COVID-19: Health Care Workers Face Critical Challenge in Nigeria

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Why Kano Records, High Daily Number, COVID-19
Nigeria's health minister, Osagie Ehanire

Health workers in Nigeria are fast becoming the most vulnerable in the world as they strive tirelessly to respond to the ravages of COVID-19 in the country.

A number of them have been reported to have contracted the disease unknowingly, either because of deliberate non-disclose from patients, as was the case at the University of Ilorin Teaching Hospital (UITH) where a patient who had returned from a COVID-19 ravished country denied that he had any travel history of recent or because of lack of protective equipment. Aided by a professor of Medicine in the same hospital, the UITH index case was admitted and attended to on the pretext that he had been exposed to some poisons. About 20 health workers were exposed at that reckless moment.

At the end of April, 2020, Nigeria’s health minister, Osagie Ehanire, confirmed that 113 health care workers (HCWs) have contracted the virus, apart from over 40 that had to be quarantined because they have been exposed. This has continued unabated.

In Kano State, the chairman of the state chapter of the Nigerian Medical Association (NMA), Sanusi Bala, was quoted to have said 34 health workers in the state tested positive to the virus earlier this week.

In addition, the chairman of the Kano State branch of the National Association of Nigeria Nurses and Midwives (NANNM), Ibrahim Maikarfi Muhammad, specifically said 18 nurses from the National Orthopedic Hospital Dala, Aminu Kano Teaching Hospital and two state hospitals, tested positive for COVID-19 in Kano within the week. He said 86 of them were actually exposed and subjected to tests.

Judicial Sketch could not get to the state NANNM chairman for further details, but the state NMA chairman to which our reporter posed questions about the present psychology of his members did not respond. He equally failed to answer the question on the implication this development will have on the general efforts to combat the virus.

In Kaduna State, both at Barau  Diko Teaching Hospital, Kaduna and Ahmadu Bello Teaching Hospital (ABUTH), Shika-Zaria, there are subtle grudges against the management already.

Judicial Sketch gathered that three patients tested positive to the virus earlier in the week, two of them alleged to be consultants, even though the hospital management at ABUTH has remained silent on the issue. Several others who have been exposed have been asked to proceed on self-isolation.

On Friday, the secretary-general of the Association of Resident Doctors at ABUTH, on behalf of the association’s secretariat, sent a message to all members, urging them to always ensure their personal protection. This came in the wake of the exposure of doctors to three cases that were confirmed same Friday.

“Recall we had suspected cases of COVID-19 in the hospital whose samples were taken for confirmation. Unfortunately, three of the results have returned positive. These patients were on admission in the A/E and had contacts with health workers. Some of the health workers have since gone on self isolation. All doctors who were on call on Saturday (2/52020) and Sunday (3/5/2020) and had contact with following patients …. should reach out to ….. to be directed on the next line of action,” he wrote to all members of the association in the hospital.

At the Barau Dikko Teaching Hospital in Kaduna, members of the Medical and Dental Council Association of Nigeria (MDCAN) expressed displeasure over what they termed the highhandedness of the authorities of the hospital.

The hospital management was accused of not providing adequate Personal Protective Equipments (PPE) but has come down heavily on doctors who have gotten exposed.

A heat-rending message by one of them to other members revealed that the displeasure among the doctors was high.

“They came to work as usual while others are at home with their families enjoying themselves. They were exposed to a suspected COVID-19 patient who later became positive. They are now in SELF ISOLATION which will last for 14 days. It is going to be 14 days of uncertainties. 14 days of psychological torture. These are also our Frontline HCWs.

“However the authority that be think otherwise. The Authority that knows all classified them as OTHERS because they don’t wear PPEs to see patients at the Isolation Centres. Because of the classification, they are to have the following: 25% compulsory deductions from their net monthly salaries, 10% of their net Salaries as Occupational Safety insensitive, and wait until they are positive with COVID-19 to enjoy other insurance packages.

“Where is the motivation for #kadunaHCWs? Keep on the good fight against COVID-19 and NON-COVID 19 diseases and humanity will smile at you one day,” the message read.

The question Judicial Sketch posed was whether PPEs were available for the HCWs?

A senior consultant at Barau Dikko answered: “No! The general idea among us now is, as a doctor, it is up to you. If you are not protected, do not see a patient. Meaning if they don’t give you PPE, do not see any patient.”

Does he have at least two sets of the PPEs at his disposal as he worked on Friday, since some of these protective gears are supposed to be disposable?

“I have one N95 mask for about a month now. I have been sterilising and reusing it all along. Meanwhile, there are no other PPEs like goggles etc”, he replied.

Where are those PPEs supposed to come from?

“Every hospital management is supposed to provide for its HCWs. They get from government, philanthropists or foreign donours. They also buy,” he responded.

What happened to the ones gotten? Why are they not given out to HCW, or are they not sufficient?

He said there are “Many different factors. Bottom line is corruption. No money, they will say. Plus the best of face masks are on politicians and government officials. When you watch CNN, BBC etc, it is the opposite of our own local ways. In sane countries, their health workers use the PPEs and politicians have little or none. Here in Nigeria, the only place you see PPEs is on the faces of the politicians. As soon as delivery is made, they first pack their own before sending remnant of any to the hospitals. Take note also that the best face masks do not get to the HCWs.

“The highest grade is called N95. On Nigerian TV, you see it mostly with the politicians, hardly with the health workers. It is a reflection of the quality of our leaders,” he said.

Back to ABUTH, Shika-Zaria, a staff explained that the little amount of PPEs available in wards are in the custody of the nurses who are customarily in charge of ward equipment. They share among themselves, and by the time doctors come, there are no more to give.

Health Care Workers, Face Critical Challenge, Nigeria
Types of masks. The last two are said to give the best protection, but are not available to health workers in Nigeria in most cases

“I witnessed an instance when a matron wearing surgical mask was giving some doctor cloth masks. It nearly caused quarrel”, he said, adding that “some concerned members of NMA and MDCAN went to meet the hospital management to demand that masks due to the doctors should henceforth be calculated and handed to doctors directly, while nurses should take those due to the nurses alone.”

He said the hospital management eventually gave a limited quantity of face masks, that could not last beyond two days, to the doctors. These were surgical masks that should be disposed after being used for a few hours.

Meanwhile, Judicial Sketch has learnt that MDCAN has about 170 members, while the Association of Residence Doctors (ARD) has about 600. The crisis of shortage of PPEs (or to be more specific, face masks) has remained unresolved as of the time this story was published.

Also, as three more patients tested positive to COVID-19 on Thursday, there have been disagreements with the hospital management on how their exposed colleagues will self-isolate. The management has asked them to go home, while the doctors have questioned what will become of their immediate family members with whom they have been mixing.

Judicial Sketch spoke with a junior management staff who revealed that a section of the doctors have asked the management to allow them use a certain completed but unoccupied building of about 50 rooms for isolation, but the management has turned down the request, saying doctors are not the only HCWs in the hospital. But the doctors are insisting that they are patients at the moment, and that any other staff that eventually needs the facility can as well enjoy it.

The matter has not been resolve as of the time this story was published.

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