By Sharon Atieno
Prior to the COVID-19 pandemic, Sudan’s health system was weak and vulnerable due to decades of underfunding as a result of the economic crisis, the ever-increasing inflation rates coupled with political unrest. Thus when COVID-19 hit, the health system was more than overwhelmed.
The Sudan Federal Ministry of Health identified the first case of COVID-19 in Sudan on 12 March 2020 and as of 20 December, 23,316 people contracted the virus, including 1,468 who died from the disease.
To reduce COVID-19’s toll on communities and support the overwhelmed hospitals and clinics, Sudanese American doctors in partnership with other expatriates launched a campaign to equip medical students in Sudan with skills and knowledge they needed to provide care to their communities.
Through a telementoring initiative dubbed Project ECHO – a platform which uses videoconferencing technology for learning purposes- medical students, graduates, and medical trainees were connected with highly experienced providers from around the world to hear about best practices for treating patients with COVID-19 in their homes and in rural and underserved communities across the country.
“ We found that there was a group at Columbia University here in the United States and University of Texas San Antonio, who did a very similar model where they trained medical students on telehealth for people who are staying home with COVID-19,” narrates Dr. Nada Fadul, a Sudanese-American infectious disease physician at the University of Nebraska and one of the founders of the campaign.
The university models had students and an escalation team such that when the students came across a challenging case, it could be channelled through the doctor consultants.
How it started
“ We put together a protocol using the model from Columbia, the World Health Organization(WHO) protocol for home management, the Sudan Ministry of Health Protocol and we presented it to the Ministry of health. They modified the protocol and approved its use,” she said.
From there, they reached out to student organizations in Sudan and the campaign started with about 20 students.
According to Dr. Fadul, it started as a focus group, where they ran the modified protocol by the students and then got feedback from them. Also they discussed the visibility of the campaign and community needs.
After this, the students went and did a community assessment visiting local primary health centres and religious places among others to gauge if the intervention will be accepted.
It is in the process of the assessment that, she says the need for health education and promotion was realized.
“ In some areas, we realized that we needed to do more than educating people on home management and needed to start by educating them on COVID-19,” Dr. Fadul says, noting that some communities were still in denial of COVID-19’s existence.
Through project ECHO, the expatriates were able to customize the training sessions tco the needs of the community depending on the feedback by the medical students who were on the ground. “ They bring the cases and we bring the subject matter experts then we discuss it, everysone learns from each other and everyone teaches each other,” she notes.
So far, they have trained more than 400 medical and healthcare students across Sudan.
The initial trainings focused on the principles of home management for mild to moderate cases; home isolation and quarantine methods; and identifying life-threatening symptoms that require immediate medical attention.
According to Abrar Alaliem, a medical graduate and research coordinator for the community medical response team, the students were working within their own neighbourhoods where they would create awareness on COVID-19 and home management.
This, she says, made their work easier as there were no extra costs incurred such as transport.
Saida Alkhateeb, a student and media coordinator of the team notes that it takes a collaborative effort between the students, community leaders such as sheikhs and other trusted organised groups for the information to reach the communities.
The group also did sensitizations against vaccine hesitancy to dispel myths and misconceptions about the COVID-19 vaccines.
Alkhateeb notes that after the training on vaccine hesitancy, they were tasked to tailor the information and make it culturally sensitive and simple so that the communities could understand and get vaccinated.
However, despite being able to increase vaccine acceptance in communities, they realized that transport made it difficult for some of the community members to reach the designated vaccination facilities.
The group then adapted a model of community vaccine clinics similar to those ECHO mentors in Omaha, Nebraska, had used to vaccinate people in under-resourced black communities and the volunteers partnered with community organizations and a local soccer club to hold a vaccine clinic at its facility. As a result, 2,000 people were vaccinated in one day.
Basing on this success, some of the students also learnt how to administer the vaccines and working together with other health response teams were able to reach the country’s most disadvantaged communities through holding such clinics. To date, they have vaccinated at least 20,000 people, including nomadic tribes.
However, the co-founder of the initiative notes that access to internet has been a challenge as in some remote areas there is poor connection and internet costs are expensive yet students are not working but rely on their parents for support.
She notes that with Sudan being under military coup and marred with almost daily protests and major economic collapse, it is very difficult to keep things going in such an environment.
Also, keeping students motivated despite electricity and internet shutdowns is not easy.
Besides, funding is also a concern. Dr. Fadul says the Sudan Coalition organization was able to support the initiative through fundraising but now they are looking for ways of sustaining the program through grants and other sources of funding.
Alaliem notes that being that they are working with students, it is sometimes difficult for all of them to be available at the same time due to their school time tables.
With COVID-19 waning off, Dr. Fadul says the program has escalated to primary care to address communicable and non-communicable diseases in the community. The training which began in May covers high blood pressure, diabetes prevention, cancer as well as spreading awareness on malaria prevention and schistosomiasis which are prevalent in Sudan.