Abstract:
BACKGROUND : Caledonian Stadium, the main mass temporary shelter for homeless people in the City of Tshwane,
was created as a local response to the imperatives of the novel coronavirus disease (COVID-19) National State of
Disaster lockdown in South Africa. This is a case study of the coordinated emergency healthcare response provided
by the University of Pretoria’s Department of Family Medicine between 24 March and 6 April 2020.
METHODS : This study uses a narrative approach to restory situated, transient, partial and provisional knowledge.
Analysis is based on documented data and iteratively triangulated interviews on the operational experiences of
selected healthcare first responders directly involved in the shelter.
RESULTS : The impending lockdown generated intense interactions by UP-DFM to prepare for the provision of
COVID-19 and essential generalist primary with partners involved in the Community Oriented Substance Use
Programme (COSUP). With approximately 2000 people at the shelter at its peak, the numbers exceeded
expectations. Throughout, while government officials tried to secure bedding, food and toilets, the shelter was
poorly equipped and without onsite management. The COSUP clinical team prioritised opioid substitution therapy
using methadone and COVID-19 screening over generalist healthcare to manage withdrawal and contain tension
and anxiety. COSUP and its partners helped the city plan and implement the safe re-sheltering of all Caledonian
residents.
CONCLUSION : The Caledonian shelter is an account of organisational resilience in the face of homelessness and
substance use emergencies triggered by lockdown. Through community-oriented, bottom-up self-organisation, a
clinically led team navigated a response to the immediate needs of people who are homeless and/or use drugs
that evolved into a more sustainable intervention. Key lessons learnt were the importance of communicating with
people directly affected by emergencies, the value of using methadone to reduce harms during emergencies and
the imperative of including OST in essential primary healthcare.
