Unsung heroes in virus era (I)

Bound by the duty of care, Nigeria’s healthcare givers on the COVID-19 frontlines are taking on enormous personal risks and too often working under precarious conditions in their bid to save others. This is turning the frontline foot soldiers into an endangered species, reports Associate Editor ADEKUNLE YUSUF

In Lagos, Nigeria’s epicentre of Coronavirus infections, the announcement was music to the ears of over 20 million residents. That was Saturday, August 29, when an elated Governor Babajide Sanwo-Olu declared that “Lagos has started flattening the COVID-19 curve.” After six months of a grinding lockdown imposed to halt the community transmission of the virus that crept into Nigeria on February 27, the announcement delighted Lagosians to no end, allowing them to breathe a sigh of relief.

In the worst-case projections announced during a news briefing on Friday, May 8, the Commissioner for Health, Prof Akin Abayomi, said Lagos was expected to reach between 90,000 and 120,000 cases of Covid-19 by July or August. It was a prediction that never came to pass, but it indeed sent a wave of fear into residents. At the time, total infections in the state had just hit 1,854 out of the total 4,399 cases confirmed by the Nigeria Center for Disease Control (NCDC) then. Now, confirmed cases in Lagos have just reached 19,215 by September 26, forcing the state government to close down one of its isolation centres due to under-utilisation.

Governor Sanwo-Olu, who has drawn plaudits from far and wide for providing leadership in the heat of the global pandemic crisis, has since authorised the phased resumption of economic and social activities in the state. Other states have also re-opened their states so that the process of rebuilding the economy could begin in full drive. After all, despite the much-hyped predictions that Covid-19 crisis would usher in the Apocalypse, Nigeria has only recorded 58, 324 cases, with 49,794 recoveries and 1,108 fatalities as of September 27 – a score sheet many local and international public health experts have described as not too bad for a country burdened with one of the most shambolic healthcare systems.

Heroes turned villains on Covid-19 frontlines

Contrary to dire predictions that COVID-19 could lead to dead bodies lining the streets of Africa, there have been fewer cases/deaths in the continent than other parts of the world – though there is a low level of testing across Africa compared to the rest of the world. In Nigeria, one of the gallant troops that made the relative success possible is Kazeem Amusan, 36, a nurse. He was among the first set of over 1000 health workers hurriedly drafted into the frontline of COVID-19 intervention team in Lagos, after a short training in how best to manage infectious diseases. The father of one, who resides in Magboro area of Ogun State, spent over 3 months delivering care at the 100-bed capacity Onikan isolation centre, which has now been closed down as a result of a drop in patients.

Amusan, who has since returned to his normal duty post in one of the public health facilities in Lagos, said he volunteered for COVID-19 response because of the “special pay we were promised.” Like many volunteers working in different areas of COVID-19 response across Nigeria’s 36 states, he was initially shunned by relatives and friends who feared he could pass on the infection to them. Throughout his three and a half months he spent on the frontline, he said “I did not come home” to see his child and pregnant wife.

The nurse was one of the health workers housed in a hotel in Ikeja, with free meals and free transport to and fro work. “I could not come home to see my family throughout the time we were being asked to stay in a hotel in Ikeja. This left me with the only option of communicating on phone with my family. I have to move my family to my uncle’s house nearby so that they would not miss me too much,” he said.

Matters, however, got to a head when Amusan sneaked out of his hotel room one day to see his family. On reaching Magboro, his uncle bluntly prevented him from moving near his family, forcing him to stay outside to exchange pleasantries with his kith and kin. This moved him to tears. “That day, my pregnant wife did not find it palatable at all. Everybody asked me to call it quits. Please come home; tell them you are no longer interested. I almost broke down. I was in tears, but I had to go back to my duty,” he said.

