Pandemic Diary #2: Doctor, USA

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Second entry in the series

Could you tell us how COVID19 started in America?

From the news, it started from the city of Wuhan in China and was reported back in December 2019. We did not get the information here in the United States until the end of February. Although our government knew about it, they did nothing. The first case in my hospital was discovered the first week of March; the patient I admitted from the emergency room.

How does it feel to face the risk attached to COVID19 every day?

The risk is there and it is very scary. Right from the moment I admitted the patient who had had symptoms for about ten days. He was a school teacher who taught in two schools. He had pains, difficulty breathing and dry cough. I admitted him the third day when his fever didn’t subside, one of my colleagues decided to test him for COVID19.  Thank God I had my mask and my gloves on when I saw him at the emergency room. 

It was very scary because this was the first patient at my hospital. Due to this, I was told to stay home. That day, everyone kept on calling, my children were frightened.  I eventually didn’t develop symptoms. Regardless, we still have to see the patients and protect ourselves. However, the background anxiety and the reality of the situation is there. 

How does this affect your mental health?

Right. The first week when we had a lot of cases in my hospital, it wasn’t easy. I’m in a group of physicians and we are about ten in my group. Everyone kind of broke down in tears. People were crying all around, the day I actually cried was the day I had about 11 patients. Having to constantly change, this and that, about ten times. My head was hurting, I came down to my office and broke down in tears. My colleagues were all there and at this point, we all agreed this had to stop. Unfortunately, it has not.

To help ourselves, one of my colleagues brought in a 10-minute meditation tool to relax. We all sat in the office, put the lights off and listened; we did that continuously for three days. At this point, we just joke about it in the office because we can’t avoid the situation. So, I honestly don’t think I am affected now. I have a lot of friends who I open up to and who pray for me. I release a lot of tension by talking to my friends. That kind of helps.

What’s the typical day like working with a COVID19 Patient?

Hmm. Firstly, we have designed a protocol at my hospital. Instead of going into the room with the patient, we use a telephone. I call their room, introduce myself and give them their results.  If positive, I ask about their current symptoms. If the patient has had any CT scan done, I explain what their oxygen levels are like. I then give them the opportunity to ask any questions on the forum. After, I inform the patient that I will be coming into their room to examine them and that I would not be asking any questions in the room, as it is highly infectious.  When I go into the room, I do all the necessary examinations and between a minute or two, I’m out. That’s for a typical patient.      

How has your personal life been affected?

Well as a physician, I’m passionate about the wellbeing of my patients. It is my priority most of the time. It really affects me when I see my patients not getting better and still having to transfer them to the ICU, especially the young ones. When I come home, I think about it and I follow them on the computer to see how they are doing. Like I said, because I have so many friends that are doctors, I kind of let out my anxiety through my medical school forum and I have a lot of friendsand relatives that keep on praying and calling me to make sure that I keep safe. At the same time, I pray for my patients, just to make sure that they are okay. So far, I have not had any deaths on my list.

Do you think America has done a good job so far?

The news that you guys see over there is the international news. Over here, we get first-hand information from other news channels asides CNN.  The President originally made it political rather than listen to the scientists. Due to this, it took the government a while to believe that this was real. Initially, the government promised that the number of cases will be very low, about 15 cases and after two weeks, it should go away. The President actually mocked the Governor of Washington state, which was where the first case was recorded. 

The Governor acted swiftly on the case, as a result, he was mocked by the President of America. The President said that he was trying to gain the attention of the media and referred to him as a snake. Due to these, the government was not prepared for the tsunami attack of the virus. When it started spreading to other states, nothing was done about it till about the middle of March or something. Many people had died at this point in New York. 

The government’s response caused the majority of the lives that were lost. The President didn’t call a national shutdown, but it was done state by state. Most of the republican states did not call for a lockdown, this was because they were following the President. News stations like Fox news are largely republican and the President and other republicans speak through Fox News. Hence, most of their listeners are old, Caucasian men who do not listen to any other news besides Fox News. The result of this was a large exposure because they initially assumed it was fake news.

