COVID-19 and the Frontlines in Nigeria
By Titi Tade, Medical Social Worker, Lagos, Nigeria
The COVID-19 Pandemic plunged the world into an unprecedented crisis. Globally, most gaps within the different health sectors in Africa were exposed due to the contagion.
In Nigeria, the initial high of identifying and isolating our index case and his close contacts by the National Centre for Disease Control (NCDC) gradually gave way to the reality of community transmission that has been aggravated by the economic fall out of the lockdown, fear of seeking COVID-19 treatment from government facilities and a general distrust of the government led COVID-19 fight as a scam. Nigeria, as at 5th June 2020, had 11,844 confirmed cases during which Lagos State maintained epicenter status with 4,694 cases.
As a Health/Social Care worker in Lagos State, I am both a member of the public who is worried about the growing rates of community transmission and a member of the “frontline” who has to provide services to the general public within a health system that is in the beginning stages of being overwhelmed. Prior to COVID-19, the health system had always faced the challenges of gross under-funding, inadequate staffing, brain drain and competition from traditional healers.
On a day to day basis our challenges mirror those of healthcare workers around the world. We worry about getting infected at work and taking the infection home to our loved ones, we worry about insufficient supply of Personal Protective Equipment (PPE) and how to safely reuse them. Due to the shutdown of commercial transportation during the lockdown, if you did not own a vehicle, you worried about how you would get to work. As the lockdown eases and people resume their daily activities, you worry about community transmission in commercial vehicles as you make your way to work.
Normally in government hospitals, the number of patients that come in on a daily basis number are in the thousands, it is not unusual for a clinic to be run by 3 nurses with 150 patients waiting to see 10 doctors. During the lockdown, most cases seen in the hospital were COVID-19 cases, emergency cases and a handful of other illnesses but nothing as overwhelming as pre COVID-19 numbers. Unfortunately, as the lockdown is being gradually eased open, the number of infections is rising, and the hospitals are opening to patients who have not been able to see their healthcare professionals in about 2 months for their regular appointments, this combination means that the number of people accessing healthcare services will outstrip the pre COVID-19 numbers. Hospitals and healthcare workers are bracing for the surge in patients with trepidation as we watch how the healthcare systems of ‘developed nations’ are being overwhelmed by treating and responding to the Coronavirus.
As the saying goes, behind every dark cloud is a silver lining. Our silver lining is the fact that since colleagues have been fighting the virus globally for over 6 months now, there are a lot of lessons to be learned from them. The digital age has made it possible for new information about how best to fight the pandemic become available in literally seconds from when the initial author posts the information on the internet. In Nigeria, we have used numerous virtual platforms such as Zoom to conduct trainings on experience learning and best practices for healthcare workers. We have also used the platforms to reach healthcare workers in locations of the country that are only just recording their first infection of the virus. The NCDC is working with affected State Governments e.g. the Lagos State Government, the Federal Ministry of Health as well as State Ministries of Health to ensure a coordinated approach to our Isolation and Treatment Centres and to shorten the timeline between testing of people to hospitalization of COVID-19 positive people. This doesn’t mean that everything works perfectly just yet, but we are learning, adapting, documenting and sharing the new information as we go along.
Everyone has been talking about the “new normal”, but what that is for us in healthcare in Nigeria is still being shaped. Everything from the way patients are booked to visit the hospital, to how healthcare professionals attend to patients will most likely change. These routine processes would now have to respect infection prevention and control measures, physical distancing and, rather harshly, be implemented with the assumption that everyone has the coronavirus until proved otherwise. It will take some adapting to the “new normal” for both healthcare providers and service users but it is a change we must embrace
So…
In Nigeria, we are adapting to these evolving rules for socializing and engaging others. We are adapting to wearing face masks anytime we are outdoors. We are adapting to the ‘new normal’. Being the resilient people that we are, we begun a trend, the fashionable re-usable face masks, which I think will stay, long after the end of the COVID-19 Pandemic.
Reflections on COVID-19 - who can be reached?
