Constructing an “infrastructure of care” – understanding the institutional remnants and socio-technical practices that constitute South Africa’s Covid-19 response

《Constructing an “infrastructure of care” – understanding the institutional remnants and socio-technical practices that constitute South Africa’s Covid-19 response》

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作者

来源: URBAN GEOGRAPHY,Vol.42,Issue3,P.391-398

语言: 英文

关键字: COVID-19,pandemic,smart,South Africa

作者单位: School of Architecture, Planning and Geomatics, University of Cape Town, Rondebosch, South Africa

摘要: The WHO recently praised the South African state’s urgent response to the Covid-19 crisis. It has promoted ascience-led response coupled with financial mechanisms to offset economic hardship. The decisive approach taken by the state, however, contradicts the heterogeneity of livelihoods that define the functioning of its socio-economic fringes. This paper focuses on acommunity-led initiative, connecting neighborhoods through relations of care. Focusing on this third mode of existence gives insight into the limited reach and efficacy of the data strategies, policies and legislative adaptations that make up the first mode: the state-led response to the pandemic. It also reveals the interrelationships between all three modes, that could potentially contribute to an “infrastructure of care”, illustrating the diversity yet contextual embeddedness of the elements of progressive socio-technical change.KEYWORDS: COVID-19pandemicsmartSouth AfricaCoronavirus in South AfricaAfter the first case of Covid-19 was reported1, in early March 2020, the South African government moved swiftly in addressing related public health concerns. A 21-day lockdown was announced from 26 March, with a two-week extension thereafter. A mass community screening campaign was implemented at the end of the first lockdown period, targeted at preparing the country’s public health service for an increase in infections amongst low-income households. The greatest concern was spread in informal settlements that have limited basic services. In examining the country’s response, a number of tensions arise, mostly associated with the spatial inheritance of Apartheid. The idea of legacy would, therefore, be my starting point in understanding the “pandemic South African smart city” and how it represents ongoing provincialization. Rather than interpreting the virus response as new, to a rupture of sorts, I would argue that some forms of continuity are present. They relate to what exists geographically and materially, and the social and institutional structures that form the backdrop to its socio-economic landscape.Existing state-led and bottom-up responses are layered, or build upon, a legacy of material and social networking that have emerged from Apartheid-era mobilization. This contributes to, an “infrastructure of care,” referring to the data, technology and human agency that contribute to the care landscape emerging from the virus response. Whereas the term “landscapes or care” refers to the “sociostructural processes and structures that shape experiences and practices of care” (Milligan & Wiles, 2010, p. 739), this paper foregrounds the socio-technical evolution of care in current circumstances. There is a layering of technology and solutions, but also a temporal dimension that speaks to continuity woven between ruptures. The government has embarked on community screening and door-to-door testing using a social vulnerability index; with much of this relying on a deployment of community health-care workers to enable localized screening and testing. Many of these systems exist due to the AIDS/HIV and tuberculosis challenges that could be interpreted as a deinstitutionalized response to crisis that recognizes the limitations of state capacity. Like Gleeson and Kearns (2001), I would argue that seeing this as a community/state binary, or indeed entirely separate modes of existence, is not terribly useful. Institutionalized or state-led care together with caring communities potentially contributes to an interdependency best operationalized through shared values (Gleeson & Kearns, 2001). Jon (2020) argues that the coronavirus has necessitated recognition of the interdependency between human actors and institutions as a “geography of care” that includes consideration of the natural environment. In this paper, I extend this to the role that technology plays as enabling such an integrated lens across scales.The approach taken in this paper foregrounds heterogeneity in infrastructure deployment in that it recognizes that technology-informed responses to Covid-19 are informed by local regulatory regimes and patterns of appropriation. More pertinently, as a theoretical approach, it acknowledges that technoscientific responses are situated and contingent upon local knowledge systems and ways of knowing and doing. What emerges from the South Africa case, is a tension between top-down public health measures that mimic “international responses,” informed by state-appointed experts, and the differentiated, localized responses on the ground.I examine the tension that emerges