Living in a COVID-19 ‘hotspot’ in rural coastal Kenya
Mary A Bitta
7 April 2020
Like many parts of the world, Kenya has felt the crippling effect of the COVID-19 pandemic with majority of services coming to a standstill in line with the government’s strict regulations of self-isolation and physical distancing. Some of the tough measures include closing all schools, places of worship and recreational centres like pubs and public parks, stopping all international flights except cargo planes and those landing to evacuate foreign nationals, a countrywide curfew from 7.00 pm-5.00 am, and more recently, a 21-day containment order in the four hardest hit counties: Kilifi, Mombasa, Nairobi and Kwale. This means that no persons can travel into or out of these counties for the next three weeks, news that has not been received well by the residents of Kilifi county.
Kilifi, a predominantly rural coastal county, is one of the country’s hardest hit regions by the COVID-19 pandemic. It is also one of the poorest regions in Kenya with majority of the people living from hand to mouth and mostly relying on a daily income from manual jobs to make ends meet. Ironically, as the number of COVID-19 cases increase, residents of Kilifi county seem to relax their previously stringent handwashing and physical distancing routines that were observed when the pandemic initially hit the county. As one walks through the streets of Kilifi or along its sandy beaches today, it is not surprising to see throngs of people who are not practising physical distancing or handwashing points which no longer have running water or soap.
Residents are having a hard time understanding the concept of physical distancing and self-isolation with some even wondering what the local Swahili language equivalents are for these practises. Practises such as the use of motorbikes as a mode of transport, that invariably causes close contact between the driver and multiple people per day, remain unchanged, despite the government’s strict warnings. In the present circumstances where the government has provided no directives on how it will cushion citizens from the far-reaching consequence of measures such as containment, one can hardly blame the residents of Kilifi. They are faced with very limited choices: (i)to either stay at home and avoid contacting the COVID-19 pandemic, but also risk the consequences of lack of basic requirements such as clean and safe drinking water and food or (ii) to go out to public places and risk contracting the virus but acquire their basic requirements. The situation has further been complicated by incidences such as some senior government officials and religious leaders refusing to follow self-quarantine regulations and consequently testing positive for the virus, having had contact with large crowds of people in public gatherings, leading many people to be put in isolation units. Majority of those in isolation units, many of who tested negative initially, await retesting, to establish whether they were infected by the virus.
Some of the hardest hit people are health care providers, particularly those providing care for chronically ill patients such as those with mental illness. Although these practitioners have received basic training on how to handle patients who present with symptoms suggestive of COVID-19, recommended protective equipment is limited in supply thus putting them at constant risk of contracting the infection, should their clients be infectious. In spite of this, they continue to provide essential services routinely, placing all their trust in the government to safe guard their wellbeing through the measures that have been put in place such as screening of all patients at all entry points in the hospitals before they report to their respective clinics.
Kilifi is not all doom and gloom. The county government has made efforts to provide hand washing equipment at strategic places such as bus stations and near major shopping centres and markets. It has also supported diagnostic and research efforts through collaboration with the KEMRI-Wellcome Trust Research Programme which is based in the county and is working closely with the National Government to test and genotype samples from persons in isolation throughout the country. However, like everyone else in the world, the residents of Kilifi are in a limbo wondering when they will resume to, at the very least, a semblance of normalcy.
By Mary A. Bitta
Kilifi resident | Views are my own | Copyright to all images are my own
Mary Bitta is a graduate of the Global Mental Health MSc programme (2016-17).She is a nurse by training, currently undertaking her doctoral studies at the University of Oxford's Department of Psychiatry. Her research interests are in mental health interventions that lower the treatment gap of common mental disorders in rural areas of low-income countries. Mary's present work is based in Kilifi county, in coastal Kenya where she has lived and worked for 5 years.
We heal as one: Community participation in the fight against COVID-19
Bonface Beti and Angi Yoder-Maina, Green String Network
9 April 2020
Since the declaration of COVID-19 as a global pandemic, we have witnessed radical efforts by countries across the world to secure their population’s health. It is disrupting normal lives and paralyzing major world economies. The death rates specifically in Asia, Europe, and North America has alarmed countries in Africa.
