Covid-19 has put pressure on everyone in SA, but particularly the health minister of a country in the grip of a pandemic. For Zweli Mkhize, every day is a series of battles. This is what Thursday was like for him
I tuck my feet back into the consolation of my blankets — they’ve turned stiff in the chill that has cocooned my bedroom.
A glance towards a slightly frosted window reveals the orange ember of a nearby streetlight. It’s still dark out and for a second there is the temptation to turn over and steal a few more winks of sleep.
But there is already restlessness.
Twice a week, I trolley home a foothill of folders stamped with the national department of health logo and containing policy submissions, reports from various divisions in the department, notes from committees that require my advice, outstanding authorisations, and minutes from the meetings of multilateral forums.
Tucked underneath are troves of lists from medicine pricing committees; reports outlining issues faced by medical councils; submissions by ministerial advisory committees (MACs) focused on maternal and child health, microbicide resistance, cancer treatment and mental health; and documents outlining statutory issues.
Last night was one such night: the first document was opened at 9pm; the last was closed at ten minutes to three. That was two-and-a-half hours ago.
Did I single out priority issues? Have all my concerns and recommendations been forwarded to the relevant people? Perhaps I missed something?
It can’t be. Perhaps it’s symptoms of obsessive-compulsivity or a cursed fixation on completeness that drive away my slumber when work is unfinished. A quick scroll through e-mail folders ticks all the boxes: everybody concerned will wake to find work on their tables.
My eye moves to the corner of my screen where that little green WhatsApp icon is obscured by the number 1,035. I really should get to those unread messages.
No point in dilly-dallying any longer. My feet touch the floor and the day begins.
A LOT TO DO
Covid-19 has been a herald of change, influencing the way we act socially as human beings, how we conduct our work, earn our livelihoods and acquire knowledge. The virus has ripped through the old normal and forced its way into the lives of citizens across the globe.
South Africans have braved lockdown restrictions for almost 100 days. Where once, under level 5, our streets were deserted and our shop doors shut, life is beginning to return to street corners. Vendors perch in their stalls and the whistles of taxi conductors ring through the air.
A slow phasing-in of normalcy to protect a fragile economy, however, does not mean the threat of Covid-19 has disappeared. Lessons from the hard lockdown must remain.
Today’s diary is a stark reminder — all my meetings will be conducted digitally.
First on the agenda are four interviews with television and radio media. But there is a lot to do beforehand.
Though one is in the comfort of one’s home, the correct mindset is essential for productivity. Conducting work in the throes of pyjamas and tossed bedsheets is not an option. It’s 6am and I have an hour before my first interview.
First, a 30-minute exercise routine comprising weighted pulldowns to strengthen the latissimus dorsi (lats), shoulders and upper back.
AN ORCHESTRATED INTERROGATION
Then, arguably the most important call of the day, to my dear wife, May. She, too, is an early riser back at our family home in KwaZulu-Natal. We steal minutes to check up on one another, inquisitively probing our diaries to find an opening where we may speak again. It’s her constant pampering and cooking I miss most when we are apart.
She knows my diet best: no foods fried in oil, no fats, no margarine. Half a plate of protein and the remainder divided between starch and vegetables.
My call with May is intersected by another from my daughter Nokulinda — she is struggling to respond to an orchestrated interrogation from her four children, Kimzozo, Nini, Yeye and Gagu. They want to know why I missed my regular FaceTime session with them last night.
How do I tell them that my heart sank when I saw their call but could not pick up? At the time, I was in the middle of a meeting with Eastern Cape health MEC Sindiswa Gomba, discussing the province’s progress in ramping up Covid-19 contact tracing efforts.
A humble apology is warranted, along with a promise to make it up to them.
STOCKS OF DEXAMETHASONE
It’s 7am and the first media house calls in. A quick stretch and it’s time for the second. Then the third and the fourth, with enough time between the two for a hurried breakfast plate of boiled eggs and seeded bread accompanied by a cup of rooibos tea.
The focus of the media is ever-fluctuating — and necessarily so. When our first case of Covid-19 emerged, we were flooded with questions about the nature of the virus, its anticipated epidemiological trajectory, and our preventative plan. Now, we are in the midst of the Covid-19 outbreak and the debate is robust.
Questions this morning mainly focused on recent preliminary findings that a glucocorticoid called dexamethasone — normally used to treat inflammation, skin disease, allergies and asthma (to name a few) — has been shown to be effective in treating critically ill Covid-19 patients.
