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How COVID-19 pandemic undermines fight against other diseases

By Kelvin Ebiri (Port Harcourt), Chukwuma Muanya (Lagos), Nkechi Onyedika-Ugoeze (Abuja) and Murtala Adewale, (Kano)
03 May 2020   |   3:39 am
When Nollywood actress, Omotola Jalade-Ekeinde, on Saturday, April 11, 2020, took to her verified Twitter handle- @RealOmosexy to lament the death of a dear cousin

Advent Of COVID-19 Has Overwhelmed Management Of Other Ailments – NMA
• Disruption Of Measles Vaccination Campaigns in Chad, Ethiopia, Nigeria, South Sudan Puts 21 Million Children At Risk – NARD
• Number Of Malaria Deaths In 2020 in Sub-Saharan Africa Could Double That Of 2018 – WHO
• Lockdowns Hamper Free Movements, Access To Hospitals

When Nollywood actress, Omotola Jalade-Ekeinde, on Saturday, April 11, 2020, took to her verified Twitter handle- @RealOmosexy to lament the death of a dear cousin, who died in the faraway United Kingdom after failing to get sufficient attention owing to the rampaging Coronavirus Disease (COVID-19), not many people could relate to the development, or immediately get the import of her post.

Jalade-Ekeinde, a Nollywood veteran, who lamented that Jalad’s death was so hurting to her because he died alone, went ahead to United Kingdom’s health system for her dear cousin’s demise, as, according to her, health facilities were so focused on COVID-19 to the detriment of other ailments.

She wrote: “I lost a Dear Cousin Yesterday in London. I am hurting. He didn’t get COVID-19. He died from a kidney transplant complication; he couldn’t get proper healthcare because hospitals were focused on COVID-19 and help didn’t get to him fast enough. How sad.”

The actress continued: “Jalad is gone. He died alone. Jalad was too loved to die alone. The health system in the UK failed him.”

Jalade-Ekeinde’s lamentation may have sounded like tales from a distant land, but the reality on the ground reveals that a similar scenario is playing out within the country as the clan of COVID-19 sufferers continues to swell in the country.

For instance, on Monday, April 27, a skincare therapist and Chief Executive Officer (CEO) of Ghunu Effects Times, 24-year-old Judith Ihenosen Omonua died after missing a scheduled surgery.

The surgery was delayed by the lockdown, and according to the information shared on Instagram by the deceased’s sister, the late CEO had been battling with a heart condition, which led to heart failure for three years. “Her situation got worse and she was confined to a wheelchair and also constantly weak from the drips administered on her. However, she had hope that she could beat the condition after she was told she could have an implant to reduce the strain on her heart.

“Unfortunately, the operation could not be carried out as a result of the lockdown and it had to be after the lockdown. The lockdown seemed never-ending and the young lady started to lose hope of ever getting better and hinting that she was tired of life. Judith was later found dead in her bedroom by her sister.”

With the lethal virus now present in 34 states of the federation, health workers and their states’ governments are in dire straits as they are grappling with managing the deadly disease effectively alongside regular ailments, especially in the light of the massive strain put on healthcare services by COVID-19.

Indeed, matters are made worse when patients may not have coronavirus, yet the suspicion is there. In such situations, frontline medical workers, who are poorly kitted have to be extra careful and come up with innovations in order not to expose themselves to danger when trying to save other people’s lives.

Apart from significantly affecting the practice of medicine globally, because people with many regular illnesses are also avoiding going to the hospitals for fear of being labelled with COVID-19, or even being infected with COVID-19, that is, if they are lucky enough to get the attention of healthcare workers.

Muhammed Jamo, a public affairs analyst, while painting a pathetic scenario of what is playing out in the northern city, accused the Kano State government of “being a little more political, than being proactive in managing the situation.”

Jamo, who spoke on a Channels Television live programme, Politics Today, alleged that while states like Lagos have done so much in containing the ailment, including training of medical personnel, Kano State failed to take any concrete step, including training of medical personnel or making elaborate preparations for the pandemic.

