The shifting shape of the COVID-19 frontline

In the past four-and-a-half months ‘the frontline’ in treating COVID-19 has shifted from a purely medical interface to include less-defined community spaces as NGOs and civic and activist organisations confront the pandemic’s social and economic fallout, said the University of Cape Town’s (UCT) Dr Leanne Brady.

Brady, a doctor in the Western Cape’s Emergency Medical Services (EMS) and a PhD candidate in the Health Policy and Systems Division at UCT, was in conversation with Dr Shaheem de Vries. De Vries is head of the EMS in the province. He is completing an executive MBA at UCT’s Graduate School of Business.

Their webinar discussion, “Experiences from the frontline: community healthcare during COVID-19”, was the sixth in the UCT Summer School’s “Unlocking COVID-19: Current realities, future opportunities?” series. The series features conversations with leading authorities, UCT academics and alumni.

Brady is also part of the Salt River Community Action Network (CAN) and the Cape Town Together CAN. These networks were established by public health professionals, community organisers and social activists as a rapid community-led response to COVID-19.

“This is not just a health crisis. It’s a social and economic crisis as well.”

“This is not just a health crisis,” said Brady. “It’s a social and economic crisis as well. And I would argue [that] it’s also a crisis of care.

“As a doctor it’s really important to talk about the ‘actual’ frontline: the 14 hospitals for the 15% of people who need hospital care. But the 85% of people who don’t need hospital care still need care.”

Civil society stepped into the breach between those whose duty is constitutionally mandated, the “entitative frontline”, and those who work ‘behind the lines’ in communities dealing with the COVID-19 fallout.

She added, “A huge number of people in many parts of the city have come together to find creative solutions in their own neighbourhoods for the risks COVID-19 poses. These kinds of networks are made up of many self-organising groups who are very much at the frontline in a range of ways.”

“One thing that COVID-19 has done is remove the illusion of control. Now you step out of your house to buy groceries [and you’re at risk]. Suddenly we realised that the ‘frontline’ is not something out there, distant. It’s here,” De Vries said.

As such, he added, CANs have supplemented the efforts of those working in the formal public service sector who carry a constitutional mandate to serve.

“And at 20:00 they clap hands for the entitative nature of the frontline. But between 20:00 and the next night at 20:00 we are all embroiled within the constitutional nature of the frontline; in issues of education, in the delivery of care.”

Without any formal leadership or formal access to state resources, community groups and networks mobilised quickly, sometimes hustling to provide what was needed, where it was needed, he said. This community impetus could “spread as fast as the virus”.

“We need action and organisation that are able to multiply at the same exponential rate as the virus has. And this is where the civil sector and the NPOs come in.”

No ‘copy-paste’

But there is no “copy-paste” modus operandi, Brady said.

“Every neighbourhood is experiencing things differently. COVID[-19] doesn’t affect all of us equally, so the challenges look different in different parts of the city. But that network has allowed the broader community to draw on a collective wisdom and a collective energy.”

She added, “It’s not perfect … There’s no plan … I guess the plan is one that hasn’t been designed in a top-down way. It’s a plan that emerges. And what emerges is what’s needed … And we build structures around that and then move with those until they’re no longer needed. We don’t cling to them for the sake of keeping them – we move towards where the next energy is. It’s a different way of engaging.”

Brady said that while CANs were a vital part of the overall societal response, they were never intended to replace the state.

“That would just be insane. They were always seen as something that would complement the state in one way or another.”

“Colleagues talk about how this feels like the Struggle, with a street-by-street level of organisation.”

Nonetheless, the momentum gathered was catalytic.

“Colleagues talk about how this feels like the Struggle, with a street-by-street level of organisation. It has that energy behind it: thousands and thousands of people mobilising around a shared concern and about shared ideas.”

“Going back to normal” would be the worst thing for a society where COVID-19 had magnified vast inequalities and extreme injustice. It was too profound a learning moment in the face of an uncertain future.

“There was nothing normal about our society before the pandemic. Now communities and networks have shown the value of collaboration, the power of collective action, moving at the speed of trust, and flattening hierarchies.”

Relational capital

From the EMS side, De Vries said he’d been struck by the roles of “big G”, or government, which administers billions and billions in taxes and “little G”, the community networks, and the value of the social and relational capital that exists within communities.

“Little G is that guy that’s travelling from house to house in his neighbourhood, picking up injured patients or stemming bleeding [from a gunshot wound].

“If we build our government around that little G and the agency that exists within that community and its networks, we’d have a far more agile and effective government sector.”

“If anything, COVID-19 is disclosing to us how very many different South Africas there are.”

The pandemic has been teaching society how to build back.

“I think we imagined that the only way to support social change is through grand designs. That’s often not the case. What we’ve seen is a catalytic emergence of people coming together in difficult circumstances, trying to organise across race, class and finding a way forward with mutual generosity, mutual commitment and mutual concern.”

The challenge now is for society to harness the moment and to share these lessons with the formal state sector.

The answer, he suggested, was in designing future systems and processes that privilege the relational nature of our beings.

“If anything, COVID-19 is disclosing to us how very many different South Africas there are – all the way from community level through to provincial and national levels.”