It’s 5.30am on a cold morning in a small Eastern Cape town. It could just as well be any town, in any other part of South Africa, since a line has already started forming outside the locked gates of the public clinic, spilling over to the hair salon across the road.

I’m standing alongside a mother and child. Both are on HIV-medication and have come to collect their monthly prescription. Like most others here, Andisiwe, the mother, has stood in this line innumerable times. She knows its rules and pace. Her experience of queueing dates back to infancy: being held by her mother, waiting to be weighed or immunised. 

Some of those in the line are ‘place-holders’, queuing on others’ behalf. Andisiwe herself has sometimes asked a friend, who lives much closer to the clinic, to reserve her position, paying R15 for her time. The mood of the queue hangs ominously on the precipice of conflict, since protecting one’s own position means policing the behaviour of others. There are those who arrive early, signal their place in line, and then leave to wash themselves before work, hoping to reclaim their space later. Instead, many return only to be met by the anger of the queue, and must begin their wait all over.

Most of those waiting here would queue again later that month to draw wages or government grants, including pensions, child support or disability payments. On ‘payday,’ even the clinics are emptied, as families spill into the town centre and join long lines for the cash machines and grocery stores.

Waiting is an intractable feature of life here. Survival depends on it.

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Queues have been at the centre of South Africa’s Covid-19 story. National lockdown was declared on the 26^th of March 2020, around the time ‘month-end’ salaries and government grants are paid out. Within the first few days, reports came of the long lines outside banks and supermarkets,  with journalists regularly citing people’s failure to ‘social distance.’ Of course there is good reason that people waiting in line have not, traditionally, maintained a 2-metre distance from their counterparts: it creates opportunities for others to intercept.

Covid-19 has reconfigured the architecture of queues, marking 2-metre intervals with floor stickers, overturned trollies, and carefully-spaced chairs. Police officers and security guards have taken on roles as queue-marshals, prompting those in line to maintain distance with outstretched arms.

By the end of April, amid deepening joblessness, news outlets described mile-long lines for food aid. Meanwhile, even the wealthy were becoming accustomed to queueing outside supermarkets, as retailers sought to control the numbers of customers in-store. In June, when restrictions on the sale of alcohol were eased, reporters covered early-morning queues outside the country’s liquor stores: some patrons singing and dancing in anticipatory celebration. And, as commuters attempted to cross provincial borders, long lines of cars and taxis were recorded at roadblocks, waiting for their permits to be checked and passengers screened.

We are living amidst a worldwide, highly-contagious pandemic – the fodder of thrillers and sci-fi dystopias. And yet, one of the most prevalent images of the time has come from something seemingly mundane: the queue. 

It’s easy to forget that even the most everyday behaviours have their history. For all their banality and bureaucracy, queues originate from crisis. One of the earliest accounts of queueing, written in the English language, comes from Thomas Carlyle’s 1837 book, The French Revolution. Describing a shortage of bread, he wrote: ‘If we look now at Paris, one thing is too evident: that the Bakers’ shops have got their Queues, or Tails; their long strings of purchasers, arranged in tail, so that the first come be the first served.’

For millions of South Africans, however, the queuing brought on by Covid-19 lockdown is not new. Queueing is not reflective of a ‘crisis moment,’ but a commonplace necessity. This is especially true for those like Andisiwe and her 12-year-old son, who will be collecting medication routinely for the rest of their lives. Much of South African illness is long-term, if not life-long, requiring routine check-ups, pill collections and blood tests. For the 4.7 million on HIV-treatment, the 4.6 million people with diabetes, and the 322,000 who contract TB annually; receiving healthcare often means spending weeks of the year waiting in line.

Queues come with the pretence of fairness. But in fact, there is little that’s fair about them. Those who can, simply buy their way out of queuing. In South Africa, the Departments of Home Affairs or Transport, for example, have often been described as ‘great levellers,’ forcing citizens of every class-bracket to queue for identity documents, passports or vehicle registrations. But, increasingly, the better-off opt out. With money and internet access, a range of government documents can be ordered online, or collected from a centrally-located bank. At airport boarding gates, despite a set departure time and allocated seating, some will pay for priority boarding, simply for the privilege of not waiting. Here, skipping the queue confers little or no benefits, suffice the public declaration that one’s time is of greater value than those resigned to waiting.

Under lockdown, too, some have been able to avoid queues entirely, ordering necessities to their door. 

The labour of queuing is not evenly distributed. Instead, waiting-time is stratified and socially patterned, such that disparities in queuing tend to map onto those of power. This inequality is reinforced by the queue itself, since waiting has its own consequences – pulling people from work, schools, and homes. Many travel great distances to wait. Or worse yet, pay to travel – to wait.