According to the public affair analyst, this lack-lustre attitude of the government, he further alleged, “prompted 70 percent of medical doctors in Kano State to absconded from their duty posts because they are scared for their lives since they have not been provided with Personal Protective Equipment (PPE). The only patients that state-owned hospitals and the Aminu Kano Teaching Hospital (AKTH) are attending to now are accident victims and emergency cases. When you go to the hospitals, you find out that there are quite a huge number of people that are waiting to see doctors, who though focusing on accident and emergency cases are crying because there is no motivation. What is happening in Kano is a very sad development.”

The Chairman, Lagos State Health Service Commission, Dr. Bayo Aderiye, equally share the view that immense pressure has been brought to bear on health infrastructure in the state.

According to him, “It (COVID-19) has put pressure on healthcare provision in Lagos State because a lot of healthcare workers are being withdrawn to take care of COVID-19 patients. And that is why some of the volunteers that we are training (even though they may be elderly) may not be able to go to the war front. So, we are arranging that they would replace those in the clinics and hospitals, while the younger ones that are withdrawn from the hospitals will go to treat COVID-19 patients. So, we have been managing, but because of Mr. governor’s kind declaration that some categories of people should be treated free, a lot of people who would have gone to private hospitals decided to take advantage of that as well, and are rushing to public hospitals to benefit from that largess. On our part, we are trying to encourage and motivate our health workers through incentives and palliatives, in addition to providing adequate PPE.”

There is no gain reiterating the fact that the emergence and persistence of COVID-19 have put a severe strain on public health systems in the country and indeed other parts of the world.

Unfortunately, as countries battle to bring the outbreak under control, it is feared that other health emergencies and progress made against diseases such as malaria, polio, cancers, diabetes, and hypertension have derailed.

Before the arrival of COVID-19, the World Health Organisation (WHO) had stressed the need for countries to ensure the continuity of routine essential health services.

According to the WHO, an overburdened health system not only undermines the effectiveness of the response to COVID-19 but may also undermine the response to a whole host of preventable threats to human health. Even brief interruptions of vaccination make outbreaks more likely to occur, putting children and other vulnerable groups more at risk of life-threatening diseases.

Investigations by The Guardian revealed that the country’s health system has been overwhelmed by efforts to contain COVID-19, as most teaching and specialist hospitals have dedicated most of their medical personnel and infrastructure to the containment of COVID-19.

FOR the President of Nigerian Medical Association (NMA), Dr. Francis Adedayo Faduyile: “The advent of the COVID-19 pandemic has relegated the management of other illnesses and chronic medical conditions including, cancers, diabetes, and hypertension to the background. This pushback is understandable because of the acute nature of COVID-19, which requires mass mobilisation of human and material resources,”

“And because of its highly contagious nature, it will be challenging to continue to see patients with chronic illnesses at the same pace and circumstance. Our numbers in the management of chronic diseases are low, but now they are abysmal. Our fragile health system cannot strain. It will take enormous resources and efforts to rebuild even after the pandemic,” Faduyile added.

The NMA president said that a total number of 264 doctors have been exposed to COVID-19 situations out of which 20 contracted the infection; two recovered so far with three mortalities, noting that “these are among the over 66 healthcare workers who have tested positive after their exposure and four that have died.”

The medical practitioner, who said the NMA acknowledges that contracting the virus from patients, with the highly contagious COVID-19 is feasible, even with the best of conditions due to the inevitability of close contacts with the sick, noted that the occurrence could be reduced with strict adherence to the global best practice of Infection Prevention and Control (IPC) protocols.

He stressed that the availability of quality PPE and in sufficient quantity, and amenities like running water, enabling environment in the health service space, as well as spirit-lifting motivation and incentives can mitigate hazardous environments, reduce drastically the incidence of nosocomial infections and engender a hazard-free health service environment.

