KAMPALA – Over the past few weeks, I have been thinking about a Ugandan living in rural areas in the wake of COVID-19, including how the government could respond, and what he can do in case he got infected with COVID 19.
And when I visited my village, I found my relative very sick but relatives had crowded the home, very close to the sick person, some feeding him while others just giving him comfort; he was suffering from malaria according to the medical forms I accessed.
This is what a typical village life is,. You don’t abandon the sick but you stay close to them to feed and comfort them. This relative was suffering from malaria but what if it had been Coronavirus? How many would have gone away with the disease.
I’m not an infectious disease expert at all, but I have a fair amount of experience in health reporting for about seven years and I know how much First aid is necessary in the event that one can’t easily access medical services in rural hard to reach areas.
And while I think the leadership of the government has been 100 percent on-point in the past few weeks after the discovery of COVID 19 in the country by telling people to avoid shaking hands and hugging, avoid close contact, staying at home, avoid self-medication among others.
What we have seen is a lot of recommendations on how to avoid contracting Coronavirus [COVID 19] by observing the above but we have not seen advice on what happens if you actually get infected in hard to reach areas.
I’m conscious that a phase of “First Aid” in the communities in case one was infected has been forgotten and yet knowing how to help a person is just as important in emergency situations as saving his life later.
First aid is the first and immediate assistance given to any person suffering from either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery.
Therefore, I want to pull together some thoughts, albeit not exhaustive, on how a Covid 19 patient could be managed in Uganda rural hard to reach areas during these times, in case he got infected with Covid 19; a subject government has forgotten.
It is true that there is no specific treatment for disease caused by a novel coronavirus, however many of the symptoms can be treated and therefore treatment based on the patient’s clinical condition.
It is also true that people of all ages can be infected by the new coronavirus (2019-nCoV) although according to WHO older people, and people with pre-existing medical conditions (such as asthma, diabetes, heart disease) appear to be more vulnerable to becoming severely ill with the virus.
How can one protect himself from Covid 19?
Doctors insist that there is evidence that moderate exercise; adequate sleep and a healthy diet help keep your immune system in shape.
“We don’t know if smoking increases the risk of people with covid-19 becoming severely ill because China hasn’t been reporting if infected people are smokers, but previous studies have shown that smoking increases the risk of being hospitalised in you get flu,” says Dr Jennifer Nuzzo at Johns Hopkins Center for Health Security in Baltimore.
She added that it might also be worth getting the flu and pneumococcal vaccines if you can still do so safely adding that in some countries these vaccines are now being sent to people to inject at home.
“And these vaccines won’t prevent infection with the covid-19 virus, but the pneumococcal one can reduce the chances of getting bacterial infections after developing covid-19,” adds Dr Nuzzo.
But according to Dr Jonathan Wangisi, DHO Mbale, WHO advises people of all ages to take steps to protect themselves from the virus by following good hand hygiene and good respiratory hygiene.
What happens if your family gets sick?
Watch out for these signs in your communities for Covid 19;
The president has emphasised that Covid 19 can be won by discipline therefore watch out for these signs and symptoms that present at illness onset vary, but over the course of the disease, most persons with COVID-19 will experience the following:
-Fever (83–99%)
-Cough (59–82%)
-Fatigue (44–70%)
-Anorexia (40–84%)
-Shortness of breath (31–40%)
-Sputum production (28–33%)
-Myalgias (11–35%)
Dr Michael Osterholm, University of Minnesota says there is a high risk of the virus spreading among people who live together and that ideally people who are ill should stay in a separate room and use different bathrooms.
“And if all people require care, both they and the carer should wear masks for safety,” says Dr Osterholm.
In rural areas where there is no medicine even testing apparatus, let us take steps to slow the spread of the disease by isolating the most vulnerable, and to protect entire communities, especially in regions where hospital care is remote or unavailable.
Dr Mulongo believes that that way better adaptive thinking will be encouraged, and some of the more futile or nonsensical ideas can be quickly weeded out.
He adds that perhaps a useful approach for behavioural adaptation to Covid-19 is to make use of the social science research method known as “proxemics”, first proposed by the anthropologist Edward T. Hall in the 1960s which involves paying close attention to the presentation of the body in social interaction as an important aspect of non-verbal communication.
Like Ebola, Covid-19 is a disease that transmits when humans form crowds and the crowd does not need to be large; a family gathering will be sufficient.
It is true that families in Uganda especially rural areas will insist on caring for their members, whatever the cost; so some ways have to be found to care safely of its members.
“We need now to re-imagine the fields of social interaction in which problems may be encountered in order to find ways of reorganizing internal space to allow essential functions to take place more safely,” said Dr Mulongo.
He revealed that Covid-19 is mainly spread by people who have no idea that they are sick, and many more people will be carriers as the epidemic advances.
Dr Elioda Tumwesigye, a physician and epidemiologist says that there was need to take up the sequestration of healthy but potentially vulnerable people.
“Eating well-balanced meals, exercising regularly, getting plenty of sleep, avoiding alcohol and drugs and doing activities they enjoy will keep us older generation out of Covid 19,” DR Tumwesigye said.
He urged those that are taking care of the sick to be alert in order to understand that your hands aren’t the only things you need to keep clean that researchers have also found that the virus can remain on cardboard, copper, plastic and steel from hours to days.
Dr Wangisi, the DHO Mbale district said the major threat to tackling the virus is misinformation and that this is bound to create more panic among the masses.
“I am requesting the parents not to panic, but to get in touch with their doctors especially for cases where one has other health conditions that may make them more vulnerable to the virus,” said Dr Wangisi.
Dr Wangisi fears come at the time when reports across Eastern Uganda indicate that there many are fleeing major towns like Kampala, Jinja and Nairobi through the porous borders to seek refuge in the villages and that these are exposing the virus to the rural people especially the elderly at home.
But the Uganda health systems are generally poorly equipped to cope with a huge spike in respiratory cases like Covid 19, an immediate strengthening is needed to supply necessary items – electricity, oxygen and breathing apparatus.
Managing patients
According to Centres of Disease Control [CDC] paper entitled; Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19), the Patients with a mild clinical presentation (absence of viral pneumonia and hypoxia) may not initially require hospitalization, and many patients will be able to manage their illness at home.
The paper adds that the decision to monitor a patient in the inpatient or outpatient setting should be made on a case-by-case basis and that the decision will depend on the clinical presentation, requirement for supportive care, potential risk factors for severe disease, and the ability of the patient to self-isolate at home.
What Uganda needs to do now?
-We need a health system strategy premised on testing, telehealth, and treatment across the country in all regional referrals that achieves the objectives of curbing transmission and optimizing care for the influx of suspected patients in the country.
-There is need to also monitor Covid-19 patients with mild illness at home, and preserve limited hospital capacity for those who really need it.
– For people unable to seek testing on their own, those in rural hard to reach areas where accessible to hospital is difficult, such as the elderly, the poor, the vulnerable groups, trained staff from regional referrals should be dispatched to their homes to collect samples.
-And people should also be given the option of receiving home testing kits that allow them to swab themselves.
– Although Covid 19 has exposed our health systems in Uganda, it is also a lesson for us as a country that today we need immediate contingency planning and funding to quickly provide hospitals with surge capacity for space, staffing, and key equipment.
It is important to note that if an exposure occurs, there is no way of reducing the risk of infection to zero, this means that avoiding an exposure in the first place—by washing your hands regularly, disinfecting the surfaces of places of exposure and following medical guidelines religiously—are the most effective method of preventing infection.
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The writer is a veteran journalist and senior writer at PML Daily Limited, Uganda’s leading online news portal.
