Dr. Zolelwa Sifumba is a health worker, multidrug-resistant tuberculosis (MDR-TB) survivor, Global Fund advocate and global health activist in South Africa, and Community Representative in the Access to COVID-19 Tools (ACT-) Accelerator. As a medical doctor, she has intimate knowledge of the challenges health workers on the front lines are facing in the fight against COVID-19. She shares her story and her dedication to improving the situation for health workers across the globe.
News of COVID-19 arrived last year while I was doing my medical community service in a district hospital in rural KwaZulu-Natal, South Africa. Since contracting MDR-TB as a medical student many years ago, I have known about the dangers of under-resourced health systems, and I have become an outspoken activist for their improvement. When COVID-19 arrived and we found out that people who had previously had TB were considered high-risk, I began to get very anxious. As the small towns around the district hospital started to report patients with COVID-19 symptoms, I could see the virus coming closer, and closer, and closer.
It was scary. I had seen images from overseas in which health workers were wearing full medical coveralls to protect themselves from COVID-19. We were given basic aprons and K95 masks – we couldn’t find N95 masks anymore. I knew that we didn’t have space for the number of patients that were expected to arrive over the coming weeks. I realized that things were going to be bad, and I was afraid of getting infected with COVID-19 myself. Despite raising my concerns with the hospital management over the lack of adequate protection for health workers, we were expected to carry on working as usual. Eventually we started getting COVID-19 outbreaks among the hospital staff.
As more and more patients arrived at the hospital, we began to experience shortages. These included shortages of personal protective equipment (PPE), but as health workers we were expected to go to work and tend to patients, even without the necessary protection. We also experienced shortages of oxygen to treat our patients. It is so traumatic to have two oxygen tanks and so many people who require oxygen, while knowing that if we don’t give all these people oxygen, we are going to lose at least half of them. I was seeing people walking in with oxygen saturations of 20% and I was thinking to myself: We don’t have enough oxygen tanks here, so what are we going to do? And it happened many times, and even some of the people that we were able to put on oxygen, they ended up dying anyway because we couldn’t get the concentration of oxygen high enough.
This trauma is overwhelming and everywhere: It’s the trauma of not being protected ourselves, mixed with the trauma of how upset we are that the community we are serving is not adequately cared for because of shortages. It’s the trauma that all over, health workers from around the globe are dying from the pandemic, while others are taking their own lives because of how stressful things have become.
This has weighed seriously on my anxiety – I have been struggling with anxiety for a few years within the medical profession, but COVID-19 has made things a lot worse. In fact, I ended up catching COVID-19 myself. I was tired, I had a cough, headaches, and my chest hurt – the effort of breathing was odd. It was really tough. I went to the hospital once for oxygen, and it helped, but I waited a very long time to get it. In the end, I was able to rent a tank of oxygen to have at home, and friends and family helped me with food while I quarantined.
I remember trying to go back to work after that, but my anxiety was overwhelming. I was working with makeshift protective gear, and I realized I could not continue to do this. Being exposed while lacking adequate protection was how I contracted MDR-TB in the past, and I knew I had to use my voice to change things. After completing my community service, I left the front line because I saw that I would not make it out alive if I didn’t take care of myself. But it was tough to tear myself away from something that I loved doing. However, I knew that as an advocate I could use my voice and contacts to bring about change. As much as it has been a difficult road in medicine, my calling is to support health workers themselves.
We cannot expect health workers to sacrifice their lives when we can’t even protect them. Health workers get applause, and they get congratulated as heroes. But it is structural support that they need. I don’t know how the world expects to beat COVID-19 if we do not invest in infrastructure or invest in our healers. And it’s important that we do these things for other pandemics too, because these structural changes will not only improve things for COVID-19, but will also improve things for TB and HIV.
I advocate for the front-line workers, and I help to provide services like oxygen tanks. I know people ask themselves: How is oxygen for patients going to benefit the health worker? But as health workers, we care about our patients. It’s not just a job! We are happy and relieved when someone survives when we didn’t think they would.
I have started my own organization: Uxhaso Home of Hotep. ‘Uxhaso’ means ‘support’ in the Xhosa language, and what I am doing is providing a space for health workers to ask for what they need – whether PPE, oxygen, or other kinds of support – as well as a place to tell their stories, so people can understand what we are going through. I am trying to get as many connections as I can to help provide oxygen tanks to the health workers who reach out to me. I have teamed up with private organizations to donate oxygen to hospitals. I have been very loud over the past years, and because of the contacts I have gained, I can use my voice to advocate effectively for others.
Our healers are the ones that are going to help us through the crisis right now, but who affords them healing?
Health workers put themselves at risk to protect our communities and have a right to be protected. During the COVID-19 response in 2020, 14% of cases reported to WHO were among health workers – rising to 35% in some countries. A survey of healthcare facilities in Africa revealed that 60%-80% lacked sufficient PPE to protect their health workers.  The Global Fund co-leads the Access to COVID-19 Tools (ACT-) Accelerator’s Health Systems & Response Connector, and to date has awarded US$791 million for personal protective equipment (PPE) since the beginning of the pandemic to protect health workers in low- and middle-income countries. The Global Fund is the largest multilateral investor in grants for health systems, investing US$1 billion a year to build resilient and sustainable systems for health.