Kampala, Uganda | THE INDEPENDENT | The lack of personal protective equipment for health workers is likely to lead to the spread of infections and deaths.
Uganda has so far confirmed 44 cases of COVID-19 as of March 31, 2020. No health worker has yet been infected according to the ministry of health. However, the increase in infections puts health workers at risk.
According to the World Health Organisation, health workers treating any infections like COVID-19 are exposed to several hazards or risks like pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma and physical and psychological violence.
Dr Tedros Adhanom Ghebreyesus, the WHO Director-General says that countries need to prioritise on providing health workers with protective equipment because they are the front heroes that need it most.
“Health workers fighting this disease are heroes. To protect them, we need to provide them with PPE like gloves and masks. Denying them equipment is leaving sick people without help,” Dr Tedros said.
Despite such guidelines, countries in the world are reporting high numbers of infected health workers.
In countries like the United States, Italy and Spain over 20,000 health workers are estimated to have been infected with over 150 deaths recorded. In Italy over 63 health workers have succumbed to the disease. In countries where deaths have been recorded, the lack of PPE has been highlighted as the major cause of death.
In Africa, over 2,000 cases of COVID-19 have been confirmed. While there are no reports yet of infected health workers, this does not mean that health workers are safe.
Previous outbreaks on the African continent have not left health workers unscathed. In 2015, during the West African Ebola outbreak, the World Health Organisation estimated that health workers are at least 21 times more likely to suffer from the disease than the ordinary person. At the end of the outbreak, 350 health workers had died.
The death of health workers during outbreaks is not a new phenomenon in Uganda. To date, more than 20 doctors have succumbed to different outbreaks of diseases like Ebola. In the first Ebola outbreak declared in the country which occurred in Gulu, at least 16 health workers are recorded to have died by the health ministry. Among them was Dr Matthew Lukwiya of Lacor hospital.
Over 300 members of hospital staff have been assigned to cater for persons with COVID-19 in Uganda so far at four hospitals- Mulago National Referral Hospital, Entebbe General, Hoima hospital and Adjumani. Around 100 health workers have direct contact with the 44 confirmed cases.
Dr Baterana Byarugaba, the executive director of Mulago National Referral hospital that currently hosts 16 confirmed cases says that even if his staff has adequate PPE to protect them, there’s no way of protecting them from getting infected in other places like their homes.
Due to limited test kits and reagents, Uganda is only testing people who have more than one symptom of the disease. The symptoms include; flu, cough, fever, difficulty in breathing, loss of appetite.
With such measures, Dr Byarugaba says that health workers can easily pick the disease from their homes and spread it within themselves or even patients in the hospital who might be undergoing screening.
While doctors at the national referral hospital have the equipment, the picture is different in many upcountry health centres. Health centres located in districts on the outskirts of Kampala like Wakiso and Mukono, do not have essential equipment like gloves, goggles or even facial masks according to district officials.
Dr Obuku Ekwaro, the former president of the Uganda Medical Association says that health workers are being forced to work within the hardest conditions. He says that while health workers make an oath to preserve life, they are not protected from both security officers and COVID-19 which makes it impossible for many of them to do their jobs.
“Right now health workers going to work are not protected from soldiers and the disease. They are not safe. On their way to work, they are beaten by soldiers. In the hospitals where they come face to face with sick people, they do not have the equipment. They are working in unsafe environments,” Dr Ekwaro said.
The ministry of health recently got a consignment of PPE from the Alibaba Group that was supposed to improve the provision of essentials to health workers. The consignment consisted of 100,000 masks, 20,089 COVID 19 test list, 741 personal protective equipment and 1,111 face shields.
However, according to Dr Ekwaro, these must-have essentials for health workers are not reaching the hands that urgently need them.
“In health centres upcountry, these things are not there. Health centres have not received these materials. Health workers there are like soldiers being sent to the front line without a gun or bullets. They have nothing to use to defend them,” Dr Ekwaro adds.
Dr Diana Atwine, the permanent secretary at the ministry of health says even the with the donation of equipment, the government does not have enough equipment. She says the lack of enough PPE leaves health workers not fully protected.
Dr Atwine quickly adds that they have offered for more equipment and hopes that it shall be delivered next week. For now, the health ministry urges health workers to use what they have sparingly.
Uganda is not the first country to lack PPE material. China is one of the world’s leading producer of PPE but the country stopped exporting materials during the first peak of the disease. To cope with the shortage of PPE, presidents in developed countries like the US are asking health workers to reuse PPE like masks and gloves.
To try and reduce exposure, Dr Byarugaba says the hospital is considering providing housing for their staff. He believes that health workers can be kept in designated sterile environments, they would be safer than they are today. The hospital director, however, is hesitant to provide details of where this accommodation will be.
The success of measures like the ones Dr Byarugaba is suggesting can only be measured in time. But as of now, the threat that all frontline health workers face every day is more evident than before.