This week, Farida and Damilola spoke with an infectious disease specialist working in the COVID19 management team.
What is your current role in the COVID-19 response and what was your role before getting involved?
Primarily, I work as a clinician, I am a doctor; I see patients and that’s what I do on a day-to-day basis. For the response, I see patients and I work in the infection, prevention and control unit. I do training for doctors. I also help to assess health centre standards for COVID-19 management.
I specialize in infectious diseases.
From your background, it’s evident that you worked during the Ebola period.
Yes, I did.
Based on your experience managing both outbreaks, what are the major differences so far?
They are both RNA viruses, though Ebola is a type of hemorrhagic fever similar to Lassa fever. However, COVID-19 is a bit different because it is more of a respiratory virus so the route of transmission is different. Also the major difference between these viruses is that the Ebola virus outbreak was quite short, it basically lasted from July to October before Lagos was declared free. In addition, the confirmed cases in Nigeria were not up to 20 patients. However, with COVID-19 the confirmed cases are in the thousands with no end in sight for the response, so it’s more of a marathon.
Why was Ebola controlled in a shorter space of time?
When you look at the global response, we have never dealt with something like COVID-19 before in recent world history, of course, we had the Spanish flu in the 19th century. The problem is that we have never dealt with something on this scale. So it has been quite difficult.
When you look at Nigeria, Lagos state had a tremendous advantage over other states because of the extreme experience we had with viruses like Ebola. So there was a more coordinated response but these are two different viruses and no one has experienced COVID-19 before, so we are all learning as we go.
Cool. How do you feel about the federal government’s imposed lockdown, as seen by the developed countries of the world?
It would be difficult to make a judgment call on that now. This is because all over the world people have been placed on lockdowns and there are many arguments on whether lockdowns are effective or are not. The U.S tried to lockdown but they currently have the highest cases of COVID-19 patients in the world. Now that they are trying to reopen, we can see a surge in cases. Sweden didn’t lockdown and the virus dealt with them rather badly. For Nigeria, based on the situation we were in at that time, I think a lockdown was inevitable. The effectiveness of the lockdown can be questioned. Did we achieve what we sought to achieve? I don’t think so but like I said, we wouldn’t beat ourselves too much over many of these things. We just rather move on, learn, and go.
On treating patients, what’s the mental effect it has had on you?
As physicians, we face one of the highest levels of mortality. It’s not very strange to see patients die; sad to say. The problem with COVID is that it has been difficult to predict. We see patients who get into critical situations and go home. Some get in similar conditions and die. The most disturbing aspect for me is those that talk until they die. You examine them breathing well and all of a sudden, like the snap of a finger, they are here and the next minute they are gone. I’m like, “What?! Is this the man I just spoke with?” So it’s been challenging, you know.
I have been practicing medicine for years now so I have kind of built a fortitude against these things. However, you can’t be hardened. These things still consume us and we just try to move on to the next patient.
Any highs and lows so far?
Well, I will start with the lows; In the early days of the response, especially when we saw a lot of funds being spent on unnecessary PPEs and the guidelines weren’t being followed. Personally, it was a hard time for me because I saw things sliding and I couldn’t do much about it. Change is difficult. It was only about two to three months after that we were able to win people over and people started coming around. I was happy that people were trying to conserve PPE like hazmat suits, as they knew they could do well with just a surgical gown. This aided in the preservation of limited PPEs.
Furthermore, I am happy with every patient that survives COVID, we have had a 98 year old survive, and for every patient I discharge, I reiterate the fact that they are very lucky to survive. It has been quite challenging, I have never been this stressed in my life. I am chronically tired, a lot of times I wake up but I doubt I have the energy to get up but I just have moved on. I pray we just get out of this phase because this has very challenging for all of us.
As an experienced doctor, we realize that you are used to this, however, have you heard of other doctors breaking down?
Yes, we have had other doctors suffer a physical and mental breakdown which is quite worrisome. However, for me, I have not suffered either, although I get very tired. I wish everything could be over because it has been very stressful. Thankfully. we have not been as swamped like other parts of the world but we have also been strained. I have been close to breaking down but due to my reserve I am yet to suffer one
How has this affected your family life?
Interestingly, I got married in September 2014 which was smack in the middle of the Ebola response. My fiancé then, now my wife used to drop me off at Yaba; so she has been extremely supportive. There was also an outbreak of yellow fever at Bauchi in 2019. We went on vacation to the Yankari game reserve and all of a sudden, there was an outbreak. Immediately, I started case investigation and she was there with me.
