LGBTQIA+ people have been particularly affected by the COVID-19 pandemic. In a country that very rarely prioritises the needs of our community, circumstances have worsened during the pandemic, especially as the poor and working class face greater risks. LGBTQIA+ people are at the intersection of multiple vulnerable communities, with those who are immunocompromised, living with HIV/AIDS, unemployed, those who are homeless, refugees and others who are forced to live with homophobic family members. Even within non-governmental organisations, funding very rarely prioritises our community.
Regardless of this, queer people are still working tirelessly as essential workers across a range of sectors. They are working in our food stores, within public transport and media, they’re within cleaning, sanitation and security services, at our pharmacies and banks, they’re helping bury our loved ones and take care of far more within the healthcare sector. Queer people have always done care work and yet, they are often the first to be forgotten or pushed aside.
I was able to speak to three queer medical practitioners to hear about their experiences working during this time; just how it is that our community is uniquely affected within a pandemic and how they’re coping with that.
Buhle Radebe*, a nurse at a public hospital in Johannesburg is a queer woman who lives with her mother and brother, notes how fortunate she feels to be in close quarters with a family that is completely accepting of her sexual identity.
“Some people are lucky to have homes that are allow for their full expression. Unfortunately, with schools closed many have had to leave residences and are now stuck in abusive spaces,” she says. Whether we are out or not, being in a lockdown period with a family that is unaccepting or oblivious to the person you are is immensely terrifying for many.
“They can’t be themselves entirely, having to change the way they speak or dress. They’re dying for this time to end so they can remove themselves from that space and environment. They can longer seek safety at school, work or with friends, there’s no easy way to preserve themselves.”
Dr. Anastacia Tomson, a medical doctor, author and activist is a trans woman in Cape Town. She notes that housing is a huge problem that she’s seen patients and queer individuals alike facing. This is definitely not a new conversation, the effects of COVID-19 add a different element to the frustrating experiences of queer people currently; the pandemic has worsened homelessness. Having a safe place to call home and having access to loved ones that understand their identities is not always the case.
“I think as with any socio-economic phenomenon it’s always the marginalised populations who are hit the hardest and not always in ways we even understand,” shared Anastacia. “The reason it’s so difficult right now is because we didn’t really recognise or pay enough attention to how lacking these structures were before the pandemic. So now we find ourselves in a space where we need them and don’t know where to start.”
While NGOs attempt to bridge the gaps between the needs of the community and the actual service government provides, this is a systemic issue. Worse still, even the services that the government does provide often result in incredibly traumatic experiences for queer individuals who are able to access them.
“This is the dilemma as a queer person, the majority of healthcare providers we go to are not necessarily going to be part of the community, they aren’t going to have the context, they aren’t going to have the understanding,” shared Anastacia.
Accessing general healthcare comes with immense trauma and red-tape that’s used to discriminate against the community. Trans-identifying individuals cannot access specialists they need as easily now, those without updated ID documents with affirming gender markers find this even more difficult. Many are dead-named, misgendered and treated condescendingly which becomes a greater problem when such a large part of the population cannot access healthcare because they’re aware of the trauma involved in doing so.
Many queer medical practitioners are having to work as much as possible in order to allow for access to medical services, across sectors. Aware of the unique challenges the community faces, these practitioners are working extra hard to ensure that queer people have access to and feel safe to seek necessary medical care.
Dr. Melusi Dhlamini, Clinical Executive at Marie Stopes South Africa and a medical doctor, is a queer man who is determined to ensure that all who need to access sexual and reproductive health and rights (SRHR) during the pandemic are able to. Reported (and legal) abortions for 2019 sat at 105000; one can only imagine how this number has plummeted during the pandemic, with so many having less access to services during lockdown.
“When lockdown started there was a feeling of SRHR not being essential. Every resource is being redirected for COVID. This is part of flattening the curve and I get that, but then what is deemed as essential? What is the cost once you delay an abortion? We have a limited amount of time, 20 weeks to work with. People don’t get the importance of this conversation,” he shared with me.
