequalities. However, we are not encouraged to perceive this subtlety and nuance. Rather, prior to the arrival of  COVID-19 in South Africa, xenophobia were commonplace on the streets, in taxis, in supermarkets, in Home Affairs offices, at schools, at universities, at local clinics, in townships, and in barbershops; if not in deed, then in thought and in word. The psychological distancing created by the word makwerekwere – a reference to African migrants among us – still stings. 
Yet other stories exist too. For example, as xenophobia made headlines in South Africa in 2008, residents in Makhanda (then Grahamstown) protected immigrant spaza-shop owners. Women, in particular, discouraged looting of spaza shops, arguing – as elsewhere in South African lokshins – that foreing nationals fed the hungry and protected the destitute from complete and utter ruin. They allowed umama to purchase essentials such as maize meal, oil, sugar, and tea on credit. Child-headed households, old-age pensioners, and other destitute households were also assisted.

Some residents begrudgingly commented that ‘these foreigners’ worked together, combining their money and buying in bulk. By buying in bulk, they were able to purchase more products, and offer these to consumers at lower prices than their South African counterparts. The land of milk and honey had become competitive, and rather than respond to competition proactively by creating solidarity networks among themselves, many South African spaza shop owners fell into ruin.

As government’s plans for its citizens are shared during COVID-19, the silence on serving the needs of the African migrant population is deafening. Small business owners, students, barbers, cooks, hairstylists, car park attendants, pastors, traders, and entrepreneurs – they too are affected, with no recourse to government’s coffers as non-citizens. As non-citizens, government does not perceive them as bona fide beneficiaries of the state; their assumed rootlessness and statelessness leave them in a precarious quagmire, reliant on handouts from local South African and other diasporic organisations. Yet, their labour too contributes to the ticking over of South Africa’s economy. Just like you and me, they purchase food in supermarkets or vegetables from hawkers on the street; they pay taxi fares, pay university fees (much higher than South Africans), need medical care and attention, participate in illicit undertakings, fall in love, marry, live and die. More pertinently, in the time of COVID-19, they – like South Africans – also shared what they have and more with South Africans in need.


Educational migrants
From the suspension of academic activities to the total shutdown of the country, little has been noted about the experiences of African educational migrants. The suspension of academic activities on 16 March led to the closure of South African universities in an attempt to limit movement and gatherings on campuses. This reality forced students to head home. Those educational migrants who could not return home for various reasons, were accommodated by certain higher education institutions and remain in lockdown on campuses, separated from immediate family and the familiarity of ‘home’.  These are anxious times.

Stop for a moment and conjure up the feelings, smells, experiences, and attachments related to home. Imagine the smile of your grandmother, the sound of your siblings’ laughter, the earthy, homely smell of your mother’s cooking; the heat of the day, the shade sought under the tree in the backyard, gossiping with favourite cousins, your grandmother, or aunt. Get lost in the stoicism of your father, and the familiar sounds of home. The sound of padded feet moving down the passage; the click of the kettle as it boils water for the day’s morning beverage. The radio or TV tuned in to the news. All of this and more provide the backdrop of familiarity, comfort, and casual belonging, ‘back home’. All of this, gone with the stroke of an ordinary ballpoint pen held by the hand of President Ramaphosa, ratifying the closure of South Africa’s borders. Gone.

Access to medical care and attention
Hard lockdown rules, including physical distancing, curtailed movement via taxis within provinces, no interprovincial travel, and a ban on street vendors and entrepreneurs limited the movement of vectors of transmission – human beings – irrespective of nationality, race, gender, age, and profession. An early attempt at curtailing movement included the closure of South Africa’s borders, which left numerous circular and economic migrants from Zimbabwe, Malawi, and Mozambique in limbo. Provision was made for African migrants whose visas expired before or during lockdown. However, asylum seekers whose request for asylum has been denied, as well as undocumented migrants, have not been provided for. 

On 15 April 2020, the Centre for Human Rights and the Centre for Applied Legal Studies issued a plea to government to ensure the inclusion of African migrants in updated frameworks for healthcare during COVID-19. This plea was not without reason. Research shows that undocumented and legal migrants have met with disdain from various medical personnel when seeking urgent medical care in South Africa. Yet, the nature of the virus knows no borders. It doesn’t check your legality or illegality, nor does it ask to see your bar-coded South African identification document or identity card. 

The situation we find ourselves in demands that every individual resident in South Africa be screened, tested for, and treated for COVID-19. There is no room for medical discrimination, as the efforts to curb the exponential increase in the infection rate could be nullified by this act. The vulnerable among us, irrespective of nationality, should be assisted with the promise of amnesty from prosecution and persecution. The failure to include African migrants, however categorised, threatens every other individual in her environment; and as the virus is non-discriminatory, it behoves South Africans to follow suit.

At death’s door
The government gazette dated 2 April 2020 prohibits all forms of social gatherings, with the exception of funerals. As per the rules, the number of mourners attending a funeral or cremation service should not exceed fifty.  A permit for attending funerals or cremation services is obtained from the nearest magistrate’s office or police station.  The applicant must produce documents such as the death certificate, and in cases where the death certificate has not yet been issued, a sworn affidavit must be submitted. The regulation further stipulates those who are eligible to attend funeral or cremation services. Relatedness to the deceased is defined as ‘close’ and is measured by blood, marriage, and/or caregiving bonds/responsibility.