The NMA boss explained that the group has flagged off the “Save Our Private Health Practitioners (SOPHEP) Programme” to mobilise resources in cash and kind to provide adequate PPE and consumables to assist private health facilities seemingly abandoned by public authorities to practice IPC for their safety and protection of their staff, their patients, and by extension the general public.

Faduyile said: “We salute the astute conviction and unwavering patriotism of all health workers in Nigeria, especially the uncommon courage at the war front against COVID-19 and commiserate with the families and associates of the deceased.”

The association, he said, would continue to engage with appropriate levels of authority to provide for the safety of healthcare workers all over the country, while mobilising to continue to defend the country and its people against the ravaging army of Coronavirus.

The NMA president, who decried the country’s “fragile health system, which cannot withstand the jolt of a pandemic,” added that “even more developed health systems are unable to cope, so there is no gainsaying that Nigeria was unprepared… the solution to most of these challenges is for a holistic reform of the health sector, improvement in the provision of critical infrastructure, increase budgetary allocation to a minimum of 15 percent, and put in place, enhanced welfare, insurance, and training capacity for the healthcare workforce.”

ALSO commenting on the toll, which Coronavirus disease has taken on the administration of other ailments, the President, Nigerian Association of Resident Doctors (NARD), Dr. Sokomba Aliyu, admitted that the situation has been very challenging, but we have continued to manage all diseases, at all levels. The non-communicable diseases (NCDs) – diabetes, hypertension, sickle cell disease, cancer, pregnancy and related conditions, childhood diseases, and diarrhoea, which all carry a huge burden on Nigerians.

“We have learnt to attend to them and their emergencies, including the ones that present with fevers as well, while having a background suspicion of COVID-19 in some instances. This makes it pertinent for the healthcare workers to have a high index of suspicion; employ best practices of Infection Prevention and Control (IPC) at all times, and use appropriate PPEs at all times.”

But to what extent is regular healthcare impacted, by the increasing attention paid to the pandemic? Aliyu said: “COVID-19 has significantly affected the practice of medicine globally. In the first place, it has made people with many regular illnesses avoid going to the hospitals for understandable fear of being labelled with COVID-19, being infected with COVID-19, or in other instances, not even getting the needed attention by the HCWs.

“Also, whereas hitherto doctors and HCWs could attend to sufferers of these other ailments even without the necessary simple gloves, out of a desire to help in a neglected healthcare system, that is no longer possible as they could be suspected cases of COVID-19 as well. Hence the cost of being seen gets higher in terms of materials (gloves, face masks, goggles, gowns), and longer time/caution is required. Note that the Nigerian healthcare is still at the level where patients pay for services out of their pockets. Many of these patients are also more at risk for COVID-19 due to their co-morbidities.

“The lockdowns have affected free movement of the patients, access to hospitals, and regular medicines. Some of our patients are dying from the now fractured care of the co-morbid diseases, than COVID-19 itself,” Aliyu said, adding that, “some hospitals upon being in the news for having had a COVID-19 patient pass through (detected or not) have been forced to practically shut down, for losing the confidence of their patients, despite decontamination of the hospitals. This is what I call “the fear of COVID-19.”

Aliyu stressed that managing the situation to ensure that neither COVID-19 nor sufferers of other ailments suffer has been “very tough for the patients and us doctors as well. Education, training, enlightenment, counselling, and a whole lot are needed now more than ever. Infection Prevention and Control (IPC) have to be diligently adopted by patients, HCWs, and health institutions.

“From our perspective, the government needs to get more funds to the public hospitals at this time… Hospitals on their parts need the capacity to train and reorient HCWs in-house and restructure patient flow in keeping with IPC. They also need to ensure patients are placed appropriately in their wards in keeping with social distancing and IPC and also ensure that other hospital services like surgeries, ante-natal/child clinics, cancer care, immunisations are sustained and separated from infectious diseases areas to avoid cross infections. Importantly, they must build patients’ confidence. These cost a lot and may require entire restructuring in most hospitals, which hitherto had crowded looks at the clinics and wards. The cost implication is difficult for us to say now, but the government and the Federal Ministry of Health (FMoH) should have come up with it by now. Generally speaking, a lot just has to change with patients’ care and management and hospital services in the COVID-19 era and beyond.”