Many were affected because they did not stay home. As we can see, they’re getting the aftereffect of not staying home. In the next two weeks, the President will most likely call off the lock-down. There are a lot of asymptomatic patients moving around who will be the next wave of people that will be seen in America if the lockdown is called off. 

Even though many people are dying, he’s still saying that it’s better for 240,000 people to die than 2 million. If any of them were to be affected, they would be given utmost care whereas the majority of people who are affected here are really the African Americans. Those who their socio-economic class is low. They live in poverty, are uneducated, obese and usually have diabetes, hypertension, cholesterol, heart problems, etc.  They really do not have the right kind of immunity. They are dying in thousands every day. The government has obviously not done a good job.

From another angle, the so-called African-Americans who are born here usually don’t have access to good health care due to educational status. Although the republican government has tried to remove so many subsidies away that makes life easier, they still largely depend on the government for assistance. This is one of the reasons it spreads fast among them. 

For example, an African American died of Corona so a funeral was organised in honour of the deceased. More than a quarter of the people that attended the funeral tested positive to COVID19. The funeral director and about four siblings of the deceased died.  I picked up one of the family members that attended this funeral and he informed me that he was still being tested.  By the time I arrived home that day, he had been moved into ICU.

Your advice to the common man 

We should listen to all the scientists talking on the radio and on the television. One, hand washing is very important. We must wash our hands for about 20 seconds, the back of the hands, in between the fingers and the nails should be caught short. This is not the time to have fake nails. Take out the fake nails and wash underneath the nails and all that. 

We should avoid putting our hands on our faces, mouth or the nose because that’s the source of the infection.  If you have to scratch your nose or eyes, you should find a cloth or tissue.

If you can wash your hands like hundred times a day, even if you had any contact with the virus, it would have been washed out. Also, if you have the virus or you develop symptoms like aches and pains, dry cough, runny nose, bad taste in the mouth that progresses to breathing difficulty, then it’s time to go to the health department in your local community. That’s not the time to go to your doctor’s office as this may lead to a wider spread of the virus. 

If tested positive, they can be isolated. However,  it’s going to be difficult for the Nigerian government to quarantine all patients in their homes. This is because people usually live in the face-me-I-face you apartments where there are a lot of people in a home. Hence, it’s better to go where the government is isolating the patients. 

What do you have to say concerning the use of various drugs to ‘cure’ Coronavirus? 

Yeah, these drugs are just being used as a clinical trial.

From the clinical trial being done with some medications, the analysis showed that nearly 14% of recipients were unable to complete the full 14-day experiment primarily due to adverse effects like anorexia, nausea, abdominal discomfort as well as diarrhoea. Some of these drugs have a lot of side effects. It can also prolong the QT level and if not monitored, the patient can develop cardiac arrest. In conclusion, the guideline I recommend is to use these only in the context of a clinical trial; additional clinical trials or prospective outcome registry are needed to conduct research.  There’s no guideline to practice for this new virus. We isolate them, tell them to hydrate themselves and manage their temperature. without giving out medication, the majority of patients will recover and go home. 

Wow. Thank you for your time and this information.

Thank you.

Interviewed by Faridah Bakare, 17th April 2020

Removing the Barriers to Pandemic Control in Nigeria

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Pandemics are threats that still exist even with advances in medicine and technology. The closeness of the Ebola epicentre poses another risk. This country remembers too well the toll the last Ebola outbreak took on her people and health system. The relief of its successful control is tempered by the realization that it takes just an infected person and poor surveillance at ports of entry to be in the position we were in 2014.

On a wider scale, the current COVID19 outbreak has nations around the world grappling with overwhelmed health systems, a deluge of cases and deaths. It is a race against an ever-mutating virus to employ a variety of ways to protect citizens and prevent further spread of the SARSCov2 (the virus causing COVID19). This, unlike Lassa and Ebola, is transmitted via droplets and contaminated surfaces. The spread of all three can be curtailed by effective risk communication, early reporting, isolation and treatment of identified cases, personal protective measures like handwashing and debunking of dangerous myths.