In Kenya, it is feared a large outbreak will overrun our weak healthcare system. A mainstream reaction to the impending crisis from both government and citizens is the "ordinary" Kenyan citizen is either ignorant or lacks the requisite agency to make their own decisions or just needs to be "pushed” to be “saved”. It is a top-down mentality guiding almost all our policy decisions today. But the experience in other African countries during outbreaks shows us there is an alternative. When people own prevention it becomes the new norm.
The COVID-19 pandemic has caused a crisis in Kenya, a country already reeling under the weight of deeply divisive economic cracks among the classes and without a social support system for the citizens. The majority of city dwellers live hand to mouth. This reality challenges the World Health Organization (WHO) best practices such as wide testing, contact tracing, isolation and quarantine in stemming an outbreak.
The risk of deploying total lockdown by the state remains a real possibility in order to stop the deadly spread of the disease among informal settlements. The impending fear around such extreme measures being applied, continue to rattle the poor and elicit critical life and death questions as many are presented with the choice of either contracting the virus or fending for their daily bread. The city's informal settlements remain highly congested with large households often living in a small room. This alone poses a threat to quarantine and isolation as a public health response.
Additionally, due to high levels of poverty and poor access to basic services such as water, adequate housing, and food, the majority of city dwellers lack the power to choose safety over survival needs. This situation is made worse by the lack of basic healthcare services. Today there is an absence of initiatives directly engaging the poor as critical stakeholders in the fight against COVID-19. However, by building on the lived experiences of the population to create programs enhancing their capacities and tapping into their agency and resilience, the government can relegate the overall responsibility of preventing the spread of COVID-19 to her citizens. We each have to start to believe people do not wish to suffer and stop saying "Kenyans cannot be helped".
From a public health perspective, it’s important to point out how the majority of the poor in Kenya have struggled under the huge burden of other dangerous illnesses, such as malaria, HIV and tuberculosis. This lived experience has offered key lessons on how to build on the community's own resilience. For example, from Twitter chat on the first night of the Kenya curfews, a street family member had the following to say to a Kenyan journalist, "‘Karis” (his street name) said he doesn't think too much of COVID-19. I know tuberculosis, HIV, malaria, they have always been part of our life, so I just go about my business, as usual, we will meet with that disease when we meet.” His words speak for hundreds of thousands of poor families in Nairobi. The paradox is that the poor are living “normal lives” in dangerous times whereas middle-class and upper-class Kenyans are bent on “getting things back to normal”.
Communities must be central to their own recovery and should be supported by both civil society and government institutions. The 2015 Ebola crisis in Sierra Leone painfully revealed both the critical importance of engaging communities in crisis response and prevention and the reality that there were virtually no channels for doing so in practice in the early days of the outbreak. Given the historical context of mistrust, anger, and suspicion of the government, rumours were rife that the government was infusing the free government soap with the Ebola virus. Not only would the citizens not take it but also the unrests caused by the rumours were also developing into a larger security concern.
Given the deep levels of social mistrust towards the government, only community structures, such as Peace Mothers, were able to mobilize prevention and response initiatives within their communities. Once Peace Mothers began to make soap within the community, the community began to trust the soap was safe for them and their families. As the Peace Mothers handed out the soap, they were able to sensitize the community on the need for social distancing and other preventive measures communities could take to protect themselves. This was in contrast, to the pattern of the national and international response, which once again repeated harmful patterns that ignored community voices and missed the opportunity to mobilize local engagement and leadership.
Community ownership has been used successfully in Kenya with HIV and other health epidemics. Today such a process can enhance local level coping skills and develop social distancing rooted in the real Kenyan context. If we give the poor a chance to be a part of the solution they can do it, but we have to give them a chance. The starting point has to be different than in the past because we are now seeing the interconnectedness of our lives. The ordinary Kenyan citizen wants his family to be healthy and safe. She also has the required agency to make wise choices if given the right tools to do so. Let's find the right tools. And let's begin to believe in ourselves!