INDEED, the consequences of disrupting efforts to control malaria in Africa could be particularly grave. Current estimates suggest that sub-Saharan Africa accounted for approximately 93 percent of all malaria cases and 94 percent of deaths, mainly among children under five.

A new analysis by WHO and partners suggests that in a worst-case scenario if malaria prevention and treatment services are severely disrupted as a result of COVID-19, the number of malaria deaths in 2020 in sub-Saharan Africa could rise to double that of 2018.

Another essential health service, which is being disrupted by COVID-19 is immunisation. The response to COVID-19 has already disrupted vaccination efforts on the continent. Despite considerable progress on immunisation, one in four African children remains under-immunised.

Measles vaccination campaigns in Chad, Ethiopia, Nigeria, and South Sudan have already been suspended because of COVID-19, leaving approximately 21 million children who would have otherwise been vaccinated unprotected.

IN view of the unfolding scenario, the Regional Director for Africa at the WHO, Dr. Matshidiso Moeti, urged “all countries not to lose focus on the gains made in health as they adapt to tackle this new threat.

“We saw with the Ebola Virus Disease outbreak in West Africa that we lost more people to malaria, for instance, than we lost to the Ebola outbreak. Let us not repeat that with COVID-19,” the WHO chief stated.

Moeti added: “Africa has made significant progress over the past 20 years in stopping malaria from claiming lives. While COVID-19 is a major health threat, it’s critical to maintain malaria prevention and treatment programmes. The new modelling shows deaths could exceed 700 000 this year alone. We haven’t seen mortality levels like that in 20 years. We must not turn back the clock.”

UNPLEASANT consequences faced by non-COVID-19 patients in the wake of the scourge notwithstanding, the President, Guild of Medical Directors (GMD), Prof. Femi Dokun-Babalola has decried the fact that medical doctors are constantly being exposed to the dangers of the disease in their various practices.

According to him: “Many practices are still open for the sake of their old clientele because not every illness is COVID-19 or COVID-19 related. We are fully aware of the dangers of continued operations in the face of this, but we have little choice than to attend to patients. Imported PPEs that are meant to sort of insulate us from contracting this lethal disease are expensive and generally disposable, but the Federal Government has not deemed it fit to share donations from China, through one of their firms operating in the country, even though ironically, the Guild of Medical Directors had approached the company for this donation.

“We have suggested to the Federal Government that private hospitals should be equipped with rapid serological kits to aid the diagnosis of suspected cases of COVID-19, but the government feels the tests are unreliable. However, the way to go is not to dismiss all the tests, but to subject them to validation. In several countries, as we speak, serological tests are done alongside molecular tests.

“But in the meantime, we are doing our best to ensure that all patients have a temperature check; disclose their travel history, and wear facemasks. We also insist that patients use sanitisers or hand wash before they are attended to. All the same, all patients are COVID-19 positive until proven otherwise. This is what we call universal precautions.”

Rivers Shelves Elective Surgeries, Focuses Only On Emergency Cases
CARING for patients in Rivers State amid growing cases of COVID-19 is already taking a toll on healthcare delivery in the state.

For instance, surgeons at the Rivers State University Teaching Hospital (RSUTH) have resolved to attend to only emergency surgical cases, and are putting off elective surgeries for now.

A doctor at the RSUTH, who pleaded anonymity told The Guardian that healthcare providers are experiencing fear and anxiety that they might contract the virus while attending to patients with regular ailments such as respiratory tract infection, cough, fever, pneumonia.

The anxiety among the doctors, nurses, and midwives stems from factors, including inadequate PPEs.

“Getting by these days for us has not been easy, especially because we work in an atmosphere of fear. When we get to work, we put on only our basic protective gear like facemasks, despite it not being sufficient at all, but we sometimes go the extra mile to get PPEs to protect ourselves. However, most of these facemasks are not re-useable, but there is one brand- N95 that can be used for one week,” he said.