There are many factors preventing the ordinary Nigerian from fully protecting himself from pandemics. Among these are widespread poverty, lack of education, poor awareness about the spread of infectious diseases, insecurity and poor health-seeking behaviour.

Busy Street in Lagos, Nigeria. (Credit: Unsplash)

Perhaps the overarching challenge many Nigerian communities face is that of infrastructure. Irregular power supply often means lack of running water. This greatly reduces the number of times people practice handwashing. When members of a household have to go long distances in search of clean water, it is inevitable that they will minimize the use of this for hand hygiene. Many communities also lack a health centre with qualified health workers who disseminate information and conduct house-to-house checks to ensure hygiene is observed. In addition, many markets and slaughterhouses are poorly designed and so infectious waste is left lying around and may even contaminate fresh produce. Many do not have adequate bathroom facilities and thus hands used to handle faecal matter are also used to touch food for sale. Improved level of facilities will surely help in this area. However, community-owned interventions could be used temporarily to bridge this gap by alternate sources of power and clean water supply, provision of containers at strategic places with soap for regular handwashing.

Handwashing is a crucial part of infection control. (Credit: Unsplash)

Many areas are cut off from communication channels. They may thus rely only on radio services to keep abreast of information regarding a new epidemic. This gap unfortunately leaves room for fake news and rumours to spread. There may also be panic and prejudice which in turn help the epidemic to spread faster. Initiatives like call centres such as that used by EpidAlert during the 2014 outbreak have been shown to provide much-needed information for communities. This equips them to take appropriate measures to protect themselves and their families. It also debunks dangerous myths, quells rumours and reduces panic and stigma often found among the uneducated public.

Every Nigerian deserves to feel safe enough in their communities to play a board game like these two men. (Credit: Canva)

Poverty is a major barrier to good health. The reduced spending power of individuals in a society without adequate welfare plans for its citizens puts them at a disadvantage. This is because, they have to prioritize their spending on perceived basic necessities like food and shelter. The global toll of the coronavirus on world economy is a further worsens the situation. This often leaves little or nothing to cover the cost of personal hygiene in soap, personal provision of water, face masks, accessing care and information, balanced diet and comfortable accommodation that is not overcrowded. This category of people are usually left on their own and this portends doom for us all. Thus, welfare packages should be considered to help them. They are also more likely to live in overcrowded slums which make it impossible for them to keep safe distance from one another. This borders on political will in providing adequate housing and jobs. But on the organizational level, packs containing hygiene products, free outreaches and community awareness programs are to be employed to include them in prevention efforts.

Another problem which exposes people to risk during pandemics is insecurity as seen in many communities during the lockdown. Entire lives are upturned, socio-economic strata are levelled and the priority is more on safety than healthcare. The insurgency in the northern part of the country has for years deterred efforts in healthcare provision. People fleeing conflict often leave property behind, are forced to stay in cramped displaced person camps where rates of infection are higher as a result of a strain on the few facilities available. Community-led vigilante efforts often employ methods like burning tires which pose grave risk to health manifesting down the line in respiratory disease and even death. Handwashing and other protective measures take low precedence in their daily lives with overcrowded quarters, loss of access to credible information and the general feeling of despondency further putting them at risk. Attacks on health workers, disruption of transportation and essential services keep the people affected away from accessing healthcare services. In this regard, the responsibility lies with the security agencies to intensify efforts at securing lives and property of citizens. Internally displaced persons camps must also be included in epidemic control strategy.

For many communities, harmful cultural practices and beliefs hold sway over proven medical information on disease spread. It is not uncommon to find handwashing and other forms of hygiene to be greeted with scorn, with the few who try to practice this being discouraged. In addition, women and children are often not included in health seeking decisions and are thus at the mercy of male and older relatives. Female children are not given an education making them less likely to practice safe health practices. In some cases, the male head of household has to grant permission before medical care can be sought. Where he is unwilling and unavailable, this leads to a huge gap in care. This causes a situation where some individuals know the right thing to do but are not able to practice it. Some cultural practices around gatherings, greetings of physical touch, handling babies and so on to be a source of infection spread. Community health workers need to be deployed to these areas with adequate sensitization and involvement of the decision makers to illustrate why it is important for these practices need to be changed.

