It was not until the government set up a testing site near her home that Elizabeth* decided to get tested for Covid-19.
After the test, she went back home without much thought about her status. After all, she had no symptoms of the virus and did not feel unwell.
Three days after testing, however, officials from the Health ministry knocked on her door in Nairobi’s Donholm and she was taken to Kenyatta National Hospital’s infectious disease unit at Mbagathi, where she was isolated for four days.
Without symptoms and given the crowding at the facility, she was released from hospital and was put on the home-based care programme.
Elizabeth was asked to fill a Health ministry consent form, which is for patients who meet the criteria for home-based isolation and care. She says she was then asked to go home and isolate herself for a few days. “I was released on July 9, but what really surprised me is that nobody has ever come to check how I am doing,” says Elizabeth.
She says she has not received any call from healthcare workers and was not given any medication to take in case she developed any symptom or complication.
With her little knowledge on what measure to take while on home-based care, she made some “concoction” by mixing ginger, lemons and herbs that she takes every morning.
Fourteen days after she first tested positive, she says she has not been re-tested and is not sure if she is virus free or not. She does not have the money to go for testing in a private hospital.
“I am hopeful that I am not positive, but there should be a system to follow up on and know the status of those they release for home-based care,” she says.
Elizabeth is one among hundreds of Kenyans put on home-based care. And public hospitals like Kenyatta and the Kenyatta University Teaching Research and Referral Hospital have adopted the home-based care guidelines as outlined by the Health ministry.
It seems like a very well thought-out programme on paper, but home care is challenging and a little hard to manage given the increased number of asymptomatic patients, who need little care. The follow-up is especially hard for public facilities, which are mostly short-staffed. Only a few private hospitals have managed to run the programme and it comes at a cost.
Under the programme in public hospitals, patients are monitored through the Jitenge system, which is an at-home short code and text messaging system that checks with household contacts and the discharged person.
The person in isolation fills the symptom-monitoring schedule for the two-week isolation period and sends it to the Jitenge system.
Patients and all those who live in the home check their temperature and list specific symptoms, such as cough, difficulty in breathing, fever, sore throat, fatigue, headache and sneezing, daily.
In case of worsening of symptoms, patients or caregivers are advised to call or send a message to 719 and also notify the designated health worker. The health worker will assess the situation and take appropriate measures for referral, if necessary.
Patients are also advised to use a disinfectant solution and are given a formula for mixing it. The solution is used to clean all house surfaces, dedicated linen and the designated cutlery used by the patient. The patients end their isolation 14 days since the date of the first test and when they have not developed any symptoms.
The guidelines, which states that the person who qualifies for home care must have confirmed laboratory results, must be asymptomatic and without any co-morbidities, however, have not been easy for hospitals to adopt.
A source at KNH says the best way to manage asymptomatic patients is under the home care programme as it decongests facilities.
However, the source adds, it would be hard for Kenyatta to send patients to hotels for care, like some private hospitals do, as it would put a strain on the patients’ budgets.
For instance, Nairobi West Hospital, one of the private facilities that has an elaborate home care plan for Covid-19 asymptomatic patients, says it has already successfully handled more than 10 people.
The patients have been taken care of at home by health workers from the facility. The hospital provides a basic medical kit to the patients that includes vitamin C and multivitamins to boost their immune system, paracetamol to lower the temperature when it rises, a thermometer for temperature monitoring and personal protective equipment like masks, gloves and hand sanitisers. “Since all positive patients are supposed to be confirmed by the Ministry of Health, once a patient’s result is out and is positive, Nairobi West Hospital informs the ministry for accountability,” says Ashok Mehta, the hospital’s Director of Operation.
The patients in the home care plan are usually isolated for 14 days, during which they are monitored closely. A doctor and a nurse are assigned to one patient for evaluation until they test negative. At home, the patient fills a daily monitoring sheet twice a day and sends feedback to the hospital. The medics visit the patient twice in a fortnight to check their blood pressure, any changes in their condition and their temperature.