The gynaecologist explained that presently at the Labour Ward, doctors have insisted that facemasks should be provided for all patients because it is not enough for the doctors alone to be attired this way.

“If you see a potentially infectious patient and you are the only one that is wearing a facemask, there is still the risk of transmission. It is better for a patient that is infectious to wear a mask even if the doctor is not wearing one,” he said.

He continued: “If a patient coughs and has a high fever, the best thing to do at this time is to treat the person as COVID-19 patient until it is proven otherwise. A lot of people don’t like that approach as they will say they have been having cough all their lives. So, how is this one different and they start feeling they are being rejected,” he said.

While maintaining that general medical services have been adversely affected presently due to the pandemic, he added that “the surgery that we do now are only emergency cases and not elective surgeries. This is just to reduce the number of people that come into the hospital. So, in cases that can wait for the next six months, relatives do not have any need for booking the patients for now.

Biodun Shipeolu, a medical doctor, who works in an outpatient private hospital in Port Harcourt, explained that since the outbreak of the pandemic, very few patients visit hospitals these days.

“Most people do not want to come to the clinic except they are severely ill because they too do not want to contract Coronavirus in the hospital. The issue is that it is the patients who are at the receiving end,” he said.

Shipeolu said in the prevailing situation, doctors and other medical service providers treat and handle every patient as though they are COVID-19 positive.

“First, you as a doctor or nurse must guard yourself, while attending to patients. If a patient’s complaints tilt towards respiratory tract infection and other symptoms, you take 100 precautions in handling them because as matters stand, health workers are unnecessarily exposed. Even though we took an oath to save and protect lives, we do not necessarily have to endanger ours while trying to save that of others.”

The President, Medical Women Association of Nigeria, Rivers State Chapter, Vetty Agala, is upbeat that the continuous training and retraining of public and private sector health workers in handling coronavirus cases would impact positively in the state. Part of the training is focused on educating health workers on how not to stigmatise people, or turn them away when they visit hospitals for medical attention.

“As we speak, a lot of work is ongoing and most health workers by now know the protocols and should not just send people away. We know that malaria will continue, and also know that upper respiratory tract pneumonia will continue since COVID-19 did not come to dislodge every other sickness. So, people will want to access healthcare and we should not turn them away. What needs to be done is for us to protect ourselves from being infected or from infecting our patients,” she said.

Agala stressed that a public health emergency of COVID-19 magnitude was bound to cause some form of anxiety, and that was why doctors and health workers have been trained to effectively use infection prevention control where they work.

“If someone walks into a private hospital for instance, or any government facility, the doctors and health workers will know what to do. If they did not know what to do three weeks ago, well that would be taken for guaranteed. But, today, they will know what to do. We are responding,” she added.

The Rivers State Inter-ministerial Committee on COVID-19 on its part believes that even though healthcare professionals have done so much, a lot still needs to be done, especially in the light of recent identified gaps in the management of suspected COVID-19 positive cases in the state.

The Chairman of the Committee and Commissioner for Information and Communications, Paulinus Nsirim, during a meeting with members of the Nigeria Medical Association (NMA), Pharmaceutical Society of Nigeria (PSN), National Association of Nigerian Nurses and Midwives (NANNM), Association of Medical Laboratory Scientists of Nigeria (AMLSN), and the Nigeria Optometric Association (NOA), in Port Harcourt, said: “My interaction with healthcare professionals has shown immense lack of professionalism in the handling of that matter because it is widely believed that as healthcare professionals, you understand the protocols associated with handling pandemic issues. But we had that gap as a state. We thank God that that information was well managed and we are where we are.

“The gaps experienced in the handling of this matter poses a lot of question marks on how we should be operating at this point,” he said.

Chairman of the NMA, Mrs. Obubelebra Adebiyi, said one of the major problems facing health workers as they strive to manage the pandemic is the fact that some people do not even believe that COVID-19 is real. “The word on the street is that it’s not true. That is one of the major problems that we are having.”