These and other barriers must be taken care of to make pandemic control efforts become more effective. Thus collaboration is required across board to ensure that the country contains this virus.

References

  1. https://www.who.int/emergencies/diseases/managing-epidemics-interactive.pdf
  2. Parveen, S., Nasreen, S., Allen, J.V. et al. Barriers to and motivators of handwashing behavior among mothers of neonates in rural Bangladesh. BMC Public Health 18, 483 (2018). https://doi.org/10.1186/s12889-018-5365-1

Written by

Dr Mariam Toye

Editor, OumissaInspire

Humans First- The Story of Ita Faaji

The call for donations in the wake of the disaster

Life offers no guarantees to anyone; good and bad things happen to everyone at some point in their lives irrespective of their status. On March 13th 2019, we awoke to the rude shock of the news that a three storey building had collapsed somewhere in Lagos Island precisely Ita Faaji. The sad news hit home more when we read that about 18 people died, scores homeless and stranded. 

With the families on what used to be their homes

With fear and trepidation, a lot of people wondered what they could do to help. Help is good but well-coordinated help makes more impact. 

Rubble after the houses and school collapsed

Health Hub Africa

I was elated to see a group of health professionals come together and galvanize the public into action. I am proud to say I belong to that group. The group is made of forward thinking young health professionals from every sector of the healthcare space and trying to solve the Nigerian healthcare puzzle one piece at a time. 

From the social media drive and campaign, the Hub together with Heal for Africa realized the sum of N1,049,800. This was excluding other donations that came in kind including wheelchair, crutches, soap, indomie cartons among others. 

Health Hub members with the relief materials for the community

From this amount, the sum of N482,200 was spent on providing support for Ita Faji victims. Support ranged from payment of medical bills, cash relief to some victims, purchase and donation of medical consumables to some of the hospitals that were involved in treating the victims. 

There was continued support of victims until most of the victims were discharged from the different hospitals. 

COVID-19 

Fast forward to December 2019, along came a spider named COVID 19 in faraway Wuhan, China, and the spider arrived Nigeria February 28th, 2020. There was a glaring need to support our healthcare facilities especially those working in the front lines. They needed to be adequately protected against this new virus that no one currently understood because there was little knowledge about it. 

After consultations with stakeholders, Health Hub Africa, we identified four facilities namely:

▪ General hospital, Gbagada, Lagos 

▪ Oyo Isolation Centre, Ibadan 

▪ FCT Isolation Centre, Abuja 

▪ Ahmadu Bello University Teaching Hospital (ABUTH),Zaria. 

The balance of N567,684 was spent to buy PPEs for these facilities to be distributed equally which also included items like facemasks, gloves, hand sanitizers, shoe covers, hair covers among others were purchased for healthcare workers in these facilities. 

What lies ahead?

I am definitely full of optimism of what the future holds. Things will get better in Nigeria for Nigerians if only we all play our parts from our leaders down to the citizens. I am glad that a group like Health Hub Africa exists and taking leaps on stride at a time. 

They remind me that after all said and done, we are humans first above all. 

Written by

Dr Ronald Ikpe (MBBS, MSc)

CEO MRI Medic

ARTICLES #7

https://threadreaderapp.com/thread/1243000487365861376.html

Doctors Writing wills      

https://www.thesun.co.uk/news/11265400/hero-doctors-saving-lives-during-coronavirus-pandemic-are-writing-their-wills-and-feel-like-theyre-working-at-chernobyl/amp/

Mehdi Hasan speaks with expert               https://www.facebook.com/AJUpFront/videos/917286638727582/

Italian Doctor death toll

https://www.independent.co.uk/news/world/europe/coronavirus-latest-italy-doctors-deaths-covid-19-symptoms-death-toll-a9427596.html

COVID 19 Live updates 

https://www.washingtonpost.com/world/2020/03/28/coronavirus-latest-news/#link-MWVEVSF4Y5CYDOK4W2S7P5SGJU