Views and opinions expressed are entirely our own.
The Kambe-Ribe Lamukani Youth Forum in Kilifi County, Kenya working with the community.
About the Green String Network
Bonface Njeresa Beti and Angi Yoder-Maina are Senior Managers at the Green String Network.
Working in Kenya, Somalia and Ethiopia, Green String Network incorporates limited-resource methods, building upon local cultural practices and traditions by using local folk tales, case studies and artwork.
Email: firstname.lastname@example.org & email@example.com
Bonface Njeresa Beti is a Kenyan artiste peacebuilder working with Green String Network(GSN), a Kenyan indigenous organization that applies holistic and practical healing centered approaches to peacebuilding in partnership with grassroots communities. He’s currently working on supporting locally owned social messaging campaigns to prevent spread of COVID-19 among Kenya’s populous informal urban settlements.
Angi Yoder-Maina is the Executive Director of a local Kenyan NGO called Green String Network (GSN) based in Nairobi, Kenya. GSN’s programs create opportunities for people currently in Somalia, Kenya, Ethiopia, and South Sudan at the most local level to learn about the effects of trauma, begin to heal and come together as a community to plan community-wide activities and structures to support further healing, and reconciliation.
Isolated in Hell right next door to Heaven: The solitary mind of a Zimbabwean youth
Tiny Tinashe Kamvura
14 April 2020
I know a lot of people will be amazed by my choice of words but if you have lived in a country like Zimbabwe your whole life and have South Africa as your next-door neighbour, you would understand. Normally when you hear about Zimbabwe on the news wherever you are, its usually the following greatest hits:
“Doctors and Nurses go on strike”
“Hundreds die of Typhoid “
“Poverty and Hunger rock Zimbabwe”
And my personal favourite “Government official charged with corruption”.
Zimbabwe hasn’t had beautiful stories in a long time. Yes, we have the majestic Victoria Falls but stories, NO! So, you can only imagine what it’s like living in a country like Zimbabwe in a time like this, knowing that death is no longer on your doorstep but has moved in and is keeping you company.
A friend of mine said to me right before the 21-day nationwide lockdown, that the corona virus was going to reveal a lot about this country, well the truths that we have been ignoring really. And it has done just that. It has brought to focus the real societal issues that have been bedevilling our once great nation for decades and now that we have got a catastrophe staring us in the face, we cannot help but feel anxious and afraid.
Despite the government having introduced a raft of measures meant to prevent the virus from spreading, the major highlight being the 21-day lockdown which they implemented after unending cries from the civil society and the death of a local celebrity. While these are commendable there are a few stubborn realities we must face.
Zimbabweans can’t really afford to stay at home!
When I say this statement, I do not only refer to the people out there, but I am referring to myself too. Over 80% of the Zimbabwean population is not formally employed which means most people do not have a steady income they can rely on. Even those for who do manage to get a regular pay cheque it normally is not enough to afford them the luxury of staying at home. Take the civil servants for example, a few days before the 21 days lockdown commenced primary health care nurses were threatening to go on strike over poor salaries. Doctors have been at it for years now and so have the teachers too. Everyone now has a side hustle that they pursue when they are not on the clock. My own mother is a nurse and a cross border trader at the same time.
We are a poverty-stricken country where most of us have taken to street vending and black market forex dealing for survival. Hand to mouth has become the norm in this country. Families survive on less than a dollar a day. Pensioners earn less than US$20 per month which is supposed to take care of them and their grandchildren whose parents probably died of HIV and the kids probably living with HIV too. It just isn’t possible. It’s really sad and painful to say this, but the people just cannot afford to stay at home not because we don’t want to, but because if we do, we might starve to death. It’s like a double-edged sword there is no escaping it.
Is our public health sector really ready for this???