If Amusan ‘escaped’ without being infected, his other colleagues at Gbagada General Hospital (GGH) were not that lucky. At the hospital, which houses at least 15 health workers reportedly contracted the virus while attending to regular patients – doctors, nurses and a pharmacist. They all survived, with one of them who just got married last week, openly expressing his worst fears at the time that he might succumb to the illness a few weeks to his wedding. However, one case that attracted everyone’s attention in the hospital was the pathetic instance of a lady doctor, her nanny and kid, who all fell ill at the same time.

According to a nurse who works in GGH, the doctor was the first to come down with the viral infection before her child and nanny also tested positive – all having to spend time on admission beds till they recovered from their illness. In Lagos, no fewer than 400 health workers were reported to have contracted the infection, a crisis that compelled the state government to announce in May that it had dedicated the 118-bed isolation facility in Gbagada to the management of health workers who fell ill in the line of duty.

Just two months after joining the frontlines as a volunteer at a COVID-19 treatment facility in Abuja, Federal Capital Territory (FCT), Hauwa Ibrahim, also a nurse, was enveloped with panic – unsure whether she would see her family again. Because the 29-year-old nurse was worried she might put her family at risk of catching the virus, she opted to stay at the isolation centre, working up to 12 hours a day when it gets busy. Ms Ibrahim, who opted to volunteer fulltime when Asokoro hospital in Abuja was turned into a Covid-19 treatment centre, said few were willing to be on the frontlines of the pandemic response. “Sometimes one has to inconvenience themselves to make things right. I am happy with what I am doing. I have no regrets. I haven’t seen any of my family members for the past two months. But that’s the price you pay for trying to make a difference,” Ibrahim said in June.

Many health workers lending a hand to the country’s battle against the pandemic have forgone time with family – a huge sacrifice. According to Dr. Ola Nene Okike, who heads the volunteer team at Karu General Hospital in the outskirts of Abuja, caring for COVID-19 patients “involves such sacrifice that one has to voluntarily and consciously decide on his own without persuasion.”

Apart from sacrificing for fellow human beings in time of need, many healthcare volunteers see their service as a way to give back to their society. One of them is Dr. Cyril Chukwuemeka Ekwebelam, who supervises the team volunteering to care for COVID-19 patients at Asokoro hospital. He also ensures compliance with infection prevention and control measures to keep health workers and patients safe. Like his many colleagues, he has not been home for weeks.

“Sometimes my wife drives to the isolation centre and parks by the gate. I peep through the window and have a glance at her and the kids. That’s the closest we can see each other. I have always believed in giving back and I see this as an avenue to do so,” the father of two said.

Another frontline nurse, Julius Emasalome, said he has not seen his wife and months-old baby since May when he left home to join a team of health workers at an isolation centre in Abuja. To avoid stigma, he did not let his family know about the nature of the job; afraid of the fear the public attaches to the virus. Unfortunately for him, weeks after regular contact with COVID-19 patients, he too was infected. He spent almost two weeks at the isolation centre before he recovered.

“My case was very critical in the sense that I presented with almost all the symptoms except that I didn’t lose my sense of smell. I had fever, cough, and difficulty in breathing, diarrhoea. I had a loss of appetite; I could not eat for close to two weeks. By the time I was discharged, and I checked my weight, I had shed over 15 kilograms,” Emasalome said.

Like Emasalome, a COVID-19 frontline volunteer currently working in DSL 2 laboratory in Rivers State, also had a close shave with death. Speaking under anonymity condition, he was infected on the line of duty – only for him to also transmit the virus to his wife. Luckily for him, he and his wife survived the infection, though some of his colleagues lost the battle.

“First of all, I am a COVID-19 survivor. The virus attacked me and I recovered from it; my wife was also infected. I also know of at least six of my colleagues that came down with the ailment. Theirs were so serious that they had to move into isolation centres. But my wife and I were lucky; because I have already known the treatment protocol; so when I saw the signs, I quickly placed myself on the treatment. Later, my wife caught it through me; she is not a medical officer, so I have to place her on the medication also. And by the grace of God, we survived it. Then some medical officers I knew in the state were, however, not as lucky as we were; they died of the disease,” he said.