It must be noted that this finding does not entail the discovery of a new drug, but the discovery that a known drug has an impact on Covid-19. We have used dexamethasone in medical circles for decades.
It brings back memories of my time as a young doctor in Edendale, KwaZulu-Natal, where we would use the steroid to treat cases of severe asthma; cases where we prevented hyaline membrane diseases in premature babies whose lungs had not matured enough to sustain necessarily levels of breathing; and in trauma cases of car crash victims who had sustained head injuries resulting in brain oedemata and increased intracranial pressure.
With dexamethasone still fresh on my mind, I shoot off a call to representatives of a pharmaceutical company that manufactures the steroid locally, to follow up on my initial inquiries about how much stock we have in the country and what processes can be followed to reinforce those numbers should the need arise.
Time for a bit of necessary multi-tasking. With one hand tapping vigorously on my phone screen, replying to questions by comrades in cabinet, the other is sifting through multiple tabs on my computer’s browser in an attempt to catch up on the news of the day while waiting for a scheduled Zoom meeting with Western Cape health MEC Nomafrench Mbombo and her team.
I receive three reports from the Western Cape government daily: a status report, a record of deaths, and another answering any queries I forwarded earlier.
Today’s meeting is set down to review the work done by the provincial government and the team of reinforcements sent to assist in their fight against the virus.
The strategy is on track, but challenges have emerged in the uptake of quarantine and isolation facilities in some communities. I have since contacted South African Anglican Archbishop Thabo Makgoba to assist in mobilising church leaders to support the provincial government in rooting out issues of Covid-19 stigma.
Behavioural and social scientists have also been brought on board to help the government better understand why communities are neglecting quarantine and isolation facilities, and from this research steps will be put in place to mitigate any issues that arise.
Another matter of importance in the Western Cape is the refining of targeted testing. The province has also gone to lengths to effectively track cases of comorbidities, like diabetes, and is actively delivering chronic medication to those patients.
LUMP IN MY THROAT
The phenomenon in the Western Cape is not uncommon in societies around the world, but it is something I worry about most.
Every day, I come across people who know of others who have contracted Covid-19 and are either asymptomatic or have mild illnesses. This has created a perception that the disease is innocuous, and therefore there are some who adopt a laid-back approach towards it.
Dozens are dying daily and others savour each breath on a ventilator — and yet this is not evidence enough to make people wary of Covid-19. I wonder, then, how we get South Africans to comprehend the difficulty of the situation, the extent to which the infection can cause severe illness or death, and the behavioural changes needed to resume economic activity without worsening the spread of the virus?
I turn away from my desk as the meeting ends — there is a lump in my throat as I think about this further.
My fear is that by the time these pockets of society come to realise the severity of the virus, it will be far too late. Neglecting the warnings undermines all our efforts to contain the spread and prevent our health-care facilities from becoming overwhelmed.
I fear then for our health-care workers on the frontline who have valiantly put the lives of others before their own — what is to become of them should our infrastructure become overburdened?
Alas, as Florence Nightingale once said, “very little can be done under the spirit of fear”. We have done, and are doing, everything in our power to prevent such an outcome, I reassure myself.
The MAC and the National Health Council have agreed to prioritise the testing of hospitalised patients and those under investigation to reduce the turnaround time in attempts to avoid hospitals being clogged with patients waiting for test results.
Midday is fast approaching and as the sun begins to peep through the curtains, my e-mail inbox starts to fill with reports from health MECs in all provinces. This is a daily occurrence — constant communication is maintained with colleagues at all levels to have a better understanding of what is happening on the ground.
These MECs have shown the utmost dedication to the fight against Covid-19, listening to my rants during midnight meetings and dropping everything when an issue needs their attention.
I admittedly hound my colleagues from the Western Cape, KwaZulu-Natal, Eastern Cape and Gauteng — where the rise in Covid-19 infections is most worrying — far more often, calling them each three to five times a day for updates.
I must go through all nine reports before my next meeting at noon, picking out issues that are most urgent and making recommendations on the way forward.
While paging through graphs and tables, there is a welcome distraction. My granddaughter Lindiwe appears to have swiped her mother’s phone — her sweet voice beaming through the speaker.
Speaking to any one of my eight grandchildren is really my greatest joy. We exchange voice notes throughout the day and I often sing them to sleep over a video call when I have the opportunity.
