It has been 12 days since we lost our first healthcare worker to the Covid-19 pandemic.
For us healthcare providers, it was a matter of when, not if, this would happen. But, no one wanted the unenviable position of being the first to take the fall.
Her death and those of other healthcare workers worldwide have been a gut-wrenching experience for us. When I first watched the BBC interview of Earnest Boateng, I was lost for words. Here was a father holding his infant daughter, who had been robbed of a mother shortly after birth. Mary Agyapong, a UK nurse, died from Covid-19 in April.
The death of Dr Doreen Lugaliki served as a ghastly reminder of our vulnerable position as human beings and as healthcare workers. Dr Lugaliki was a friend, a contemporary in the practice, an obstetrician and gynaecologist spending her days delivering babies and catering to women’s health. She was a mother of two adorable children, a daughter and a sister. There is no reason whatsoever why death chose her and not me.
We have mourned the loss of one of our own, for her babies, her loved ones and for our own reality; that we are all in the line of fire. Does our reality stop us from waking up every morning and showing up at work for our patients? Never. We keep going despite the danger all around us.
This has reignited the calls to keep our healthcare workers safe. As a country, we seem to have given up on the stay-at-home mantra as a first line of defence. Community spread is here with us and the figures are increasing exponentially. Many Kenyans are still courting disaster going by their laissez-faire attitude towards the pandemic.
The situation at Pumwani Maternity Hospital is not encouraging. To have 41 staff members test positive for Covid-19 in a week spells disaster.
Such a grim situation begs the question, what is the true status of our healthcare facilities? The response from the counties has been all about the number of isolation beds and the number of intensive care unit (ICU) beds and ventilators recently procured. No one has explained what we have so far done with the fully furnished 94 ICUs that were supposedly set up through the managed equipment service seven years ago.
This may look like great progress, but it remains a smokescreen. ICU beds and ventilators mean nothing without the necessary skillset. The country does not have enough critical care anaesthesiologists to service the 47 counties. These are the bosses of these units and without them, the unit is not useful. We currently have about 180 for all our patients.
These specialists work with the support of general practitioners in the unit, who gain the necessary skills on the job, under supervision. Currently, most counties are banking on these newly set up units to be run by general practitioners without the benefit of the specialist supervision and mentorship. Pray tell, how will they be of use if they have never even intubated a patient?
DEAL WITH SURGE
Covid-19 is a respiratory infection. Functional facilities understand the need to pull in respiratory physicians, cardiologists, haematologists, endocrinologists and other specialists who form the care team. This is before we appreciate the role of critical care nurses who run the units, physiotherapists, nutritionists, laboratory technicians and support staff, without whom, the unit is useless.
This takes me back to the question to our governors, how prepared are we?
In the four months we have had before the surge, how many healthcare workers have you taken for training to deal with the expected surge? Do these units have the support of proper functioning labs, dialysis units, adequate blood transfusion services and supplies to handle the tide?
How are we sharing the few specialists we have for maximum effectiveness of patient care? Our level six facilities are flooded and intercountry referrals for Covid-19 patients has been restricted.
I am a firm believer in devolution, but at this point in time, I have no confidence in the devolved management of the pandemic. My highly unpopular opinion is that the national government should have taken charge of the pandemic response to ensure uniform standardised services.
This would have ensured uniform training and dispatch of healthcare workers to facilities across the country and continued shuffling of medical teams around the country as per need. There would be central procurement of personal protective equipment for the units they would be working in at the county level and uniform supervisory support.
This would free up the counties to continue focusing on continued provision of healthcare for all other essential services so as not to drop the ball. The Counties would provide isolation centres from among their facilities for the national teams to operate from.
This has been tried and tested and it produced results. We have a rich history to borrow from in our health sector. We have had isolation centres for infectious diseases including Alupe and Mbagathi hospitals. We have worked with community isolation centres such as the TB manyattas of the 80s and 90s that were extremely successful in ensuring compliance to treatment. The pandemic is not here for a lifetime, we need more aggressive strategies to effectively deal with it.
We must also never underestimate the value of information sharing among healthcare workers regarding their situation. Panic is derived from administrators failing to come clean on the situation on the ground in facilities where these healthcare providers work. After all, we never send soldiers to war and fail to disclose to them when the enemy has infiltrated the base camp.
Dr Bosire is an obstetrician/gynaecologist