Masks for everyone: How we can make it work

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MONDAY May 4, was the first real business day after we moved to lockdown stage 2. My husband and I were driving to our daughter’s school when we noticed an unusually high volume of traffic. It seemed as if everyone was going to work. There was also a high number of pedestrians going about their business.

Almost everyone was wearing a face mask. Impressive compliance with the need to protect ourselves from COVID-19 infection. One woman caught my attention. She was wearing an originally white disposable mask which clearly had been worn so many times, it was visibly dirty from a distance. I remarked to my husband that I was not sure many people knew how to correctly use a face mask and he said, “are you sure that’s the only problem, how many people can afford a face mask?” I did not have an immediate answer but this conversation made me think about the challenges most people will have around laying their hands on a mask.

Poverty

One thing that is not negotiable is that we all need to wear masks when we step out of our homes.

What is prohibitive is the cost of the masks. In preparation for this article I did a quick survey of the cost of disposable face masks and found that on average a disposable single use mask costs at least US$4. From what I have observed, most people seem to prefer either surgical or some kind of disposable masks. There are those who have started making and selling reusable masks and these cost an average of US$2 which at parallel market rate is $90. I am not sure many ordinary Zimbabweans who are already vulnerable because of the impact of the lockdown on livelihoods can afford these masks. If the mask is to be effective, one needs at least two washable ones. A family of six will need to spend $1 080 on masks. For most families, that is double the breadwinner’s monthly salary. Clearly, disposable masks are out of reach for many and washable ones come at prohibitive prices. The risk posed by the unaffordability of masks is that family members will share a few masks and take turns to use them with the one who is leaving the house having priority. Clearly, this defeats the whole purpose of using masks. Some people might use disposable masks several times which also defeats the whole purpose of a mask.

Vulnerable groups such as children in difficult circumstances, the poor, children living and working on the streets (these were rounded up and put in places of safety but they seem to be back on the streets), might not have easy access to this essential piece of personal protective clothing.

Children living on the streets might pick up the discarded disposable masks and cover their faces in order to comply with the requirement. Already there is a picture circulating on social media that shows two women washing disposed surgical masks obviously for reuse. I shudder to think of the possible outbreaks that can arise from this unhygienic practice, maybe not of COVID-19, but of other infectious diseases.

We must also keep in mind that masks are a new thing for all of us except healthcare workers. I am not sure if many people know how to correctly use a mask in order to get effective protection from it. Improper use of a mask such as reusing a disposable mask, inadequate cleaning and sanitisation of a reusable mask, constant touching of the mask while wearing it, sharing of one mask by users can be as harmful as not having a mask.

What then shall we do?

Clearly, most of us cannot afford disposable masks because of the prohibitive cost. The world is looking for surgical and N95 masks for frontline health workers. We have no business trying to compete with the health workers for these masks. Logically, the most affordable option is the home-made reusable mask.

There is, therefore, urgent need to come up with visuals on how to make an effective reusable mask at home. This would include information on what type of material is best, how many layers are needed, what part of the face should be covered by the mask. Someone must urgently do homework on whether cloth masks provide adequate protection and advise the public accordingly. If they do provide protection, what form should they take.

Those of us who have access to information might take this for granted, but this might not be that obvious among the poorest communities. There is also need for information on the correct and effective use of a mask. This should include the number of times a reusable mask can be worn before it needs to be washed and ironed.

The police officers manning roadblocks can play a very positive role in educating the public.

Instead of just enforcing the public health regulation on masks for everyone, they should be educating and encouraging the public. All forms of media have a role to play in ensuring the general public understands the personal benefit of correctly using a mask to slow down the spread of the virus.

At the moment, all we are hearing from the media is information on the criminalisation of not wearing a mask in public. When the media, with their power of influence, focus on the illegality of appearing in public without a mask and the penalty that such an offence attracts, the public concentrates on perfunctory compliance rather than real effective self-protection.

Compliance as an end in itself breeds deceit and more importantly desperate use of substandard non-effective materials to cover one’s face and nose. This obviously does not produce the desired results.

The Ministry of Health and Child Care has done well in using social media to encourage people to stay home, social media can also be used to educate people about masks. Social protection packages by both government and its partners must include masks to cater for those who just can’t afford.

Last week I was in one of the rural districts of Zimbabwe, I saw first-hand some of the ineffective masks that people are buying and using. As always happens in such situations some people have quickly identified an opportunity to make money out of the desperate public. I saw people wearing very thin single layer pieces of cloth in the name of masks. I would recommend that the Ministry of Health and Child Care take on the role of providing guidelines on how to make a reusable mask and of being the certifying authority for masks. Any mask producer must have a certificate from the ministry allowing them to do so after passing the requisite test.

There is also need to educate the public on using other alternatives to masks. Every woman has at least one scarf or tie cloth (dhuku/iqhiye) in her wardrobe. Let’s teach them how to use these as masks. This might appear like common sense but it is not, the complication is on how the piece of cloth is used for it to serve the requisite purpose. We do need to harness the policy on masks and educate the public so that they understand the objective behind this public health regulation — to teach them how to make their own masks, how to assess a mask on the market before they buy and how to use what they have to protect themselves if they can’t afford a mask.

We will beat this!

 Sibusisiwe Marunda is the Regional Psychosocial Support Initiative Zimbabwe country director. She writes in her personal capacity.