“We have a Covid-19 helpline number that the patient uses to talk to the doctor to report anything unusual. We advise patients that have underlying conditions like diabetes not to disrupt their medicine intake pattern even when they are being treated for Covid-19; they have to take them as usual,” Mehta explains.
At home, to avoid the spread of the disease to other members of the household, the patients are advised to isolate themselves in a different room until the 14 days are over and they have tested negative for Covid-19.
Nairobi Hospital uses Silver Springs Hotel, which is across the road from them, as an alternative to home-based care.
The home away from home type of environment created by the hospital is meant to make asymptomatic patients get all the care they need from the hospital without actually being in one.
From the standard rooms, which go for around Sh11,000 to the executive suite that costs Sh25,000 a night, patients with Covid-19 are also offered three nurses and one doctor visit a day. The staff check their temperature and how they are doing.
Dr Allan Pamba, the hospital’s CEO, says the costs depends on the room which the patient is staying in because it determines the level of care needed. “The cost of home-based care is resource intensive and driven by personal protective equipment (PPE). Those staying in the standard suite for example are seen by one nurse who goes through all the rooms in the period using the same PPE, but those who stay in other suites and require more visits a day will pay a little more because a nurse has to change the gear every time,” he says.
The hospital has a medical team situated there and they offer hospital catering, play cards in the communal area and patients can get out of their rooms to sit in the balcony to enjoy the view, says Dr Pamba. “Home care is not as easy as it sounds and that is why many hospitals have not developed their own programmes,” adds the CEO.
Dr Majid Twahir, the chief of staff at Aga Khan University Hospital, says they are yet to develop home care protocols owing to the intricacies surrounding it. “We have discussed it. However, there is a lot of planning that has to happen before we can commence on home-based care. There are issues like security of our staff and medical issues that we have to consider before we can start,” he says.
The government, however, says despite the challenges home care is a success. Acting Health Director-General Patrick Amoth says under home care, the government has been able to save resources and use them on patients who need critical care. He says a patient admitted to a hospital spends at least Sh21,300 on treatment per day, with the bulk of the cost going to PPEs.
Dr Amoth says the home-based care system was informed by the fact that 90 per cent of Kenya’s Covid-19 patients are asymptomatic or have mild symptoms. “There is no need of putting patients with mild symptoms in hospitals which eats into resources. Before we put them under the home system, we ascertain they are stable,” he adds.
Health ministry’s Chief Administrative Secretary, Dr Rashid Aman, on July 22 applauded the strides made in the home-based care programme since its inception. He noted that patients were responding well to it despite the previous distrust when the programme was rolled out. “Initially, when we announced the move to have the home-based care programme as part of our strategy to combat Covid-19, there were a few people who were sceptical, but I am sure by now we have been vindicated,” said Dr Aman.
As of July 22, of the 3,500 patients put on home care, over 2,500 had fully recovered from the disease, according to the ministry. “This is a major success in the fight against this disease that has ravaged our country and put the lives of many Kenyans at risk,” noted Dr Aman.
Close to half of the total Covid-19 recoveries in the country have taken place in the past five days with a majority of the patients being on home-based care. This is even as the country recorded a further 960 more Covid-19 infections on Sunday, raising the country’s tally to 17,603. “We shall continue to emphasise to our people the need to embrace this noble idea. This is because it is far much cheaper and a better option towards the recovery of a patient, for all the asymptomatic cases, as opposed to being admitted in a hospital,” said Dr Aman.
He said the move would also ease congestion and give room for other patients who are not Covid-19 positive to be treated as they should.
But, the number of healthcare workers needed for home-based care is not increasing despite the soaring cases the country is witnessing.
Dr Pamba says one of the reasons they find it easy to have their care at the hotel is because they can assign a few medics there as opposed to having many of them take care of each of the patients in their homes.
Kenya Union of Clinical Officers Chairman Peterson Wachira says as the number of cases continues to rise, it will be impossible to manage home-based cases given that health workers are already strained. “Even with the Jitenge system, which monitors contacts, it will become hard to monitor patients as the number of cases increase,” he says.
Wachira adds that the number of health workers needs to increase and that it would be important for people to take up personal responsibility of their health by going to the hospital should they present with any of the symptoms.