One of the causes of the stalemate between health care workers and the government over the never-ending strike is the issue of improvement of their working conditions and service provision in the country’s public health facilities. There are medication shortages, outdated and broken-down equipment, and of course the issue of poor salaries. Even our government officials do not use government hospitals when they fall sick, they would fly to South Africa. Sure, the government has been encouraging its citizens to wash their hands and exercise extreme hygiene at all times, but the irony in that is that most suburbs in Zimbabwe do not have clean running water to begin with. Some haven’t had some in years. As of 13 April 2020, the ministry of health had conducted only 604 tests which is rather low for a country of over 14 million. Most of the designated isolation centres that the government is setting up are not yet complete due to the lack of resources. And to be honest for a country that is in the 21st century especially one such as ours which has one of the highest literacy rates in the world, some of the isolation centres that are being set up really don’t do it for me. Honestly its stuff that you would expect to find in war torn countries and not in a peaceful and supposedly progressive country like ours.
This is a serious wakeup call
For many Zimbabweans like myself this global pandemic is a massive wakeup call and a call to arms not only to the government but to the entire nation. A chance to reassess the situation. I live in a country that is famous for being corrupt where you hear of state funds being diverted for personal use and food aid as a political leverage. You shall forgive me for sounding a bit political, but sometimes turning to politics is the only way. We are quite lucky the corona virus has not hit us as hard as it has hit other countries, but we cannot keep in relying on luck. Now more than ever do we need sound, transparent and action-oriented leadership.
This is a call for us as a people to find one another, unite and together with one voice move towards rebuilding our country. As the corona virus has shown, the struggle is not between this and that political party but it’s us against the world. Had we been prepared on all fronts there wouldn’t be this much fear and panic that have gripped the entire nation. As hard as it is to admit this is all on us. Might I remind us that we are that country that famously “misplaced” fifteen billion dollars and did nothing about it. We have stood by and watched as the country has disintegrated into pieces and yet we remain silent. And what have we gotten in return for our silence and good behaviour; a potential Hiroshima on our hands. I may have not seen our country’s glory days, but I have witnessed my people’s capacity for good and it is high time we do good by ourselves and have the courage to make the necessary changes no matter how long and hard the road may be. Our lives literally depend on it!
Well Life Goes On…
We at the Friendship Bench have taken up the fight in the war against this global threat having recognized the toll it’s going to take on people. Knowing fully well how anxious and depressed people can be in times like these, it is now more than ever that psychology is needed on the front lines. As the Friendship Bench we have gone digital and are now offering our counselling services online. All one has to do is contact us by call or via social media (Facebook Twitter, WhatsApp) and you can have one of our in-house counsellors assist you. And that is not all, the online platform is not only limited to Zimbabwe but is open to the entire world. So, whenever you need a friend to talk to wherever you are just give us a ring and we will be there to listen.
Find us on:
Views and opinions expressed in this article are entirely my own.
Tiny Tinashe Kamvura is a research project coordinator at the Friendship Bench and is currently studying towards his Masters in Community Psychology at the Midlands State University in Zimbabwe. His research interests are in health system strengthening in low-income countries in Sub Sahara Africa and Political Theory. Tiny has been working at the Friendship Bench since 2016 where he started as an intern.
Life in Addis Ababa and parts of Ethiopia after the advent of COVID-19
16 April 2020
It has been only a few months since the World Health Organization declared that COVID-19 is a global pandemic. The WHO has announced that the consequences of COVID-19 will be profound in Africa. The pandemic has reached each corner of the continent, and Ethiopia—like the other countries in Africa – has already started feeling its impacts. Ethiopian Airlines has suspended international flights to over 30 destinations, tourists are not coming to the country, hotels and restaurants have lost their customers, and some companies have had to reduce the number of their employees.
Ethiopia is one of the poorest countries in the world, where a significant proportion of the population is unable to meet basic needs. Although the country has made considerable improvements in poverty reduction since 2000, poverty is still very high in the country. The country faces high levels of food insecurity and many people in rural areas and towns don't have access to perennial supply of water. This may complicate both the trajectory of the virus throughout the country and the efforts made to thwart it.