from the adoption (circulation) of international mechanisms such as lockdown and blanket enforcement in relation to the specifics of the South African context. To paraphrase Anderson rather loosely, to use South Africa as an anchoring point allows for analysis that acknowledged itself as a reference point (Anderson, 2017, p. 229). Thus, examining South Africa in accordance with its own logics, not as a data point for western-led intervention. Credible knowledge making in the South acknowledges hybridity, localism and indeterminacy in acknowledging complexities and contradictions within regions. It recognizes contingency and re-inscribed, iterative, sometimes experimental, technological innovation in response to state overreach. This is essentially where the South African “pandemic smart city” emerges: the proliferation of community action networks and associated digitally enabled mobilization to reinforce local resilience. Much of this paper examines the extent to which the uneasy pivot between collaboration and mobilization contributes to an “infrastructure of care” and the tensions that emerge from the postcolony within.Governing the postcolony“This is the largest and most extensive public health mobilisation in the history of our country,”President Cyril Ramaphosa, Public address to the nation on 13 May 2020.When considering the various elements of the South African state’s Covid-19 response, the material and social elements of the pandemic smart city become apparent. Human endeavor, in the form of the connectivity that allows for resource sharing and access, as well as the ability to link up to “outside” knowledge and experience, forms an essential part of the socio-technical definition of infrastructure (Flora & Flora, 1993). These “… configurations of bodies, sense and livelihood.” (Simone, 2015, p. 377) are nevertheless situated and contingent upon place, history and scale. The inherited Apartheid geographies represent one of the central challenges of the Covid response: how to target particularly vulnerable areas susceptible to spread. Less than half of South Africans have access to piped water in their houses, according to the 2018 General Household Survey. The other nearly 50% rely on communal sources, things like community or neighbors taps or rivers (Statistics South Africa, 2019). To mitigate this, the appropriate government departments have ensured access through water delivery in informal settlements, distribution of hand sanitizer at public hubs and random screening at stations and taxi ranks (Karim, 2020). Mass testing and screening in areas identified through a social vulnerability index is therefore central, using a network of 67 mobile testing units with screening centers, together with the deployment of 55 000 community health workers (Besada & Daviaud, 2020). South Africa’s community testing program is ambitious and relies on identifying infected persons, isolating them, tracing their contacts and isolating or quarantining them.Media reports reveal some difficulty in meeting the testing targets initially promised. Result turnaround times are slower than anticipated with the global shortages in testing kits impacting locally (López, 2020; Mendelson & Madhi, 2020). Test results can take up to 4 days (more recent reports indicate 10 days), with the slow pace at which results become available frustrating contact tracing and targeted action (Karim & Malan, 2020). At the time of writing (20 May 2020) 488 609 had been conducted with 13 538 done in the preceding 24-hour cycle; 58% of these tests were done in the public health sector with the rest covered through individualized private health care (Republic of South Africa Department of Health, 2020).Concerns have been expressed in the health media about the limitations to the community screening and testing (CST) campaign in that laboratories are simply not keeping up with producing test results, as well as a shortage of testing kits. The CST is unique in that it has deployed health-care workers nationwide as a testing and data gathering technique (Mogotsi & Bearak, 2020). The technology dimension is largely centered on information dissemination, dashboards and a number of homegrown apps providing location-based information on health services and combating misinformation and a public WhatsApp information service. A tracker system using cell phone data has been an intention of the Department of Health, using Disaster Management regulations to give the department access to cell phone records. A retired judge has been appointed to oversee and enforce right to privacy, whilst information on the database will be “de-identified” and can only be used for research purposes (Broughton, 2020). The aggregate information is intended to provide enough data to extrapolate distribution trends of infected people, using cell phone base stations as anchors. Base station coverage is large, however, casting doubt on the accuracy and utility of the data, especially in rural areas, where base stations are kilometers apart. Other experts have warned that South Africa simply does not have the capacity to interpret this data at a mass scale as required (Business