By HENRY OWINO (Senior Correspondent)
Most Africa health facilities seem to have been overwhelmed with Covid-19 patients following its weak health systems and worsen by unexpected virus outbreak. Understaffing of medical personnel to operate effectively around the clock is yet another dilemma to these infirmary facilities.
Bearing in mind that Covid-19 caught everyone unaware, both government and the general public became confused, panicked and were only gasping of what lies ahead. Uncertainty led to misinformation and fake-news in social media platforms which worsen the situation.
Fortunately, political leaders set aside their differences and came together for a purpose. This was to counter the deadly disease by any means possible and save lives. All efforts were driven towards Ministry of Health including the media, providing the public with daily updates of Covid-19 cases.
Hospitalization of people found positive was a priority then quarantining their contact persons even if found Covid-19 negative. Learning institutions were shut down with country governments and head of States imposing dusk to dawn curfews and partial lockdowns including suspension of international flights.
Public hygiene such as hand-washing or sanitizing, observing physical distance, wearing face mask, refraining from hand-shakes among other new normal came in handy.
In Kenya, President Uhuru Kenyatta declared dusk-dawn curfews and partial lockdowns in Nairobi, Mombasa and parts of North Eastern to help tame spread of the virus. County Governments were also directed to improve respective health facilities especially bed capacity. Others include isolation wards for Covid-19 patients, hiring of more medical personnel, all in attempt to manage the situation.
However, according to Mutahi Kagwe, Cabinet Secretary for Health through daily media briefings on the status Covid-19 cases, the infection rates were too high. This was scaring and overwhelming to medical personnel and beyond hospitals bed capacity.
Kagwe had on several occasions cautioned Kenyans to be more vigilant in observing Covid-19 guideline measures. This time round, the caution came alongside surprising pronouncement that only Covid-19 patients under critical health conditions would be admitted in public health facilities.
“I am concerned with the rapid increasing numbers of Covid-19 patients in the country. Our public health facilities are currently occupied to capacity and cannot admit more patients. So, we are only going admit patients with critical conditions and are in need of ICU services,” the CS Health affirmed.
“The other patients with stable conditions would be taken care of at home under home-based care regulations whose guidelines would be issued shortly after this press-briefing,”Kagwe disclosed.
“We are going to issue a circular healthcare guideline for the home-based care for Covid-19 patients. This is owing to challenges we are experiencing in admitting more Covid-19 patients in our health facilities across the country,” Kagwe explained.
“So, Covid-19 patients who are critically sick with severe respiratory or cardiovascular problems that require Intensive Care Unit (ICU) services, would be admitted in our public health facilities,” he stated.
Upon the issuance of the statement by the Ministry of Health, the general public panicked as most houses especially in Nairobi are small, single-roomed, poorly ventilated, large families, unskilled caregivers in health services, name it.
By this time, daily up-dates of the Covid-19 infections statistics by Ministry of Health showed clearly the rates were very high. According to Ministry of Health data, on average, 200 new cases were being reported after every 24 hours during the second wave between October and November.
The 22 page Home-based Care Guidelines for Covid-19 Patients had the following conditions: A positive Covid-19 test, no underlying health conditions and no household members with underlying health conditions. Moreover, a suitable home should have no pregnant women, elderly persons or children under the age of two in the household. It should also have access to an isolation space, preferably with a separate bathroom for the patient.
A visit to Dandora Phase 5 estate by Science Africa Senior Correspondent, a family was struggling with home-based care of their son suffering from undisclosed ailment. The father said illness could have been triggered by Covid-19 pandemic weakening immune system.
“My son has been sick for a while now. I thought it was HIV/AIDS but diagnosis results revealed it was not. Until recently the mass testing of Covid-19 diagnosis found him positive,” Michael Olang’ explained.
“We were advised by health experts to take-care of him at home as Kenyatta National hospital or other health facilities were secluded for specific patients. This information was news to me and I felt cheated, provoked but had nothing to do except to content,” Olang’ lamented.
The family lives in one bed-roomed house, sharing bathrooms with other tenants making it difficult for physical distance or self-quarantine. Other four siblings had to be transferred or distributed to relatives elsewhere to reduce possible infections.
The two parents (mother and father) argued they had no choice but to stay with the sick son even if it meant getting infected. “We are ready for any eventuality. Blood is thicker water and our God is with us.” The family affirmed.
Surprisingly, both parents were not properly equipped with any personal protective equipment (PPEs) apart from face masks and sanitizers. They could only wash their hands and sanitize frequently, and change their masks as often as possible. During this interview, the two parents changed the masks twice for the one hour Science Africa Senior Correspondent had interview with them.
Elsewhere in Kibera’s Laini Saba slums, yet another family had no choice but to nurse their patient at home after being barred from accessing Mbagathi hospital. Despite pleading with medical personnel, Rebecca Nanjama lamented she was turned away with her husband who needed urgent medical attention.
“My plea to the doctors and nurses fell on deaf ears. They refused even to look at his medical diagnosis record book let alone testing for Copvid-19,” Nanjama explained. Since then, I have been using some traditional herbs I know of to steam (treat) him.” She added.
“I am not aware of any home-based care guidelines. Even if there are, it is not applicable here in my house as you can see how congested we live.” Nanjama complained.So, I think those guidelines are applicable to rich people where they live in luxurious apartments.” She argued.
Nanjama’s husband who is 57 years old now, with six children in the same house joined the wife in disputing the Ministry of Health’s home -based care guidelines. He said it is practically impossible and cannot work in informal settlements.
He is pleading with the government to change this policy as many patients are likely to die due to unskilled capabilities of caregivers in home-based care especially with Covid-19.
According Dr Patrick Amoth, Director General for Health, home-based care for Covid-19 patients was meant to ease pressure on hospitals so that patients with more serious symptoms or vulnerabilities could be handled.
Dr Amoth said the numbers of Covid-19 patients in the country were getting higher than the number of bed capacity in the public hospital. For example, when coming up with the home-based care, there were 113 isolation facilities with a capacity of 3,800 patients for the entire country, yet there were 4,952 Covid-19 patients at the same time.
“Besides easing pressure on hospitals, home-based care is also meant to ease the cost of providing care for patients admitted to hospital for Covid-19 treatment,”Dr Amoth explained.
It costs Ksh21, 400 per day to care for a patient with mild symptoms, and Sh21, 300 for asymptomatic patients making home-based care nine times cheaper than hospital-based care.” He added.
Dr Amoth urged the caregivers at home to monitor the patient’s vitals while the community health worker’s role is to monitor and report in case a patient’s situation changes to worse. Community health volunteers are also expected to give advice on diet and household sanitation measures to prevent transmission of Covid-19 from the patient to other household members.
“They are also expected to offer psychosocial support and to help identify probable isolation centres in places like informal settlements where a patient’s home may not work for home-based care,” Dr Amoth urged.
He stated that households and the caregivers offering home-based care at home should be empowered with accurate information and sensitized on what to do if a family member gets exposed to Covid-19.