Back in January and February, before the infection was first reported in Africa, most radio and television programs in Ethiopia were focused on reporting other issues in the world like politics and sports, and there were many people who thought that the illness wouldn't come to Ethiopia. Nevertheless, many politicians and activists were asking Ethiopian Airlines to stop flying to China.
Then the entire news program shifted to cover the number of people who became infected or died of the illness in European countries. Earlier in March, we heard an announcement that a 48-year-old Japanese national went to a quarantine center five days after he entered Addis Ababa from Burkina Faso because he showed the symptoms of the infection. A few days later, the Ethiopian Public Health Institute (EPHI) confirmed that the Japanese national was COVID-19 positive and told the people that the 25 people who had contact with him were under quarantine. In light of this, the Prime Minister, the Health Minister and other higher officials advised people to keep their distance from other people, wash their hands frequently, and avoid gatherings and handshaking. They also entreated religious institutions to advise their followers to pray in their houses rather than congregate in churches. All of these measures are difficult to implement in Ethiopia because of the strong collectivist culture.
At this point, some people started buying in bulk the things that they thought they would need in their households if things got worse. Price gouging was widespread and in response, the government took strict measures on businesspeople who unfairly raised prices of goods and closed their shops. Similarly, pharmacies that raised the prices of alcohol, sanitizer gloves, and face masks were closed by the government. Some young men and children made fun of people who wore masks and gloves in the streets.
When the first COVID-19 related death in Ethiopia was reported earlier in April, the number of people in the streets who wore masks and gloves increased and people started practicing physical distancing at taxi stations, shops, banks, and supermarkets. However, many people still did not stop shaking hands or gathering in cafes, restaurants, and bars at that time. The second death was reported the next day. After this, the number of people wearing gloves and face masks increased further and the busier streets in Addis became deserted. Supermarkets and flour mills became packed with people who wanted to reserve food, cooking oils cleaning materials, alcohol and sanitizers. People flocked to pharmacies to by facemasks which were in low supply. At about this time, some volunteers in places like Mexico square, The National Stadium, and Megenagna put water containers with pipes and started telling people to wash their hands frequently. Shops, pharmacies, banks, and other people started telling people to wash their hands and use hand sanitizer before they were allowed to enter.
On March 16, the government closed schools and universities for 15 days and told students and parents to be in their houses and follow further notice on the issue. Following the increase in the number of people infected by the virus, the government announced its decision that everyone that enters the country will be quarantined for 15 days and extended the closure of schools for another two weeks. The government also made an announcement warning people that they could declare a national state of emergency if things get worse. In the meantime, they told people to keep a distance from one another and avoid gatherings and going to mosques and churches for worship. Many people refused to listen to this guidance.
In Ethiopia, people have lost their trust in the information they get from the media because most of the main media outlets have been used by previous governments as propaganda machines. And it is a custom for Ethiopians to go to their places of worship in times like this. We pray to God to save us from anything that could threaten our peace and stability. Some of us even believe that it is God who assigns our leaders, autocratic or not, to us. So we normally go to our places of worship and pray to God to change or correct our governments because we believe that it is God who assigns governments or send illnesses to us. Understanding this entrenched aspect of our culture, the current government convinced the authorities in mosques and churches to discourage mass attendance and prayer programs started being televised.
Another complicating factor is that a significant number of people believe that the illness is sent by God or in conspiracy theories about its origin. Some portion of the people believe that the illness was sent to us because of our sins. They claim that we should pray God to turn from His wrath. Others say that the virus was engineered by some secret society to depopulate the world. Historical mistrust of the media and the government gives weight to these types of ideas.
Although these measures and warnings were meant to keep people in their houses and avoid public gatherings, within days, the streets and market places started becoming full of people again. Those who were told to take a mandatory day off or work in shifts used their time outside their offices to meet friends and relatives. As previously mentioned, Ethiopia is a country with strong collectivist cultures; it is therefore very difficult for people to understand and implement physical distancing. Ironically, a common sight around Addis was people making lines with gaps of two meters between them only to then get into taxis that carry numbers of people far beyond their carrying capacities.