By Olúwafúnmiládé Eunice Ṣóbọ̀wálé, Ọláwálé Micheal Adébọ̀wálé, Grace Ìdòwú Awósanmí, ADÉYẸMỌ E.O and Samir Halliru
COVID-19 pandemic is a great peril, daunting and daring humanity by bringing extreme contrasts in relationships and communications in our present world. The patterns of communication engaged in the Global South are crucial to the social changes experienced by the population. The use of correct modes and methods of communication enhances participatory and mass communication, bringing about positive and unexpected outcomes. In the Global South, interpersonal relationships and social ties play a vital role in the cultural and traditional communities while embracing changes and developments. These age-old customs of cultural ties have revealed the sensitivity of the communities to spontaneous changes and developments. Perhaps this explains the poor compliance with the measures laid down to lessen the spread of the virus. Most of the traditional communities in Nigeria have found it difficult adapting to:
- The lockdown protocol or the restrictive movement order, which suggests everyone should stay home and only go out when necessary.
- Avoidance of social distancing or gatherings of large groups at burials and weddings, and also in market and worship places.
- No shaking of hands.
For people in the Global South, the importance of complying with these measures has been questioned as a result of their disposition to their culture and traditions. This contrasts with those in the Global North, where the pattern of social interaction is more private. Assenting to the new rules stated above has introduced serious hurdles in stopping the spread, especially in Africa. This is connected to the fact that a large percentage of the population get their means of livelihood daily, which means following the stay-at-home order results hardship. Further conversations with some of the individuals on why they are not obeying the order exposed some pertinent factors that make staying at home problematic. Some of the typical responses are ‘What are we going to eat? and ‘Staying home does not feed my large family’. What is provided is not sufficient for all those in need when compared to the supplies available. Our government’s efforts should be geared towards providing information on the danger of breaking the lockdown.
Whenever the lockdown is relaxed, overcrowding occurs at marketplaces due to the influx of many people coming for supplies within the allotted time. The mingling by the people and the ineffective crowd control at such places raises alarms about the poor adherence to individual safety measures. These situations could be prevented with adequate education and public awareness to ensure the safety of everyone.
No shaking of hands is another measure used to curtail the spread of the virus. Handshaking is an age-old part of the culture of most communities in the Global South; it is used as an expression of gratitude, respect or agreement. The new rule of avoiding handshaking is causing individuals that obey or enforce the rule to face stigmatization and be looked at by members of the community with disdain. In the Global South, addressing this issue will require creative and sensitive local-based education strategies to ensure that everyone adopts this measure.
The communications on COVID-19 by the National Centre for Disease Control (NCDC) in Nigeria are broadcast in the English language, meaning only the rich and educated receive the information and suggesting that that is the only demographic at risk. The crucial information needs to be translated into all the local languages and must be transmitted through local radio programs to educate the masses about taking the appropriate safety measures and how to contain the spread in local markets and places of worship. Also, engaging the use of different social media platforms such as Facebook, Twitter, and discussion groups (zauren hira) will help with compliance. The above strategies will increase public awareness and compliance with the guidelines and bring about a positive connection in moulding the lives of individuals or groups, thereby encouraging the adoption of the COVID-19 measures issued by the government.
In addition, recruitment of local ambassadors within the local communities is essential. Such recruitment will actively involve religious leaders who have influential bonds with their followers. This is important because many local people appreciate a closer link to their local perspectives rather than adhering to concepts that originate at a central
COVID-19: Impact on Women in Rural Communities
By Kyauta Giwa and Grace Awosanmi, Nigeria Hub
Ever since the outbreak of the COVID-19 pandemic around the globe and in Nigeria in February 2020, the effect of the different measures has taken its toll on the survival and livelihood of the rural population. Farming and small-scale businesses, which is largely dominated by women in agrarian and rural communities, have not been exempted from its effects. A large percentage of these women are not educated, and they earn their living through homestead farming/gardening or petty trading. Many of these women who survive on daily sales were shut out of business for weeks. The restriction of movement caused an increase in the cost of living and the prices of goods and essential services, thereby affecting household incomes. Moreover, the women who engage in daily subsistence businesses have found the situation especially difficult. Considering they cannot carry out their business activity as usual, they face a serious threat and a huge economic challenge to their survival and that of their families.