Dr. Collins Elumelu, who works in the emergency department, University College Hospital (UCH), Ibadan, Oyo State, enjoys pouring out his love to his patients. Suddenly, he started to feel ill but failed to realise he was infected.

“It took me a while before suspecting it was COVID-19 because, normally, I don’t fall sick. Until the body pains now increased and it became severe, the headache became very bad, even to get up from bed became a problem. I couldn’t eat again. I lost my appetite. My taste disappeared,” he said in August. When it got more critical, Elumelu became a patient in the same emergency unit where he works, receiving drugs to treat his symptoms. Before he left the ward for isolation, a number of his colleagues had also tested positive. “While I’m not sure of how I got it, I’m so sure that those that came in contact with me, all of them tested positive. For my group members, out of six of them, four became positive,” he said.

Inside the dreaded walls of isolation centres

While sharing his experience, Amusan disclosed that behind the glossy façades of isolation facilities, many of which were hurriedly constructed to accommodate the COVID-19 exigency, are minds perpetually riding the wave of fear. According to him, as caregivers battle to save lives, fear of the unknown is real in the wards – fears over perpetual feelings of being inadequate in the face of a novel virus that is tormenting the world.

“Initially, everybody was afraid. We were under the fear that the tragedy befalling our colleagues in China, the United States and other countries could happen here. We feared then that similar level of fatality being reported abroad would happen here. But we were lucky. Ninety-five to ninety-six per cent of cases that presented in our isolation centres were normal-mild levels, which was responsible for the low fatalities recorded in the country compared to other countries,” Amusan said.

Also narrating his experience, a medical doctor still engaged in COVID-19 duties in Lagos corroborated Amusan, saying panic in Nigeria’s isolation wards is as contagious as the virus itself. The medic, who simply identified himself as Dr. Oguns, works in one of the state’s general hospitals. He said the fact that news now travels at the speed of light means that frontline workers are constantly abreast of happenings in COVID-19 frontlines in other climes with better healthcare infrastructure, especially in more advanced countries with massive infections and death casualties among healthcare givers.

“The news from abroad always sends jitters down our spine. Are we going to be dying like our colleagues abroad? What will happen to our families? These are some of the questions that occupy our minds. Don’t forget we mistrust the political leadership to deliver on promises they made to us. Remember, we did not sign any agreement form when we started. We just rely on what government officials said. You know it is dangerous and risky to believe in what the government says in this country. All this also contributes to why we are always in the panic mode while managing patients in isolation centres,” Oguns said.

All Covid-19 workers who spoke with The Nation said Lagos provides free meals for over 1,000 health workers in all its isolation centres: Onikan Stadium Center, Gbagada General Hospital, Lagos University Teaching Hospital in Idi-Araba, Infectious Disease Hospital in Yaba, Landmark Centre, Lekki Center, Agidingbi Center, and First Cardiology (for critical care) – all with a combined 547-bed space. In addition to free meals, there is free accommodation for all medical volunteers in hotels scattered around the state, with dedicated buses conveying Covid-19 workers to and fro their places of assignment.

This, however, does not seem to assuage the psychological pain many healthcare volunteers contend with. Among the sacrifices of COVID-19 workers is they have to embrace unpredictable work schedules to work for longer hours, sometimes, in overstretched facilities to defeat a virus that is not fully understood. Time to treat a COVID-19 patient is not the best of time, Amusan said. Unlike soldiers who wage war against an enemy they know or probably see, he said what exerts enormous pressure on caregivers is fighting an invisible adversary through treatment protocols that make close interaction with patients difficult without wearing personal protective equipment (PPE). This, he said, is a huge sacrifice because PPE reduces access to “normal oxygen” by creating a barrier that somehow tampers with the natural process of “breathing in and out” from the usual atmospheric oxygen.