Despite the campaigns made by ministers and influential people, markets like Merkato, the biggest open-air market in Africa, are still packed with many people. The government moved the vegetable market to a place called Jan Meda because people refused to keep their physical distance from one another. Some people even attacked those who have told them to avoid gathering. Yesterday, four people attacked and killed a restaurant owner in Worabe, Silte zone, just because he told them that they shouldn't gather and chew khat.
As I am writing this, 85 people have tested positive for the virus in Ethiopia. The government of Ethiopia has just declared a state of emergency to fight coronavirus (COVID-19) pandemic and put restrictions on public transportation into and out of Addis Ababa which is the epicenter of the virus in the country. The city's mayor has said that Addis Ababa will not be put under lockdown. Instead, he said the city would focus on other ways to contain the spread of coronavirus. As for me, I think that putting Addis Ababa in full lockdown would be very difficult because most of the people in Addis Ababa can't afford to stay inside their houses, as many of them do menial jobs as daily laborers and they are very poor. The city administration called for the city’s rich people to help the mayor’s office in its endeavor to help poor people and established food banks for people who could face food shortages if the worst-case scenarios happen and lockdown becomes imminent. However, the number of people who need food help might overwhelm the city administration's capacity. There are many street dwellers in the city and some of them are seriously mentally ill people. Another problem is the shortage of adequate and consistent, clean running water which may make it more difficult for people to wash their hands frequently.
Yesterday, the federal police announced that it will take measures against people who don't follow the rules set by the government for the state of emergency without any preconditions. If there is perceived police overreaction, however, this could aggravate political unrest in the country and lead to riots or other demonstrations.
Much has been said in the international press about the worrisome lack of ICU units in most sub-Saharan African countries to help patients if the worst-case scenario is to pass. There aren't enough protective clothes for physicians to treat patients. In Ethiopia, there are less than 300 mechanical ventilators in the country and some biomedical engineers and physicians are working hard to fix those whose warranty has expired.
Easter for the Ethiopian Orthodox Church is coming tomorrow and is a massive national holiday marked by eating meat dishes to celebrate the end of a long fasting season. Many people were worried that they might not be able to eat raw meat like usual, however the meat markets for chickens, goats, sheep, and oxen have been open.
Throughout the city, we can see instances like this, where culture and public health measures and advice come into conflict. It is safe to say, however, that the entire population of Ethiopia is and will continue to be praying for the country to be spared the worst of the virus outbreak.
The most important thing to mention amidst all of this however, is that Ethiopians did not stop caring for one another, irrespective of their religious, ethnic, political and other differences. This is what we need at this unprecedented time and is an example for the region and the world.
Views and opinions expressed in this article are entirely my own.
Kaleab Ketema lives in Addis Ababa. He graduated in Applied Genetics from Addis Ababa university (2007). He did his research in EPHI, with the support of Ethio-Netherlands Aids Research Project (ENARP). He was an instructor in Menschen für Menschen (ATTC college in Harar, Ethiopia). He works as an independent consultant for research projects. He is interested in medical anthropology, molecular biology and social psychology.
A glimpse into how COVID-19 is impacting Uganda
Rebecca Kyomugisha & Dave Ndyanabo
21 April 2020
On the 22nd March 2020, a man travelling back from a 4-day business meeting in Dubai UAE was detained for further testing at Entebbe international airport, Uganda. During routine screening his body temperature was detected to be above the 37.8 degrees. A few hours later he was confirmed to be the first recorded case of COVID 19 in Uganda. Since then, all the passengers travelling from the UAE were called back for testing and several community tracking measures are currently on going. The recorded cases have since risen to 54, 4 with 4 recoveries and no deaths.
Uganda, as a nation has had previous experience in dealing with epidemics first with HIV and Aids in the 1990’s and more recently Ebola. With both scourges, it has been able to succeed in fighting off mass destruction by timely interventions and an open information sharing policy.