“Are you okay Mkhulu? When are you coming to visit?” she asks.
It’s difficult to answer. She turns seven in a month and I’d like nothing more than to be present on her birthday, but it probably won’t be possible.
“Soon, my child, soon.”
HOT SPOTS AND HOT SEATS
After several long goodbyes, it’s time for the World Health Organisation’s Information Session, where my counterparts from various countries provide an update on their efforts to contain the spread of the virus.
Wherever you may go, the principles of managing the infection are the same.
Presentations from Cambodia, Colombia, Bulgaria and Zambia show fruitful results in their respective regions — and serve as a stark reminder of the mistakes we have admittedly made. Yes, we did lose an opportunity for the early detection of contacts in Western Cape. But where we have failed, we have moved to implement new measures, like the hot-spot strategy that identifies sub-districts for more intensive interventions.
It is now a matter of trying to deal with new clusters of infection that may arise in other parts of the country as restrictions on activity are eased.
While the representative from Zambia is on the mic, I receive the daily report from the National Institute of Communicable Diseases. Out go a few calls to MECs and heads of department to clarify issues raised in the report, just before I log back on for a parliamentary plenary session with President Cyril Ramaphosa, who handles the hot seat superbly.
Our president has led from the front, meticulously aligning cabinet towards common goals in our country’s Covid-19 battle — his decisions fittingly lauded by members of the international community.
‘NO SLIDES, NO SLEEP’
The parliamentary session runs well into the early evening — but my time is no longer measured by the hands on a clock. Each day now folds into the next, a constant and linear timeline broken briefly by three-hour (if luck should have it) naps in the early hours of the morning.
It’s when the sun sets that, to my own preference, the bulk of the work gets done.
I receive the evening report from the department’s Covid-19 management teams and a briefing document from my media liaison officer highlighting any issues that need to be addressed in the public domain. Then begins the process of collating all the information I received throughout the day into slide presentations (something I take great pride in putting together on my own) for the National Coronavirus Command Council.
My deputy directors-general know far too well my “no slides, no sleep” policy when it comes to matters for the NCCC.
Those who work with me have come to expect late-night text messages, e-mails or urgent meeting requests (although I have made a concerted effort recently not to wake people up unless it’s absolutely urgent).
Our team members often log on to late-night Zoom meetings, their eyes heavy and their coffee mugs at hand; some switch off their cameras and mute their microphones, so I surprise them every 15 minutes to make sure they are awake (they always are).
Midnight draws nearer with a call to officials in the North West to get an update on issues affecting that province specifically.
When that’s done, another call with the department’s new director-general, Dr Sandile Buthelezi, to go through any outstanding matters for the day before preparing notes for an upcoming meeting with the National Health Council.
I remember I must also prepare a speech I’m scheduled to deliver at a University of Western Cape webinar tomorrow (or is it today? Later?). Best get on that.
It’s 2am when I crawl back under the covers. I wonder whether there’s a possibility my diary may pardon me for the weekend so I can return to KwaZulu-Natal to see my wife.
I do revel in the anticipation of strolling through the farm and tending to the cattle with May at my side. I hope my grandkids Neme, Zuza and Singela will be able to tag along — they enjoy having picnics on the farm under one of the trees.
But still, I am restless.
Have I done enough today? Is there something I missed?
I sit for a moment and ponder our future as a country as we strategically embark on the balancing act of reigniting the economy while keeping people safe from Covid-19.
WHEN MORNING APPEARS
The lockdown has bought us valuable time to prepare for the onslaught we face in the coming months: we have flattened the curve at an early stage, aggressive testing and screening campaigns were conducted, the capacity of hospitals has been increased, millions of units of personal protective equipment and thousands of additional ventilators have been sourced, and field hospitals, quarantine and isolation facilities have been erected.
A larger responsibility now falls onto the shoulders of each and every South African, as we slowly reintegrate, to take the precautions necessary to protect ourselves from the virus. Back to the basics we go: frequent hand hygiene, cloth masks and social distancing.
My mind casts to Nurse’s Song by William Blake: Then come home my children, the sun is gone down,/ And the dews of the night arise;/ Come, come leave off play and let us away/ Till the morning appears in the skies.
Like in the poem, we have stayed safe inside and sacrificed our liberties, avoiding the threat that lingers. When will the morning of a Covid-19-free South Africa appear in our skies? I take consolation from my own words to Lindiwe earlier today:
“Soon, my child, soon”.
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