In the queue, the language of ‘social distancing’ is loaded with meaning –  illuminating the connections between physical distance and social disparity. Queues make visible the social distance between those who wait and (often far-removed) centres of authority. Meanwhile, those serving the queue – including nurses, tellers, and civil servants – are themselves only ‘placeholders’, standing in for the real power-brokers, while also putting further distance between those at the centre and those on the margins. 

It should strike us as deeply troubling that those whose health is most threatened by Covid-19 – the elderly and the chronically ill – are also South Africa’s most routine queuers. Their physical and social vulnerability is only reinforced by the realities of waiting. For many, to wait is to forfeit a day’s pay; to leave children or housework unattended; to endure physical fatigue or hunger. In the time of Covid-19, waiting brings new fears: of contracting the virus, of being found positive and forced into quarantine, or of being wrongly arrested for being ‘out on the street.’ Clearly, some have chosen not to assume these risks.  Over the course of the lockdown, fewer people have tested for TB, checked the level of HI-virus in their body, or refilled their chronic prescriptions. When routine care stops, and conditions like diabetes, hypertension, TB, or HIV are not managed, many more become vulnerable to serious Covid-19 complications. 

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On the day I stood in line with Andisiwe and her son, Covid-19 had not yet been discovered. Andisiwe, now an expert of the clinic system, turned to me to explain how the day would unfold: at 7.30am, the people gathered here would move into the building, along with a cleaner. The nurses would arrive around 8am and say a public prayer.  Then, there would be a routine announcement about staff shortages, as nurses pleaded for patience. Finally, the crowd would be divided into queues to begin their long wait. By the time the clinic closed, many would be sent home, including some of those among us, who had gathered since sunrise.

This would be my first experience of the clinic at opening hour, but I had seen closing time before. Around 4pm, one of the nurses announced it was time to ‘fax’ the patients. ‘Faxing’ was what she termed it when the waiting room was cleared. The language was steeped in bureaucratic imagery: patients reduced to paperwork for dispatch. I watched as the people gathered on the hardwood benches began collecting their things and leaving, muttering complaints under their breath. A young man rushed to a nurse, pleading for his treatment.  

The Sister in Charge scanned the room of displeased patients. ‘What time did you all arrive at the clinic?’ she asked, hoping to prove a point. Some protested they’d been there since the early-morning. ‘You’re lying!’ the Sister accused, ‘you only came here in the afternoon.’ She took a pause. The tension in the room did not ease. Then, she tried again: ‘Our brains are tired. You people think we don’t do anything. It’s almost 4 o’clock and we still have to go home and cook. I’m also a mother and have a family that’s waiting for me. You think I have nothing to do but be at the clinic.’ A few meters down the hall, a pharmacist, locking up her dispensary, added, ‘My brain is so tired, I could give you the wrong medicine.’

Where turning patients away has become the norm, and the prospects of tending to all who queue feels impossible, both nurses and patients come to view one another as callous.

South African clinics have been turning patients away for a long time. To wait does not guarantee that your due diligence will be rewarded. Instead, it is often run-through with uncertainty and arbitrariness.  In response to seemingly unending lines of patients, many clinics have adopted their own practices of triage, assigning degrees of urgency to their cases, and allowing the very sick to be attended to first. In this same Eastern Cape clinic, I’d heard nurses draw on the potential resentments that long-waiting patients might feel in response to triage, as a tactic to encourage HIV testing. ‘If you don’t test,’ they told patients, ‘you could come back here very sick. Then you’ll have to skip the line, and the queue will be angry with you.’

The articulated goal of lockdown has been to avoid a scenario in which the practices of ‘faxing’  or triaging patients reach our Intensive Care Units (ICUs). It has been an attempt to keep the queues ‘in their place,’ rather than displacing them to emergency care.

The question of ‘distance’ has been central to the Covid-19 response. But the distance between waiting for an ICU bed, and the more ‘ordinary’ queues for food, grant money and healthcare, is shorter than it seems.

As nurses were quick to point out: delaying testing shortens the distance between HIV-positive patients and severe illness. Similarly, the distance between the person with diabetes and serious Covid-19 complications, is directly related to their ability to access food and medicine, and the wait this entails.

In large part, our health, and therefore our resilience to Covid-19 illness, is made or broken in the everyday – including in queues. It is about the distance between us and that which keeps us well.

Some of us are in longer lines than others.

Biography

Dr Beth Vale is an independent writer, researcher, and consultant, whose work spans health anthropology, creative non-fiction and body politics. She is currently working on a book that tells the recent history of South Africa’s desert Heartland through stories of health and healing. Website: www.thebodyarchive.net

The featured image for this post is a painting by Amy Sillman, Green Painting (Queue) (2001).

References

Carlyle, T (1837) The French Revolution. Oxford University Press, Oxford.