With the new Covid 19 interventions, our previous experience has helped the health ministry briskly jump in to quarantine and contain likely trouble spots first by the closing of borders and mandatory isolation measuresbord, and then by the country lockdown that was enforced a fortnight ago. This has seen our numbers of infection being kept low with no deaths being recorded. This is in contrast with some of our neighbors like Kenya that seem to be on the back foot with numbers growing exponentially.
Austerity measures like the supply of foodstuffs like grain and beans to the most vulnerable groups have also been introduced. Though it remains to be seen if this exercise will be successful with many gaps already being highlighted. Misappropriation remains a major concern in the country with senior line ministry officials recently being apprehended for diverting much needed supplies to their homes.
Borders would remain open only to cargo vehicles and their accompanying driver and tan boy. (Not more than 3 people per vehicle).
Uganda has declared a lockdown for an initial 21 days subject to review and has initiated a curfew every evening at 7:00pm.
These measures are not affecting people equally. The women who sell their goods in the market are forced to spend the night in the market so as to not be caught outside during curfew time. During curfew, a local police force referred to as the Local Defense Unit is deployed to enforce the curfew. They are armed with sticks and canes and punish offenders with beating to deter further offense.
Showing an unidentified military officer enforcing the new government guidelines using force. This woman was later tracked down by citizens who were outraged by the image of a woman being beaten and resources were pooled to support her and others as their incomes were clearly at risk.
H E Yoweri Kaguta Museveni released an exercise video demonstrating to Ugandan’s how they can achieve physical fitness indoors and encouraged them to avoid meeting in groups to work out outdoors.
Views and opinions expressed in this article are entirely our own.
Rebecca Kyomugisha a postgraduate student at Kings College London & LSHTM & Dave Ndyanabo Writer, Social Critic and Blogger in Uganda.
Risking life in order to survive
22 April 2020
Ethiopia is one of the biggest sub-Saharan countries, with a population more than 110,000,000. Sub-Saharan Africa (SSA) countries are known to have weak health systems and shortages of healthcare workers (1, 2). After the COVID-19 outbreak the Ethiopian government has taken several measures to prevent and control the spread of the disease, ranging from advising to wash hands to declaring a state of emergency.
However, community members seem not to take precautions seriously. After the detection of the first case, for the first couple of days most people were washing hands seriously. As the time passed, in many places either the soap or the water containers were empty when you checked to wash your hands. Like many other African countries, implementing the social distancing is not easy for most people in Ethiopia. I feel that we Ethiopians have a very tactile culture where we shake hands and talk to people with soft voice and get closer among each other when we communicate. I wonder how we could manage to adhere to social/ physical distancing.
I am living in one of the outskirts of Addis Ababa. The area is filled with many daily labourers. In my neighbourhood there is a very small coffee shop that provides service for about 70 to 100 people every day. Food and coffee is served in the street because there is no space in the shop. This place is chosen by many people because of its low cost and good taste of the food. Most of the customers are bajaj (tricycle) drivers and daily labourers. Around the first week of April there were 44 confirmed COVID 19 and on the 6th of April the ministry of health has announced the death of 2 cases. Then the response to movement restriction by the coffee showed owner and customers was very swift. I felt they had started staying at home to protect themselves.
If we stay at home we will die starving, if we go out we will die by Corona ... so I chose working and feed my family.– Addis Ababa coffee shop owner
It was reopened on the fourth day. I asked the owner and she said “if we stay at home we will die starving, if we go out we will die by corona ... so I chose working and feed my family”. When you see this coffee shop the service is provided in the same pattern as it was before COVID-19 - people eat together, three to four people are sharing a plate and having coffee together. The only thing that has changed is the shop has put soap next to the hand washing bowl. With our weak health system and with this lack of strict adherence to World Health Organisation recommendations such as hand washing and physical distancing, I wonder what is going to come when the disease begins spreading in the community. Poverty, living as a daily labourer or working in an informal sector have complicated the effort to contain COVID-19. Some people have to work in the morning so that they can buy lunch and work in the afternoon to buy dinner. The effort being made by the government and stakeholders to tackle COVID-19 should give more attention on how people working in the informal sector may subsist in such times.