The women that are involved in small scale farming produce food for immediate consumption and sell the remainder to help meet their families’ other needs. Rural women are known for transporting goods and farm produce on trucks and pick-up vans when accompanying their goods to the various local markets. The closure of the interstate borders and the stay at home directives issued in the country affected the movement of farm produce from one part of the country to another, leading to an increase in the prices of staple food items. Most people have complained that their food produce is getting spoilt. Despite the lockdown, these women have still found ways of getting their goods to different neighbouring markets. They usually transport their farm produce to the market in groups by hiring vehicles and each person must accompany her produce, which does not permit adherence to physical distancing and thereby exposes them to the pandemic. Sales at the market during at this period were stated to be general low.
For rural children, the means of getting an education during this period has been impossible. Most rural women are household heads, and most of them do not own internet enabled phones and therefore cannot afford data for internet connectivity to engage their children on online educational programs. Some of the children run errands or hawk petty wares, wander around or are at the mercy of the neighbours or elders within the communities during the lockdown. Information on the spread of the disease by the Centre for Disease Control was not relayed in local languages, thereby making it difficult for these women to access credible information. Most women lack access to basic information about preventive measures to ensure personal hygiene, thereby exposing them to infection. Poor responses have been seen in most rural areas where people do not believe in the outbreak of the disease and act ignorantly.
The low cost of living in rural communities makes it difficult for people to be able to afford hand sanitizer. Most people have never used hand sanitizer before, so many have resorted to producing homemade hand sanitizers using chemical products within their reach. These homemade sanitizers might be unsafe to use, or inefficient. The government should empower and protect the rural women and children in this time of coronavirus by ensuring that they are included in targeted information concerning COVID-19. They should also ensure the inclusion of the agricultural produce by the women in the palliative package as good source of income.
COVID-19 Pandemic Realities and Imaginaries
By Dora Nyirenda, Research Administrator, Malawi hub
Waking up in the morning with COVID-19 pandemic you are flooded with messages from various media that hits you in the face creating confusion. The Malawi Government through it’s official pages and legal radio and TV stations talk about scientifically proven ways in-line with World Health Organisation recognised management principles of the pandemic, for example, social distancing, washing of hands frequently, wearing of masks and coughing in the elbow or handkerchiefs and if a person has signs and symptoms of the corona virus infection or exposure, one does not go to the hospital or visit a physician but call a toll-free number so that a person is assisted from where they are. These are straight forward practices to manage the COVID-19 pandemic. These are practices at individual level, at country level, measures include closure of all schools, working from home for non-essential services, working in shifts and only those providing essential servicing report for duties on a regular basis while observing personal hygiene and social distancing.
However, the social media is awash with additional information that at best brings disarray to the normal procedures. Here we see the entrance of confusion, misinformation and muddying the clear waters of the pandemic if at all the pandemic is of clear water. Messages like taking hydroxychloroquine or aspirin as medicine, boiling garlic together with lemons and drinking the juice and boiling neem leaf together with pawpaw leaf, lime orange, garlic, ginger, guava, mango leaves and lemon grass, drinking the solution three times per day, are available in various media spoiling the broth just like too many cooks do. For example, see one of the messages below;
One incident that caught my mind happened in a public minibus in which one passenger whispered boldly that ‘just sniffing raw onion you will be cured from corona virus,’ he said this whilst holding a raw onion in his hand. Are all these messages that have been roaming around really about managing and reducing the number of deaths or increased registered cases due to COVID-19 or an addition to the mess about the pandemic?
The Malawi Communications and Regulatory Authority through the Malawi Computer Emergency Response Team warned citizens against sharing fake news about corona virus on different social media platforms, that the public is, advised to refrain from committing these acts. But does it have the tooth and capacity to intervene? Because on the ground, the messages keep on coming.
All hope is not lost. Citizens are informed to use trusted sources like Government websites for up-to-date, fact-based information about COVID-19. Radio and TV stations in Malawi are broadcasting ways of preventing the spreading of corona virus. In addition, many artists and singers have performed songs educating citizens about the virus and one of our SFA partner Art and Global Health Centre Africa’s’ (ArtGlo) Make Art for Sustainable Action Youth Squad members developed a song, and video called TipeweCorona (prevent Corona), using artistic styles they believe will appeal to their peers to share information on COVID 19. Held a dance challenge on social media for youth to share dances to the song, giving a fun, creative way to engage. More info is at https://www.artgloafrica.org/our-stories
