Fight stigma for the home-based care for Covid-19 patients to be a success

Kentrade Chairman Suleiman Shahbal tries out one of the PPEs. He handed over 1050 full body kits to the County Government of Mombasa on June 13, 2020. Photo: Sherry Kui.

By Dorcas Moraa

info@womansnewsroom.africa

On Sunday May 31, 2020, Sengera sneaked into his father’s compound in Nyakwerema Village, Nyamira County, just before the crack of dawn. He had not been home for six months. Apart from visiting his parents after being away for such a long time, he yearned to meet his two-year old daughter and wife of three years.

The young man had travelled overnight from Nairobi – one of the counties under cessation of movement- by tucking himself inside a truck carrying luggage-that is an authorized to operate an essential service.  Upon arrival, he went straight to bed.

At about 6:45 am, an ambulance and two police vehicles with blaring sirens, arrived and parked outside their home. Fortunately, their compound is well fenced. As the mother and father scampered to find out what was happening, the police and two people in Personal Protective Equipment (PPE) approached the gate. Sengera staggered from his sleep. He approached the team cautiously, and in a short conversation with the people in spotless white “suits’’ as his mind worked fast to seek an escape route.  He offered to go back to the house to wake up the ‘Covid-19 patient’.

That was the last they saw him. Villagers lined around to the see how a Covid-19 patient looked like. They helped the police search for Sengera for over three hours – unknown to them that he was already on his way back to Nairobi.

What followed was ostracization of the family, that was immediately nicknamed the ‘Corona family’. For over two weeks, the mother, father and siblings of Sengera could not leave their home. They had to close their ever-busy shop and consume the tens of litres of milk from their seven dairy cows. The mother at first ignored the stigma and went to the local buying centre to sell tea. The villagers had forgotten her name; she was ‘Mama Corona’. It is more than three weeks since the incident, but reintegration into the Nyakwerema community has been a chewing of nails for his family.

Robero, a widow in her 30s in the next village, Nyankongo, went back home from Nairobi after the government suspended international passenger flights, as one of the measures of taming Covid-19. She had left home for the United Arab Emirates, where she had secured a job. Upon reaching home, word spread that she had been denied travel visa to the UAE because she was Covid-19 positive. Since the disease is deadly, nobody wanted to even meet her. Whenever she would appear from one direction, the young and the old took off in the opposite direction. Two days after returning home, she went fetching water from Rianyaturu Springs. All those who were queueing for the commodity took off shouting Corona run! run! run! The women and girls left their jerricans at the springs. She went back home without water and broke down in tears.

People walk through a Covid-19 sanitiser in Kangemi, Nairobi, on June 16, 2020. The Sanitiser was set up Westlands MP Timothy Wanyonyi in collaboration with other partners to ensure minimise transmission of the virus in the open air market. Photo: Samuel Kisika.

This is the shocking reality on the ground on how people associated with Covid-19 are treated even as the Ministry of Health releases the first 600 patients into the community under the homebased care programme, as per the June 2020 Ministry of Health Homebased Isolation and Care Guidelines for Patients with Covid-19. This has been implemented as Covid positive cases surpassed 4,700 as of June 20, 2020.

Under this programme, asymptomatic patients- who can still pass the virus to others- are to be isolated in homes. A caregiver is assigned to take care of the patient, under high standard operating procedures, which the public is yet to understand well.

Health Cabinet Secretary Mutahi Kagwe says the government opted for home-based care for recovering or asymptomatic Covid-19 patients to free more beds for critical cases as the current facilities overflow due to the rising number of infections.

Although the Guidelines were customised from those released by the World Health Organisation, the MOH is yet to show a robust strategy of dealing with the ripe stigma, which appears to have been planted by the government when citizens were asked to report visitors to their counties, from hotspot ones such as Nairobi.  The rife situation, therefore, means that many, including family and other caregivers, are exposed to stigamatisation just like it is largely happening to Covid-19 patient.

Besides stigmatization, the implementation of the homebased care may have their share in negating efforts of flattening the curve of Covid-19.

Caregivers are also required to wear tightly fitted N95 masks that cover the mouth and nose while in the same room with the isolated patient, who is under home-based care. The Guidelines say masks will be issued. This mask is said to be most effective. Five pieces of the mask, according to online sources is Sh1,999. No recycling of these masks. When not provided, the burden of purchase of the mask goes to the families, which are already suffering from the economic fangs of the virus. No sufficient awareness has been done on proper disposal of the masks; this remains in the Guidelines.

Even as the country rolls out the homebased care, over 80 medical practitioners had contracted the virus and are in isolation. These are trained and experienced practitioners, who also know how to effectively use the masks as well as other personal protective gear. It a huge task for a Kenyan in Nyakwerema Village to protect herself or himself against the virus if they are offering homebased care to their kin.

Homebased care may work if more trained personnel is available to compliment the caregivers. In Cuba, for example, a country whose mass testing has been door to door, has one of the world’s lowest doctor to patient ratio of 1:155. Kenya has a doctor to patient ratio of 1:6,355. The situation is even worse in the nursing profession- about nine nurses for every 10,000 patients. 

 On another note, hygiene has been pointed out as a critical component of combating the virus. Even in the home-base cared, access to clean and safe water is a requirement. Unfortunately, 40 per cent of Kenyans rely on informal or open sources of water while 70 per cent lack access to basic sanitation.

It is also unclear whether the government has partnered with underutilized private hospitals in bid to secure more beds as infections grow. 

Countries, such as the US and Brazil overburdened by the virus opted for establishment of care centres in stadia and other temporal set ups. Closer home, Machakos County has set up beds in Kenyatta Stadium in case of a surge in the numbers. These are best practices which if borrowed, will help Kenya manage the pandemic and flatten the curve quickly.

Article 43 (1) (a) says every person has the right to the highest attainable standards of health, which includes the right to health services, including reproductive healthcare.

Although it is at the discretion of the minister on how to manage the pandemic, nothing should be done to deny Kenyans the right to health- an obligation bestowed on the government by the people- as defined by the Article.

It is the obligation of the government to deliver on this mandate, not passing it to the people who are the tax payers. 

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