Non-COVID-19 Patients in Kano At High Risk
SINCE the index case of the COVID-19 pandemic hit Kano on April 11, 2020, health facilities in the state started maintaining a balance between clinical care for their regular and new patients amidst uncertainty. But with the gradual surge in the number of positive cases of COVID-19, attention to outpatients dropped almost immediately.

Consequently, patients suffering from ailments like diabetes, malaria, hypertension, pneumonia, and other such diseases had to prepare for the worse, as little or no attention was paid them in many hospitals. Already, some major tertiary and secondary health facilities in the state had stopped receiving both regular and new patients, while those on admission, who were considered stable enough were discharged to continue their healing at home.

Some major private hospitals in the state not only scaled down their services but also stopped receiving patients.

Only recently, the management of AKTH also suspended all other clinical services, except emergency services and a few other highly critical units. The hospital advised patients to reach out to their doctors through dedicated telephone numbers instead of physical consultation. The situation is not different at the state-owned Murtala Muhammad Specialist Hospital, and Abdullahi Wasa Specialist Hospital.

A 65-year-old diabetic and hypertensive patient at AKTH, Muhammadu Aminu, regretted the deliberate shutting down of clinical services for non-COVID-19 patients. He expressed worry over the inability of the health system to manage multiple challenges simultaneously.

“In a time like this, we shouldn’t be discussing partial healthcare services or abandoning one class of patients to attend to the other. This further shows how the government is unprepared to manage the healthcare system. You can imagine, I cannot see my doctor unless on the telephone. What if the network is bad, or the young man is very busy with his business? God forbid that I run into an emergency now, how do I go about managing the situation?”

Another patient, Abubakar Danbatta said: “Now that hospitals are asking people to stay at home and call doctors to attend to them, how many times should we be calling doctors, and how many phone calls will the doctors attend to? This is not good for the health of elderly people. Only God knows how many people can afford to pay for their medication, and now patients are being asked to start making calls. Only God will save us from Coronavirus.”

Kano State lost about 600 persons in one week and this ugly and strange development put the ancient city in the eye of the storm.

Authorities in the state have debunked insinuations that the deaths were COVID-19 related, hence the verbal autopsy, which is being conducted to put the whole tragedy in a proper perspective.

This notwithstanding, the state government’s preliminary report attributed the cause of the mass deaths to ailments like malaria fever, typhoid fever, diabetes, and hypertension among several others. Incidentally, these sufferers of these ailments are presently denied medicare in hospitals due to the concentration on COVID-19.

The state chapter of the NMA in a memo dated April 18, 2020, cautioned members to consider their safety first while embarking on saving other lives.

The notice was after a medical doctor contracted the virus while rendering clinical services to patients. Although the NMA has denied the report, which alleged that over 70 percent of medical doctors in the state have deserted their duty post due to fear of COVID-19, it lamented the inadequate provision of PPEs, clinical face masks, sanitisers and other basic things needed to protect their lives.

The NMA in the memo also expressed worried over the lack of quarantine areas and SOP’s at general hospitals in the state to handle suspected, or identified cases before they are transferred to isolation centres, thereby putting the lives of its members at high risk.

Justifying the decision of hospitals to scale down clinical services, the state’s Chairman of NMA, Dr. Sanusi Bala, told The Guardian that the decision became necessary to reduce the risk of community transmission, insisting that streamlining clinical services at this period remains the best option for both caregiver and taker.

“We devised the strategy to keep everyone safe, but that does not mean that we deliberately want our patients to suffer. We gave long appointments to patients and discharged stable ones to decongest the clinic. That notwithstanding, we still work… and the hospital is not closed just that people have to take extra care. Don’t forget that some doctors are now in isolation.”

Similarly, the Chairman, Medical and Dental Consultants Association of Nigeria (MDCAN), AKTH Branch, Dr. Muhammad Imam explained that the situation at hand requires strategic clinical management.