What the gift of this unpleasant infection has helped me understand

https://www.washingtonpost.com/opinions/this-is-the-way-sickness-has-shrunk-my-world/2020/03/27/b26da7fc-7039-11ea-aa80-c2470c6b2034_story.html

Coronavirus: Why are deaths rising so quickly in Spain?

https://www.aljazeera.com/news/2020/03/coronavirus-deaths-rising-quickly-spain-200327181759832.html

Coronavirus: 150 Tunisians self-isolate in factory to make masks

https://www.bbc.com/news/world-africa-52068520

Italy’s doctors left feeling ‘shuttered and powerless’ as world’s highest death toll cripple hospital

https://www.independent.co.uk/news/world/europe/italy-coronavirus-crisis-doctors-death-toll-hospital-latest-a9430551.html

For anyone who is into manufacturing and 3D printing ability

https://www.covidlifesavermask.com/how-to-make-it

British dep ambassador

https://www.theguardian.com/politics/2020/mar/25/british-diplomat-dies-of-coronavirus-in-hungary

US Visas for medical professional             

https://travel.state.gov/content/travel/en/News/visas-news/update-on-h-and-j-visas-for-medical-professionals.html

Mask debacle   

https://www.thestar.com.my/news/nation/2020/01/28/show-your-colours-only-one-way-to-wear-surgical-masks-correctly-with-the-coloured-side-out

Visa extension 

https://www.gov.uk/government/news/visas-extended-for-those-currently-unable-to-return-home-due-to-covid-19

Rivers state closes all borders    

https://guardian.ng/news/covid-19-rivers-government-closes-all-borders/

WHO launch trial testing 4 potential COVID-19 treatment

https://www.medicalnewstoday.com/articles/who-launch-trial-testing-4-potential-covid-19-treatments

China lied about it           

https://www.nationalreview.com/the-morning-jolt/chinas-devastating-lies/

Taiwan accuses WHO     

https://www.nationalreview.com/news/taiwan-accuses-who-of-failing-to-heed-warning-of-coronavirus-human-to-human-transmission/

Models causing panic    

https://t.co/UZdyFb3TMZ

TWEETS #7

Probing

World is going remote  

Diary     

Intubation colleague

Health education on handwashing in Lagos.         https://twitter.com/Debbzdbee/status/1242922177957167104?s=19

Hand sanitizers and soap donation in Lagos          https://twitter.com/Cycogreat/status/1242877119820152834?s=19

Tenant refuse returning landlord entrance.          https://twitter.com/Damzyworld/status/1242852426958483458?s=19

Lost a friend      

Farts     

Tracking movement with cell phone signals          https://twitter.com/tectonixgeo/status/1242628347034767361?s=21

ER          

James Blunt       

Treating domestic worker well  

Trash bag PPE   

Quarantine activities      

NCDC clogged by pranksters      

Nigerian governors call for health sector investment                https://twitter.com/ntanewsnow/status/1242845471858622464?s=21

Vent splitter      

NHS Appreciation nationwide clap            https://twitter.com/skynews/status/1243267267883925512?s=21

Behavioural changes      

We are all treating one thing

Atlanta appreciates health workers          https://twitter.com/_sjpeace_/status/1243220908099219457?s=21

Green card for IMGs      

Health care workers move out for their mother  https://twitter.com/dramirkhangp/status/1243179703000862732?s=21

Brain drain         

Reaction to us visa for medical workers 

Boris Johnson positive  

Reaction to Boris             

Release patients              

Brain drain         

End of life           

Death   

Kaduna lockdown begins despite having no confirmed case yet

Fumigation of major bus stops commences in Lagos                https://twitter.com/followlasg/status/1243078344134070275?s=20

Disinfectant equipment deployed across Lagos   https://twitter.com/jidesanwoolu/status/1243126295531307009?s=20

Lagos deploys makeshift markets in government schools                https://twitter.com/followlasg/status/1243242718219898881?s=20