Tech, 2020).South Africa’s coronavirus response displays the inevitable tensions between health system readiness and the scale and speed of infection. Whilst the official response displays a healthy acknowledgment of the need for a hybrid response that combines a legacy of community-based health-care systems with a smattering of smart and enforcement of lockdown regulations, there is nevertheless a disjuncture between the specifics of spatial inequality and expert-led blanket solutions. One of the most tragic externalities is increased food insecurity. The lockdown measures favor large-scale food suppliers and retailers and have not considered how the very poor access food. As Battersby (2020) points out: informal vendors provide food in small, affordable units, with short-terms credit to consumers, whereas spaza shops (an informal version of corner shops) are important actors in the food value chain. Regulations were eased to allow for these to function but with very confusing criteria, including the highly contested provision that only South African-run shops be permitted to operate. This was later retracted but resulted in interim enforcement with dire livelihood consequences. The failure of the state to acknowledge these subtleties, what Simone refers to as the: “in betweenness: where social and material bodies collide in their highly contextualised places, scales and times” is contradictory to its intention to respect the “… domains and modalities configured by inhabitants” (Simone, 2015, p. 375). The material-social configurations that make up the legacy of the country’s socio-technical past consist of more than state-led community efforts at outreach but include the delicate livelihood strategies at the very margins. Combined with overzealous enforcement with reports of police brutality in some of the country’s poorest urban areas, the country’s Covid response is increasingly viewed as militarized. Excessive aggression is part of the legacy of law enforcement in relation to public health in South Africa. Slum clearance programs under the British colonial regime as well as during Apartheid were enacted with brute force motivated by a public health discourse claiming to serve the “public good.” South Africans are understandably suspicious of such claims, with the Covid-19 pandemic surfacing these worries and internalized anxieties.The local specifics of an infrastructure of careFor weeks now, community leaders have watched while the police and the defense force patrol the streets. Stuck at home, as most want to obey the rules, they are turning to social media with their messaging – and it is on point. (Ellis, 2020)Cape Town may well be considered the most obvious manifestation of spatial inequality in South Africa, but it is also the center of Cape Town Together, a collective of community action networks (CANs), established by a group of health professionals, teachers, activists and artists to promote solidarity across class and race lines in the looming face of the pandemic. Groups in Gauteng province and the Eastern Cape, as well as alliances with church organizations and local ecumenical advocacy networks. The aim is to enable community assistance at a neighborhood scale through WhatsApp groups. The Facebook page reflects a diverse array of actions that range from food delivery, care for the elderly, local advocacy and information dissemination. Through Facebook pages and groups, WhatsApp groups and use of Zoom and local TV and radio, a collective multimedia platform for communication and mobilization has emerged, signalizing that: “… during the lockdown and period of uncertainty, we are in this together. (Heywood, 2020).Smart features, mainly in the form of social media, are appropriated in accordance with local needs, but the function of the WhatsApp group is central. How this proliferates into other forms of smart, is dependent on the definition of local priorities. Knowledge dissemination reflects place-based histories and resources, with many using the networking capacity of individuals to overcome constraints to movement. This social network of networks is a juxtaposition to the one-size-fits-all state response (Dexter, 2020). This is essentially the challenge: a differentiated response that recognizes the unevenness across space and communities yet allows for union. Each network formulates its own analysis of what the most pressing issues are and using local resources, formulate self organizing neighborhood initiatives. The CANs (there are 30 groups in the Cape Town metropolitan area alone!) share a core set of values, continuously reaffirmed on the group Facebook site, with each then following its own autonomous frame for problem-solving.Place is absolutely central to CAN. As is explored in other postcolonial readings of technology deployment, heterogeneous networks of socio-cultural connections, economic relationships and material and virtual glue, potentially animate the qualities of geographic location (Moon, 2010). Scheepers et al. talk about coming together in virtual space, with affinity networks or sub-groups that evolve in accordance with neighborhood priorities. “We