This time has forced doctors to be more innovative, which is exactly what Melusi did. He became the first South African doctor to complete an at-home abortion. While there was some pushback from providers who worried about safety, Melusi trained providers and did the first few himself. At the time of this interview, 28 May 2020, they had completed 257 at-home abortions and continue to receive over 20 calls a day from people who look to access this service.
“If you’re less than 9 weeks pregnant you call in and are screened to exclude anything that could put you at risk of having an ectopic pregnancy and whether you have medical conditions that would preclude you from getting an at-home abortion. Once that’s done we send you the medication or you can come collect. You are counselled on how the process will work, someone from Marie Stopes, available 24/7, is directed to you should you need guidance or questions.”
This service has allowed so many to access this service privately. It’s also reached areas that don’t have centres in them; places in the Northern Cape, Limpopo and Mpumalanga, especially.
The LGBTQIA+ community is disproportionately impacted by the various ways this pandemic has put additional strain on how the community is able to access healthcare in an already difficult system. Oftentimes we already have significantly lower health outcomes because of the discrimination we face and without medical aid this is exacerbated. Individuals within the community are encounter hyper-medicalisation as trans or intersex people, or have procedures done on them without their consent. Queer refugees cannot access medical care and face increasing risks when relocating to find safety. Additionally, many procedures that the queer community may need are deemed as non-urgent and postponed or cancelled during the pandemic.
Anastacia, whose work includes providing gender-affirming healthcare to trans patients, speaks on this overall impact. Patients are unwilling to come out to the medical rooms or clinic, and if they do travel it’s challenging due to lockdown restrictions. A lot of patients are struggling with their finances, a lot more don’t have secure housing and this makes life excruciatingly difficult.
“There’s a lot of uncertainty right now and that makes gender-affirming care more difficult to do. Many public sector clinics have had to restrict their operations because of the pandemic. We definitely know that gender-affirming healthcare is essential and scientifically it’s proven to improve life expectancy, quality of life, adverse outcomes, affects depression, anxiety, substance use, etc. You can’t make the argument that this work is not essential. There are many people who would like to use this pandemic as a reason to shut down access to queer healthcare services but I think it’s our responsibility as clinicians and activists not to let them do that.”
This has definitely been the experience of Melusi, who says that many hospitals and clinics have taken this time as a justification to stop prioritising abortions, even though the need has not subsided. He talks through the various situations he’s had to deal with since the beginning of lockdown.
“I was so upset when I called to a hospital in the Eastern Cape and found out they had only done 2 abortions in 2 months. They have 40 people on the waiting list, many who are already past 10 weeks. The head of the department had no plan. Pre-COVID this clinic would have patients lining up at 5am just to make sure they could access this service,” Melusi shared. “At Bara they only see 4 or 5 clients a day and the demand is huge. They have a working list and prioritised clients are around 20 weeks. So if you’re 12/13 weeks you’re going to wait until they have no choice but to squeeze you in. This is the reality of South African healthcare."
This, indeed, is the reality of South African healthcare.
As a nurse, Buhle feels this reality in a completely different way than the doctors above. Nurses, as vital as they are to healthcare are often treated as unimportant. Within the public hospital where she works, nurses have seldomly been given information about procedures or what’s happening in the hospital. Her ward, paediatric medical, was changed into a COVID-19 ward with little to no information and they were simply told they would now be testing patients; this occurred with them barely having access to sufficient Personal Protective Equipment (PPE).
“They were dishonest about the first suspect COVID patient we had. At the time we didn’t have PPE at all, there weren’t even masks because people were stealing things. Alcohol sanitiser was being stolen, on Monday we had 20 boxes but by Friday there were only 6,” Buhle recollected. “I told them they can’t put us at risk like that. Granted, it’s our jobs to take care of patients but at the end of the day our health must come first as well. At the end of the day we go back to our families, most of my colleagues are married with kids. I live with my mother and my brother is back from school. My mother has a heart condition so I said no, I’m not going to put my mother at risk like that.”
This isn’t just in this hospital, as confirmed by Melusi. Healthcare workers all across the country are having to deal with levels of dishonesty that pose a huge risk for them.
