The Government of Nigeria, through the Federal Ministry of Health and the Nigeria Center for Disease Control, announced the first case of COVID-19 on the 28th of February 2020. For me, my opinion was that the COVID-19 outbreak was inevitable. Nigerians are upwardly mobile ubiquitous people. We travel a lot, we travel far and our borders are open to local and global trade, business, and tourism.
As a medical practitioner, the need for my services as a frontline health worker was immediately required. I had to continue working as the health facility I work in did not close. Even though national guidelines gave instructions about reduction of mass gatherings, social distancing, a total lockdown, and subsequently curfews, health seekers still accessed essential services in the hospital. The Management of the hospital shut down certain clinics, but essential services such as immunization services to newborns, antenatal care for pregnant women, reproductive and sexual health services continued as well as response to medical emergencies.
My center reduced the number of staff who work per day, and our work schedules had to be adjusted such that invariably, I was working on-site twice a week. For the days in-between, I moved my practice online and followed current trends and information about COVID-19 online. I attended several ZOOM seminars, webinars and also improved my knowledge and skills, by taking several online courses.
Working from home was not strange, as I do some remote work (editing, proofreading, manuscript reviews, and freelancing) but it was different working online and staying indoors for a long time, and experiencing physical and social distancing from friends, family, and colleagues, though I made sure I kept in touch with people online and checked in on their welfare, to know they were staying safe and to give psychosocial support, to persons who had tested positive.
I used my social media platforms to do a lot of health promotion and health education, in collaboration with different organizations and institutions. I also used the opportunity to form research teams and using my time creatively. As a result of the lockdown and social distancing, we could not conduct community-based studies and thus conducted four studies using online surveys. Our findings will soon be published.
From my own assessments, the measures that reduced the spread of the virus was the enforcement of a total lockdown across the country, the restriction of movement across states of the federation, restriction of commercial activities to essential goods and commodities, prohibition of mass gatherings, social events, and closure of educational institutions and places of worship.
The influx of travelers from countries with cases e.g Europe, the United Kingdom, the United States, and other parts of Africa was a predisposing factor to the exponential transmission of the COVID-19 infections. Up on till the third week after the first case, the Nigeria air, sea, and land borders, had not been closed. This allowed for persons who had been infected but asymptomatic to come into the country and this facilitated community transmission.
The governments of the state’s south west part of the country have been very proactive in responding to the outbreak. Economic activities did not fully close in Oyo State, there was only one day of lockdown, with curfews from 7 pm–6 am. Ogun State had alternate lockdown days with banning of social activities, mass gatherings, the closing of places of worship, and restriction of commercial activities. The use of facemasks was also made mandatory, however, this still needs more compliance. A lot of business and educational activities also moved online.
I was able to contribute to advocacy and health education on COVID-19 and was opportune to be given a platform to share my expertise and thoughts as a Guest on COVID-19 Update on Channels Television Nigeria, TV Continental (TVC), and Plus TV Africa. (https://youtu.be/CuxvxZTTZF0, https://youtu.be/Hw-5gDt6JH0, https://youtu.be/7ITHTJ51ObI, https://youtu.be/3lj43jZ2zEk, https://youtu.be/7TeOnrRe4Fw)
The concern I have had about health care services in my country is that the focus of the response for the COVID-19 at the initial phase did not incorporate the Primary Health Care System and the Private Sector.
At the Primary Health care level, which is the health care system closest to the people, however at the early stage of the outbreak, the health workers at this level had not been formally trained or sensitized about COVID-19 triaging, or screening.
In the private sector which services up to 40-60% of the health care needs of the people, there was no early on training on Infection Prevention and Control, they were not incorporated into the response, neither were they incorporated into COVID-19 screening or diagnostics.
Individual states e.g Lagos, Ogun, Oyo, Ekiti, Kano, Taraba, and Government agencies e.g Nigeria Institute of Medical Research (NIMR) only recently gave approvals for public-private partnerships for diagnostics with partners such as Mobitel Group, 54 Gene and Flying Doctors Investment Company, MDaas Global and the Young President Organization (YPO).
Due to anxiety, panic, and emotional responses to the outbreak and news that health workers were getting infected, many health centers stopped offering services, and patients stopped going to the hospital. The costs of PPEs became exorbitant, people started self-medication with Hydroxy Chloroquine and Chloroquine, and people who were severely ill could not access the urgent health care they needed.
For some secondary and tertiary facilities, most patients with respiratory symptoms were refused to be attended to due to fear and unavailability of PPEs. Around this period there were quite a number of deaths unrelated to COVID-19, however, these persons died not because they had COVID-19, but because health workers were not confident attending to these patients due to valid fears of contracting the disease, as every presentation at the hospital was suspiciously labeled as COVID-19.
Other issues were the availability and distribution of PPEs to centers where they were needed. In the distribution of these PPEs mostly isolation and treatment centers were prioritized, however, other classes of facilities e,g secondary facilities, and tertiary facilities. Another issue was the nonpayment of salaries to government-employed doctors in certain states of the country, which caused this set of employees to threaten to down their tools.
The issue of health education cannot be overemphasized especially in the rural areas and urban slums. Persons in these areas had issues with access to healthcare before the outbreak. The restrictions on movement and commercial activities further restricted access to essential health services. As such persons in these settings require adequate information, communication, and ensuring trust in the government.
Health education (and Health Promotion about offering emotional support) in and to areas and organizations discharged survivors to live and work, so they are not stigmatized or discriminated against. We still have work to do in the following areas:
Incorporating accessible, affordable, available, and efficient technology in health care delivery across public and private sectors.
Democratizing technology to the primary health care centers, rural areas, and urban slums.
Strengthening the health care system to be able to quickly respond to epidemic-prone diseases and improving disease surveillance and laboratory surveillance at all levels of healthcare delivery.
Attitudinal change of health workers to the public especially as regards communication and empathy.
Improving clinical skills amongst not only Doctors, but nurses also, and always having a high index of suspicion a disease is infectious when offering healthcare service.
Communication and cohesion amongst all members of the health care team from the Federal to State to Local Government to Community Levels.
Motivation and appreciation of all frontline health workers e.g presentation of hero badges or award plaques, presidential letters of commendation, life insurance, prompt payment of allowances and salaries, and mental health support.
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