These strict measures are meant to safeguard and protect the living from infection with COVID-19.  As President Ramaphosa said, “we have decided to take the urgent and drastic measures to manage the disease, to protect the people of our country, and reduce the impact of the virus on our society and on our economy”, when addressing the nation on 15 March 2020. 

The reference to ‘people of our country’ highlights the elephant in the room – who are the people of our country? Is the reference specific to those born in South Africa, and who thus enjoy citizenship?  Or is it inclusive of migrants from the African continent, however defined? If the President’s protection extends to include migrants, how will migrant deaths be managed? The closure of our international borders have scuppered attempts to repatriate the mortal remains of the deceased; and as fears rise that COVID-19 can still be spread by the dead, will the body of an African migrant be buried or cremated in South Africa?  Health authorities advised that cremation is the best method for dealing with a COVID-19 death. Yet, in the African context, cremation is complicated as it opposes certain belief systems. Further, mortuary facilities in South Africa are scarce and hardly able to respond to the potential need created by South African deaths, whether from COVID-19 or something else. Given this context, will African migrants finally be treated with dignity and respect in death?

Not every black African migrant crossing into South Africa is illegal or disempowered. There are middle-class nurses, dentists, doctors, university professors, mechanical engineers, businessmen, and researchers. However, they are not newsworthy, as their class status often removes them from physically violent persecution in local townships. In this extended COVID-19 moment, race and class are interlinked, as during segregation and apartheid in South Africa. So is nationality, gender, and health status. Depending on the social configuration of your identity, further confirmed by the national documents you carry, your chance of surviving COVID-19 in South Africa waxes or wanes.  Your access to healthcare, to state assistance in the form of food aid or a social grant, depends on your citizenship status; and your health and/or death is mediated through your predefined status, inclusive of your citizenship. 
The South African government will have numerous obstacles to remedy the further devastation and destitution of its citizens. We hope that the idea and characterisation of South African citizens will be inclusive of our African brothers, our African sisters, and their children. Born in South Africa, these South African children have a right to safety and security, healthcare, food, and education. Their parents too. 

In the next few weeks and months, as we move through various stages of lockdown, we should not erase ‘other Africans’ in our midst. Our humanity and our collective health are intimately interwoven with the healthy existence and humanity of others – whether South African or other African – resident in South Africa. The disease does not discriminate. Neither should we.  As James Baldwin said, “Where all human connections are distrusted, the human being is very quickly lost”. And as we as South Africans often say, ‘I am because you are’. Umuntu ngumuntu ngabantu.

News Archive

A position statement by the School of Medicine, UFS, regarding the crisis in health care in the Free State
2009-05-27

The executive management of the School of Medicine (SOM) at the University of the Free State (UFS) and its senior members wish to express their grave concern at the way the financial crisis in the Free State has negatively impacted on the provision of health care to the population. The unavailability of goods and services at every level of care has become so severely compromised that the staff of the SOM can no longer remain silent on this issue. By remaining silent it may be construed that we are either indifferent to, or even accepting the situation. Neither is true. The SOM can in no way condone, sanction or accept the current situation of health care in the Free State.

Other concerns expressed by the SOM include:

  • Medical services have been severely compromised due to the disintegrating primary health care system in the FS. This has resulted in patients who were in need of more advanced levels of medical care not being referred appropriately or timeously to level two hospitals and from there for tertiary care. Inpatient as well as outpatient numbers are steadily declining and the tendency now is to fill fewer beds with critically ill or terminally ill patients. It is also becoming increasingly difficult to find suitable patients for training and examination purposes.
     
  • It becomes more difficult to attract and retain experienced and suitably qualified medical specialists interested in an academic career, due to the inability to provide prospective career opportunities. This is particularly the case in the surgical disciplines.
     
  • It is also becoming more difficult to attract and appoint highly qualified registrars (future specialists) since the reputation of this SOM has been compromised by the negative publicity created by the financial difficulties of the FSDoH. Registrars form the backbone of the clinical work force in all teaching hospitals. If vacant posts cannot be filled in time service provision, as well as undergraduate teaching are severely jeopardised.
     
  • As a direct consequence of the rationing of health care, fewer surgical procedures are being performed. The point may soon be reached where registrars in the surgical disciplines may not get sufficient hands-on experience to allow them to qualify within the required time frame.
     
  • Non-payment of accounts to service providers and suppliers including the National Health Laboratory Services (NHLS), maintenance contracts and industry will severely compromises health care and future loyalty, goodwill and provision of critical services.
     
  • The dwindling number of qualified and experienced nurses in the public (and private) health care sector is an ongoing unresolved issue. Despite the fact that primary health care is mainly nurse-driven, nursing colleges were closed during the previous decade. These colleges must now be re-commissioned at high cost adding to the financial burden.
     
  • The morale of health care workers at all levels of health care has reached an all-time low
     
  • It is becoming increasingly difficult to conduct meaningful research in all disciplines due to staff shortages and lack of funding.

See attachment for the full statement on by the School of Medicine, regarding the crisis in health care in the Free State.

Media Release
Issued by: Mangaliso Radebe
Assistant Director: Media Liaison
Tel: 051 401 2828
Cell: 078 460 3320
E-mail: radebemt.stg@ufs.ac.za
26 May 2009
 

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