“We must put on PPE. We call it SP02. I can tell you that the minutes or hours spent under PPE are always not a good experience because we have to cover almost all our body. The nose mask is also not the normal surgical face mask. We call it N97. Breathing becomes difficult because it has been tampered with. It feels like something is sharing oxygen with you. If care is not taken, you can collapse anytime. That is why one person is not allowed to go alone into the isolation facility to treat a patient; it must be in the company of other medical practitioners – at least three or more. In case one falls, others will be able to attend to him or her,” he said.

Paucity of consumables ‘doing us in’

As of April, Nigeria was yet to come to terms with the enormity of the crisis in its hands in terms of best to curb the rising infections. However, it was already tales of woes among healthcare givers. At the time, the Minister of Health, Dr. Osagie Ehanire, said more than 40 among 5,000 health workers on the frontlines had tested positive. He disclosed at the time during one of the daily briefings of the Presidential Task Force on COVID-19, in Abuja. He also reeled out precautionary advice to all health workers, asking them to be watchful when treating any patient. “This warning has become necessary due to the number of health workers who have tested positive for COVID-19. They are over 40 now. Apart from the over 40 health workers, others have been quarantined in the last two weeks due to exposure and have not been able to contribute to efforts of the health sector,” he said.

While applauding the frontline health workers, Ehanire promised that government would continue to provide them with PPE and other things they need to discharge their duties. “Frontline health workers must undertake refresher courses on infection prevention and control at intervals… Remain vigilant in the line of duty and maintain a high index of suspicion for COVID-19,” he cautioned.

Sadly, doctors, pharmacists, psychiatrists, nurses, and other health personnel working extra time to help curb the spread of the raging virus have incessantly complained about the paucity of PPE in the hospitals and isolation wards. According to the World Health Organisation (WHO), PPE items needed in healthcare and home settings during the global pandemic consists of garments placed to protect the health care workers or any other persons from getting infected, including face protection, goggles, mask or face shield, gloves, gown or coverall, head cover, and rubber boots. The global health body also acknowledged disruptions to the global supply chains of PPE, thus recommending rational use in the context of severe shortages.

But Dr. Julian Ojebo, vice president of the National Association of Resident Doctors (NARD), who works as a critical care physician at Irrua Specialist Hospital (ISH) in Edo State, insisted that many federal and state health facilities expose workers to dangers by not having enough PPE to use. He was part of COVID-19 team in ISH, a facility regarded as the home of excellence for the treatment of Lassa fever and other infectious diseases in the country.

He explained that, because the nature of treatment protocols for COVID-19 patients makes it mandatory that PPE is discarded immediately after use, hospitals always quickly go out of stock – with supplies always not meeting up with the pace of need. “The things that are majorly our problems are that most of our federal and state health institutions do not have a lot of PPE. These are consumables. So if you provide them today, they are going to be used up such that you cannot say that you do a one-time provision and then it lasts forever.

“The rate at which we use our PPEs cannot be said to be in an arithmetic progression; it is geometric because it depends on the influx of the patients per time. Hospitals per day, in the emergency room (ER), you can have up to 40 patients for those that are very small. For those that are very big, you can have up to 100 patients per day in the ER because they come in from both medical to surgical to gynaecological to paediatrics etc. So there are different cadres of patients.

“So if you provide 5,000 PPE to say Irrua Specialist Hospital, just for the emergency room alone, they use over a hundred of it per day. For example, in our hospital, we have the Covid-19 ward and the Lassa fever ward. During the time of Lassa fever rise, you can have as many as 70 patients in your ward because they are coming from all over the country to our hospital. So each time you enter to attend to a patient and come out, you change your PPE. Therefore, for one patient you can use up to three PPE for one day. These are the issues that abound when it comes to the use of personal protective equipment. According to the presentation of each patient, the PPEs are not sufficient,” Ojebo said.

• This report was facilitated by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under its COVID-19 Reality Check project