UBA to provides $14million worth of relief across Africa                https://twitter.com/UBAGroup/status/1243128808129126400?s=20

Confirmed cases rise to 65 in Nigeria       https://twitter.com/NCDCgov/status/1243260377636515841?s=20

Healthy 21-year old death            https://twitter.com/spectatorindex/status/1242789589430841345?s=20

Art response     

ER physician self isolates              

NAF airlifts cargo to Abuja           

NIMR free testing           

We can win        

The need for marriage  

Game of Thrones Impressions   

Man on vent     

Fake news a pandemic  

Cameroon’s leader         

Air ambulance response              

Burial    

CEO Slack support for frontline responders          https://twitter.com/stewart/status/1243001749679427585?s=08

Book Reviews With Oumissa #13: When a Girl is Born

Title: When a Girl is Born

Publisher: Oxford University Press

Genre: Historical fiction

Date published: 2001

Author: Pamela Grant

Read: February 2020

Quote: “At last the time had come to be glad when a girl was born” thought Ko Chin

The book is set in China in the late 19th century. It opens with the ill-treatment meted out to two Chinese girls as compared to their brother. This discrimination is upheld by most men and their mothers. This was expressed as cultural, desirability and beauty ideals in practices like feet binding which caused the girl pain and made her unable to walk long distances leaving her with the deformation of feet. Only a few of them were lucky to be educated as most fathers considered it a waste, or worse, a travesty.

Brides, uneducated, were bundled often with little idea of who their husbands were into vehicles and delivered to his family’s house like a parcel. Thus, her family was relieved of a burden. Her job was to serve his family,suffer more ill-treatment and bear him sons. If this is her experience , she is lucky to not have been sold to a family who will treat her as a slave in all of the terrible ways a girl could fear. Her only escape then would be suicide.

Her destiny is left at the mercy of the few kind men available. Our protagonist Ko Chin was rescued from being sold into slavery by a kind man who tells her the alien command that she is to choose rather than obey. He encourages her to share her opinions and values her advice. She is then able to discuss with him and his friends on topics once thought to be for men only. Like society, politics, government . In his courts she proclaims the problem with their society being that boys are treated like royalty and not trained for resilience. Hence the weak response to colonialist threats evident in their soldiers.

The unfair attention women gave to their sons is explained by the fact that husbands showered affection on other women but sons adored their mothers. On the other hand, daughters were considered an hindrance by their own mothers.

The fact that all of this occurred less than 150 years ago puts it in sordid perspective and makes you realize how far the rights of women in china has changed. It is hinted that they may have better rights in the distant past but these ebbed over time due to selfish political, colonial and religious interests.

The agitation for better treatment was kicked back to life in this book by the influence of foreigners, new politics, new religionand a yearning to be a scientifically advanced nation. 

Ko Chin’s husband and saviour, Huan Lao, is a the revolutionary who slowly helps her break the physical and emotional chains she is bound by. 

The stifling old ways however, have been so ingrained that it is difficult to adapt to his new ideas for women’s emancipation. On the other hand, she finds that freedom is not totally a bed of roses.

Bravely ,  she learns from her husband, she teaches a member of the Royal Court and eventually becomes a trusted adviser for the revolutionary movement. In spite of all this , she is locked in the frustration of having a son for a husband who places revolution ahead of intimacy.

In detailing the lives of the characters, Grant carries us through the experiences of women of that time as they navigate public life and private things like religious rituals, the home, sex, miscarriages and contraception..

The city suffers massacres but our characters narrowly escape and benefit from the cocoon of  privilege, proximity to power and pure chance.

They come in close contact with white foreigners we also see that colonized people express aspects of racism in their resistance of the oppression of the outsiders.

With her newfound position, she is able to save a her sister from a marriage that would’ve killed her. The ruling dynasty is finally forced to succumb to the new order and Ko Chin finally gives birth to a daughter. Both events symbolize a new dawn in China that this girl would have a better future.

It was a revealing read that provided many details into the life and times of women in that period in history. Many aspects of it mirror the experience elsewhere and encourages us to question systems that hold some of us back.

4 stars