think that collective action becomes more possible in community. We have tried to take an approach that says: organizing to create community must have the goal of creating belonging. Belonging creates the conditions for collective thinking, action, and change.” (Scheepers et al., 2020).Place is of course a determining feature of the unevenness of opportunities in South African cities. The technology potentially transcends such divides. The 30 CANs in Cape Town span a range of income groups and backgrounds. A partnering model was adopted to enable linking within communities but also across neighborhoods (Auerbach, 2020), reflecting the agility of this modular approach. At the time of writing, there were 12 such pairings. The result has been sharing of information and ideas, two-way learning with food relief being a major emphasis. A radio interview with one such pairing reveals collaboration that included: fact-checking fake news, transfer of mobile phone data and electricity top-up payments to those unable to access such (Cape Talk Podcast: Lunch with Pippa Hudson, 6 April 2020). Mention is made also of partnering with Uber drivers to enable food delivery within lockdown restrictions.This “infrastructure of care” has received recognition from mainstream politicians such as the Gauteng Premier who acknowledged the need for the state to partner with such initiatives. What emerges from a scan of CAN responses on social media is an intention to hold the state accountable given fears of an overwhelming securitization of Covid-19 prevention. This is the legacy of community organizing in South African cities in particular: an uneasy pivot between trust and collaboration. What Ellis calls a “simmering trust deficit” is developed however, as the brutal and uneven lockdown measures touch the ground (Ellis, 2020). The uneasy alliance between state and local interest groups is emblematic of what Simone refers to as the struggles that go beyond the material elements of sociotechnical systems but the capacities that manage and produce knowledge surrounding them (Simone, 2015, p. 376).The hybrid pandemic smart cityWe need a system that runs on steroids of care rather than one operating on opium of destruction,Divine Fuh, Director of the Institute for the Humanities in Africa (HUMA) at the University of Cape Town. (Global Research Programme on Inequality, 2020)The state’s Covid 19 response has been decisive at best but seen by many as insensitive to the peculiar needs of place. The state’s response co-exists with home-based care networks and grassroots communication systems in a hybrid, the complexion and complexity of which is determined by spatial and socio-economic parameters. Whilst there is literature on the performativities of care within the home (see Power & Mee, 2020), where the domestic home is taken as the central location for care work, the broader articulation with social systems is less pronounced. This paper explores the notion of “infrastructure of care” from the outside, in, from outside the home. The evident temporal continuities and resources that inform it, confirm that knowledge spaces are contingent and dynamic, enacted through varying life-worlds and representations (Lin & Law, 2015, p. 119). Understanding the specificity of technoscience in South Africa, in relation to the Covid-19 response, requires uncovering local technoscientific practices, the third mode of existence, as well as the tensions between the local and the universal as expressed through the first mode of existence: state-led and data-driven responses.The aim of this paper was not to create an analytical binary between these modes, however, or indeed scales of intervention. The provincialized (pandemic) South African smart city contains many frames of reference and post-colonies that rub up against each other. Law and Lin (2017) argue for a postcolonial version of the STS term symmetry, a conceptual space of multiple centers, many forms of disjuncture and no one post-coloniality. Anderson (2017) refers to his own work using “Asia as method” as a means to decenter STS. This requires breaking with the tendency to think of South Africa, as one global South entity, as embracing one pandemic smart formation. A critical engagement with the heterogeneity within acknowledges internal contradictory epistemologies and interpretations of socio-technical solutions to this global crisis.Disclosure statementNo potential conflict of interest was reported by the author.Additional informationFundingThis work was supported by the Swiss National Science Foundation under Grant 10001AM_173332.Notes1. At the time of writing, 101 590 cases were reported, with 1991 deaths. (https://mediahack.co.za/datastories/coronavirus/dashboard/)ReferencesAnderson, W. (2017). Postcolonial specters of STS. East Asian Science, Technology and Society: An International Journal, 11(2), 229–233. https://doi.org/10.1215/18752160-3828937 [Taylor & Francis Online], [Web of Science ®], [Google Scholar]Auerbach, J. (2020, April 15). Micro kindnesses are laying the foundations for a transformed South Africa. Daily Maverick. 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