Although he admitted that the drastic measures would affect patients, he said regular patients could be exposed to further complications if hospitals were left open.

“We suggested the closure of other clinics to the management because it is not just easy for doctors to operate 100 percent in this pandemic situation. But that is not to say that the hospital is completely shut down. We still operate our emergency, labour, and other critical areas, and we still come to work every day because we don’t have relievers. Having said that, you cannot rule out the challenges of infection that is why we are being very careful.

“Of cause patients of other ailments would be affected but we have taken alternative measures. We make our telephone contact available for patients to reach us for urgent consultations, and in case of emergencies, they can still come to the hospital and be attended to at the emergency unit,” Dr. Muhammad explained.

Troubling Times In Abuja Hospitals
THE situation in the Federal Capital Territory is not radically different from what is happening in other parts of the country.

According to the Chairman of the NMA, Federal Capital Territory (FCT) Chapter, Dr. Phillips Ekpe, doctors are still treating other patients, but in trying to manage regular patients, more problems could be caused.

“For instance, if you allow antenatal visits and all the pregnant women come in and get the place crowded as we usually have at the Nyanya General Hospital (between 150-200 women), how do we decongest the crowd to maintain physical distancing and prevent the spread of diseases? This is the same thing that happens in Accident and Emergency Units, as well as General Outpatient Units. That is why most of us resort to triage. For instance, every day we run antenatal services, and we now have a timetable in place to reduce the number of cases that we see daily. But even at that, they are still very many cases to be seen. We have divided them into various days, but those that have emergencies must be seen automatically. But that is after their temperatures have been checked at the hospital gate, and they have washed their hands over running water and apply hand sanitiser. Despite all these protocols being observed, it is still tough because some of the presentations of common malaria are also seen in COVID-19, including common flu.

“Somebody can also present with sore throat with fever, or cough with fever, and you think it is an ordinary infection whereas it is COVID-19. Without a test, which is not available to everybody, you can never be sure that you are safe as a health worker, and that is why over 100 health workers have now been infected by their patients.

“As health workers, we are doing the most to reduce the crowding of patients because apart from health workers getting infected, patients can also get infected when they are crowded. Until there are a good and rapid screening process and treatment in place, we will continue to have this problem. You also know that the doctor-to-patient ratio in Nigeria is very poor, so it is a tough task and a huge problem for health workers now. What the government should do at this time is to prioritise the welfare of health workers,” the NMA chairman stated.

He regretted that health workers in the FCT are still being owed shortfalls and salaries; there are some doctors, who started working around October and November and have not been paid to date. All these things are agitating them as they risk their lives in the forefront, while their problems and concerns are not being prioritised.

Ekpe, who recalled that the last time that the Association of Resident Doctors (ARD) FCT downed tools because of COVID-19, the NMA had to intervene before they called off the strike, lamented that demands that led to the strike action are yet to be fulfilled.

“The month has ended and we are not even sure of the situation. The government is spending money building isolation centres, and buying ventilators, but the human elements that would man these facilities are not satisfied. The timeline we gave them is the end of April, so, it is difficult for us to complain now, but by the end of next week, if they have not paid all the outstanding entitlements, we will begin to complain. It’s is not that doctors don’t want to work, but we have to work smart and work-wise to guarantee our health and that of our patients.

“The Federal Government should not be owing health workers at this precarious time because it is tantamount to owing a military man who is at the war front when they ought to be paid upfront; given a lot of bonuses, and provided with all the things that they need to work with. How can a health worker be working without facemasks and hand sanitisers now? They are not protected and right now hospitals are not generating enough funds to buy all these things or even improvising. Some hospitals like the Federal Medical Centre, Jabi, and the National Hospital are now making their facemasks and hand sanitisers. It is not the best, but that is what they are doing now. But is that enough?”

Ekpe, who said that lockdown failed to have the required effect while it lasted “because many people depend on daily jobs to feed their families, and government palliatives are not reaching everybody,” expressed concerns that the gradual relaxation of the lockdown could increase the spread of the disease.