Earlier in the response, there was the challenge of either going from home or staying in a hotel. And all she said was that it was also my house and we would get through the situation together.
End this for us on a happy note
We should thank everyone involved in the response. It’s been challenging for us in every single way. I think I want to salute everyone that has poured blood, sweat, and tears to get us to where we are today. We just need to keep pushing until we get rid of it. We have been through this from the very first patient until now. We have seen all the ways we have evolved. We have become stronger, harder, tougher, better, and more skilled. We pray that God will shorten the days and we will go back to our normal lives sooner than later.
We are grateful to this doctor for graciously granting this interview.
First, explain the role you play in the COVID-19 response?
I primarily drive the ambulances used in evacuating confirmed cases from their homes to the isolation centre. Before we leave for any evacuation, we are given PPE like gloves, nose masks, and hazmat suits. While in motion, we put on our sirens to ensure swift arrival to the evacuation site. We drivers usually don’t get down from the car during an evacuation, the nurses and members of the evacuation team usually go into the house to evacuate the patient into the bus. Due to the nature of the virus, we do not use the air conditioners when we pick people that have tested positive to the coronavirus, this is to promote the circulation of air. Then they are transported to the Infectious Disease Hospital, Yaba.
Other than driving evacuation ambulances, what other role have you played?
Initially, when I got enlisted to join the response from my LGA, I was asked to help transport the samples from collection sites to the laboratory for testing.
How has the work affected your family?
The work has not been easy on my family, I have not been able to go home. I have been living at a hotel. Unfortunately, most Nigerians do not believe in COVID-19. Due to my exposure and experience, my family is very aware of the risk involved. Hence, they are very concerned about my safety.
Is it that they are frightened about your status?
Of course, they are. Usually, when I come home, they keep a distance from me *laughs*. I have not ever had symptoms that relate to COVID-19. Well, the thing is I have had the opportunity of conversing with medical doctors who have laid down precautionary measures needed to protect myself and boost my immunity against the virus. I have been encouraged to take vitamin C and fruits, to mention a few.
Since you work as a frontline driver, have you experienced any patient in a critical condition?
Yes o!!! I have seen patients that have had to be revived or stabilized with oxygen masks. For example, there was a patient in critical condition that we had to evacuate. Fortunately, we arrived early and were able to revive her with oxygen while for others, when they get sick with COVID-19, they assume that they can self-medicate which can be dangerous at times. I try as much as possible to inform confirmed patients, to seek professional medical help instead of taking unnecessary medication from local dispensaries. The biggest dilemma facing Lagosians in general regarding treating medical conditions is the misuse of medication. For example, one may have a common cold and proceed to use medicines for headaches while the actual condition worsens. This is exactly what is happening with the COVID-19 response in Lagos.
Have you seen anybody that has died during evacuation?
Yes a few about 3 to 4 deaths.
Have the deaths had any effect on your mental health?
Not at all, I am not affected. As I said earlier, the major issue affecting most people is the lack of awareness and information on preventive measures needed to prevent being infected with the virus. Like me now, after a long day, I always take my medication, supplement with fruits, and get enough rest.
Give me a breakdown of a typical day for a frontline driver.
First, I work Sundays to Saturdays. Luckily, I do not sleep a lot, “Kerosene ni mi” (I am kerosene). I am ready for duty anytime around the clock, my roommate can attest to that. For example, a few days ago I was called by a doctor to evacuate a critically ill patient from a hospital to an isolation centre. Even though the rain was pouring heavily, I was able to evacuate the patient successfully.
What advice will you give the public?
My advice to the public is that no one is above the virus and immediately you discover you have been exposed to a confirmed case or notice any symptoms, do endeavour to visit your local health care centres or hospitals. Another thing is that for some people the fear of the virus is responsible for their deaths. In one of our female wards, a patient died after hearing of her roommate’s death. On a positive note, few of my colleagues have been infected and have survived, So COVID IS ONLY A DISEASE AND NOT A DEATH SENTENCE.
Title: A Man Called Ove
Author: Fredrik Backman
Publisher: Simon & Schuster
Published: 2014Genre: Fiction
What the world sees is a gruff, socially handicapped old man. The vibes he gives off are unwelcoming and sometimes border on being harsh. Almost no one considers that he has lived a life worthy of being told as a story. They assume he has always been like this, of course with no idea of how incidents in his life have affected him.