Views and opinions expressed are entirely my own.
- Chen L, Evans T, Anand S, Boufford J, Brown H, Chowdhury M, et al. Human resources for health: overcoming the crisis. Lancet 2004;364:1984-90.
- Belita A, Mbindyo P., English M. Absenteeism amongst health workers – developing a typology to support empiric work in low-income countries and characterizing reported associations. BMC Human Resources for Health 2013;11.
Medhin Selamu is a nurse, social worker and mental health professional. She was working on integration of mental healthcare in rural primary care in Ethiopia for the past eight years. Her research interest are healthcare workers wellbeing, job related stress and burnout. Currently she is working in ASSET Ethiopia as project coordinator (Maternity cover).
'Chaotic' distribution of CODIV-19 pandemic lockdown palliatives in Abuja, Nigeria
23 April 2020
Any disease outbreak in Africa’s most populous country is never taken lightly and with the gravity of global situation of the COVID-19 pandemic, the Nigerian government moved fast to mobilize resources to respond to the outbreak response.
The first confirmed novel COVID-19 case in the country was confirmed in Lagos in the morning of February 27, 2020. The signs are ominous as the number of Nigerians infected with the deadly virus that has become a global pandemic continues to rise. By March 30,2020, the number of confirmed CODIV-19 cases in Lagos has risen to eighty-three, and from the initial three cases reported on March 23 in the Federal capital Territory (FCT, Abuja) to twenty-one. Some other states have confirmed case as well but Lagos and FCT Abuja remain the epicenter of CODIV-19 pandemic in Nigeria.
At this point Nigeria has felt the crippling effects of the pandemic and swiftly responded with a COVID-19 regulation lockdown involving cessation of movements in Lagos state, Ogun state, and FCT, Abuja for an initial period of 14 days. Citizens are to stay in their homes and businesses and offices closed, while national and international borders remain closed. This regulation has not gone down well with citizens in Lagos and Abuja who incessantly agitate for palliatives to mitigate the effects of the lockdown.
The Federal Capital Territory (FCT) is made up of Abuja Metropolitan city and five area councils of Abaji, Bwari, Gwagwalada, Kuje and Kwali. Abuja Metropolitan city has an estimated population of six million persons placing it behind Lagos as the most populous metro area in Nigeria. The five other area councils are essentially rural settlements with a huge number of poor and vulnerable households in line with the overall status of Nigeria as the poverty capital of the world.
The first phase of palliative distribution is targeted at 100,000 poor and vulnerable households in each of the six council areas, given a total of 600,000 poor and vulnerable households.
However, the distribution of palliatives in FCT, Abuja is to say the least chaotic and uncoordinated. The first phase of the distribution of the COVID-19 pandemic lockdown palliatives that is supposed to be concluded by April 14, 2020 is still ongoing. This is not unexpected because there is no verifiable digital data base in Nigerian which captures poor and vulnerable persons. Nigeria’s lack of good and systematic database has in small measure affected effective distribution of CODVIV-19 lockdown palliatives.
This has led to the allegation that the process is being politicized. The federal government has up till this moment been unable to utilize clear strategy of reaching the vulnerable and poor in the distribution of palliatives. It is not surprising to see throngs of people struggling for food as shown the pictures below. It is no news that many people out of frustration of the challenges of CODIV-19 pandemic lockdown openly complain against the government: is it possible to obey the lockdown.
We obey the lockdown. But we are hungry, No food. No light. How do they want us to stay inside?– https://www.premium timesng.com
A chaotic scene of people struggling and scrambling over food palliation on top of a truck.
A huge population disappointed and frustrated over the distribution of palliatives in Abuja, Nigeria.
Youths struggling to cart away food palliatives from inside a truck.
Peter Ezeah (PhD) teaches Sociology/Anthropology in Nnamdii Azikiwe University Awka, Anambra Sate , Nigeria. He is a member 10/66 Dementia Research Group.