“One of my friends working in Pretoria was simply told, ‘You’re not seeing psychiatric clients anymore, you’re doing COVID work. Thanks, bye.’ There was a lot of uproar. They received no training. People who work in psych wards don’t usually touch patients and now they’re being made to test people without training.”
There’s a high level of frustration that then affects the quality of work done as well as the morale within their jobs. These are some of the factors that can easily lead to incorrect results; how good can a specimen be when sent to the lab if there’s knowledge lacking in how to collect it.
“A friend who usually works with rape victims was told that they would be seeing less of these clients and they’d be working in roadblocks to help with testing from now on. They were also not trained, simply thrown in the deep end. You are just told, there’s no discussion, even with people with conditions and diseases that put them at risk for contracting COVID. No screening was done to ensure that they wouldn’t be putting their lives at risk.”
The strain on healthcare workers is not new, but has grown exponentially in the time of COVID-19. There’s fear, anxiety and uncertainty.
“We don’t know when things are going to get really bad, we’re not even there yet, Anastacia shared. “It’s now a lot more difficult to maintain boundaries and leave work at the office. It just hasn’t been possible. Over the past two months more than ever in recent memory my work has been slipping outside of office hours and I have to attend to patients and check on them after hours. It becomes a challenge. At the same time it’s the realisation that a lot of the coping measures that we use in our day-to-day lives have also been denied to us in this lockdown process.”
Anastacia touches on an incredibly important note here, the use of substances, tends to be higher amongst queer populations. The adversity so many of us face in our personal lives, with family or loved ones, co-workers and complete strangers, pushes many to find various coping mechanism. “Whether they’re deemed healthy or not, they become necessary for survival. Now being denied access to that can be a significant challenge.”
The impact of this pandemic on LGBTQIA+ is continuously expanding beyond what we know. Housing, food and financial security are priorities, with mental healthcare opening up more questions about accessibility. We have always created our own communities and support structures and now many are completely cut off from those, unable to interact with friends and acquaintances outside of home to feel understood and supported. The effects on mental health are numerous and we’re only going to be aware of the overall impact as time goes by. Those without access to smart phones and affordable internet are not even able to access virtual mental health services right now.
Buhle notes that more holistic support structures are necessary. Nurses working with COVID patients are not receiving proper PPE or a danger allowance (an additional sum of money given to workers in high-risk environments) and she they can’t afford medical aid to be able to go for therapy. She notes that the issue needs to be addressed systemically, “They may give you that allowance but if you do catch COVID and, god forbid, you die that allowance stops. It’s given to you for the time you’re working within the ward. So yes, give us money but we need support as well. If I die what does my family do after?”
“This is a crisis,” Melusi shares. “Workers are kept in the dark when there are cases of COVID, people are sent to do testing without training, wards and whole hospitals are closing, workers are not showing up to work because of these issues and work morale is incredibly low.”
So what exactly can be done within our own communities?
“Now is the time to build community-based resources where we figure out how to support this community and upskill our people so that we can provide ourselves with these services,” Anastacia said. “In order for someone to be able to get mental health assistance, we need the financial access, we need someone to be available to assist. That person needs some degree of training and fair compensation.”
Mutual aid is not a new solution for our communities. We’ve been denied the opportunities, education, training and development so long that we felt it was best to invest in ourselves.
Anastacia places great importance on this, “I think maybe this should really serve as the pivot for us to recognise that now is our wake up call, that we have to start building and growing and developing those resources that have within our own community so not to fall by the wayside. We also have to look after ourselves.”
These healthcare workers do phenomenal and often underappreciated work for the community and their role in ensuring accessible healthcare is undeniable. Our community is uniquely affected by this pandemic, battling access combined with prejudice; it is natural to wonder how we can create systems of mutual aid and development of shared resources for the community. I leave you with this: what do queer futures look like and what can we do where we are, with what we have to inch closer to futures where we are prioritised?
*Pseudonym used to preserve the interviewee’s anonymity
This article was commissioned by GALA as part of the Queer Lockdown project, with the support of SAIH (Norwegian Students’ and Academics’ International Assistance Fund).