Ove is upset by everything. The list of infractions that attract his indignation includes the carefree attitude of young people, how anyone would drive a car asides his infallible Saab, the influx of immigrants into Sweden changing the country as he knows it, the nonchalant behaviour of his neighbours towards maintaining a decent community; according to his standards of course. He is even annoyed by cats and men who cannot fix things around the house. He is a man who finds great fulfilment in working with his hands, values diligence, tidy council layouts and community responsibility.
The book is narrated mostly in Ove’s mind’s voice. He is taciturn and most of his expression is the form of monologues in his head where he grumbles and complains about different things. He has devised a secret plan to but the people and incidents around him find a way to get his attention and delay it further from accomplishment.
This is a truly beautiful rendition of how the tensions between new immigrants and already-present nationals can be transformed into relationships built on trust, friendship and even love. In this regard, the credit goes to Parvaneh, his new pregnant Iranian neighbour. She takes a liking to him and is not rebuffed by his outward appearance of steely indifference or hostility. An uncanny friendship builds between him and her young family as he finds himself; against his inclinations, helping them and accepting their help. We witness an unlocking of his memories from a childhood tragedy, youthful days, falling in love with his wife Sonja and finding radiance the type that should last forever.
They, however, suffer a terrible tragedy that changes the course of their lives. This singular incident seems like the last one too many. Choosing to carry on with what he had left involved great sacrifice, loyalty and dedication leaving a normally reticent person even less available for social interaction. He is still to face perhaps the greatest tragedy of his life, the extinguishing of the one light he has left, and the one person whose love and companionship made life worth living. He is suddenly floundering, unable to carry on, the buffer that helped him navigate necessary human relationships gone. Ove fully descends into the permanent disagreeable mood everyone avoids.
“And it wasn’t as if Ove also died when Sonja left him. He just stopped living. Grief is a strange thing.”
There is a brilliance in the way Backman reveals her death. It was easy to think she was in a state where she couldn’t talk as Ove carried on conversations with her every single day. The story doubles back to his plan to end things in a bid to join her in her realm. A plan which then gets disturbed each time by Parvaneh and her cheery playful daughters, youths in his community, his former best friend with who he has had a feud for decades and even a cat. In them, he finds help to render, receives love, and ultimately they unravel the kind, helpful, loyal man who would risk his own life to protect those he cares about.
So meticulous is he that he postpones his suicide for the duty to help these people even as he finds them annoying. They warm their way into his heart having found the real Ove wasn’t quite as scary as his reputation and inadvertently destroy his suicide plans. They form a giant family, navigating major life experiences together like birthdays, childbirth, hospital visits, crime, driving lessons, coming out to homophobic fathers, caring for a pet with human-like mannerisms.
One big theme of this book is that humans cannot be held at face value. We truly do not know what anyone is like until we get to know them. When they are hostile as Baba Ove was, it takes more effort and can be frustrating but it is clear that in this case, it was worth it especially as his attitude was more of a social recluse who was not violent to anyone. It makes you think of how many people in your life you have misjudged because you do not know more beyond their general demeanour. How many are carrying around unhealed trauma? It makes you want to be kind just as it urges the traumatized person not to view everyone else as an enemy.
The vivid representation of grief, sadness, a difficult childhood and how repeated trauma defines a person’s character and world views was heavy. In addition, we see how the system can consistently be unfair on honest upright citizens as Ove is frustrated at many points in his life by local council rules that take things he loves away from him. All his attempts at fighting back are mostly futile. This causes pent-up resentment and feelings of letting himself, loved ones and values down.
This was a unique reading experience in first, the characteristic tone translated works tend to have, each chapter being eponymous with the book title and of course Ove thinking of himself in the third person meaning he was even aloof from his own essence. An overriding issue that the author highlights is modernity moving too fast for the elderly especially those who have no one left to relive the moments their youth with. They end up feeling dissociated and lonely from the new culture.
The protagonist’s warm side came alive with his mother and then Sonja who despite being dead was such a huge presence all through the book. All of this changed with his new family, a motley of characters who create the atmosphere of love and acceptance he needed and achieved the mean feat of keeping a grief-stricken old man from taking his own life.
It is compelling and would evoke tears so be warned.
Have you read this book? What are your thoughts?