Covid-19 and medics: Who will save us as frontline staff are left exposed?

Kenya Medical Practitioners and Dentists’ Union acting Secretary-General Chibanzo Mwachonda (pictured) yesterday announced that he had tested positive for Covid-19, becoming the latest healthcare worker to contract the disease.

“The infection occurred while dispensing my official duties,” Dr Mwachonda said in a statement that also alluded to a lack of adequate protection for front-line healthcare workers.

For healthcare workers, it is not just them who are at risk, but their immediate families too. Those who have lost breadwinners are wondering whether the sacrifice is worth it, or whether their deaths were in vain.

June 24 remains permanently etched in Lucyline Gitonga’s mind.

Lucyline, a nurse in Kunene Health Centre in Meru, had not seen her husband, Moses Gitonga Ringera, for three months since the countrywide lockdown was enforced. Gitonga, 49, was a nurse in Nairobi.

Gitonga died a lonely death in one of the isolation beds at Kenyatta University Teaching and Referral Hospital. The last conversation his wife had with him was a day prior when he informed her that he was still on oxygen at the facility.

Soon after, his phone went off, unreachable for an hour. She assumed that since he was on oxygen, he might not have been in a position to talk to her. But that was far from the truth.

“It’s on that Wednesday that my brother-in-law called to tell me that he was gone,” Lucyline says in a phone interview with the Saturday Standard.

Gitonga had been taken ill a day prior to his admission on June 18. Lucyline recalls that he had complained of fatigue, body weakness, chest pains and shortness of breath. He was hypertensive, but it was well under control.

On admission at the isolation unit, the initial Covid-19 test done was inconclusive, but a repeat test confirmed he had the virus.

“I couldn’t go to Nairobi to see him, even if I went to KUTRH there is nothing much that I could do,” Lucyline says.

The curfew and restricted movements in and out of Nairobi in addition to her duties as a front-line healthcare worker made it the more difficult for her to be with her husband. In a few days, Gitonga had become a statistic.

By July 22, the World Health Organisation (WHO) reported that Kenya had a total of 558 healthcare workers who tested positive for the virus in 21 of the 47 counties. Seven of these have died, spread in Nairobi, Mombasa and Kajiado. The capital has had five deaths with Mombasa and Kajiado reporting a fatality each.

These cases bring to the fore the amount of protection accorded to our healthcare workers by the national and county governments.

Health Cabinet Secretary Mutahi Kagwe has gone on record on several occasions that there was no shortage of Personal Protective Equipment (PPEs) in the country and that front-line healthcare workers countrywide are adequately kitted to fight the virus.

However, those on the frontline say something different. Plus, the numbers are on their side.

Of the 558 infected healthcare workers by July 22, 33 are doctors, 33 clinical officers, 14 volunteer health workers, 15 pharmacists, 92 nurses, 38 lab technicians and 29 staff working at Kenyatta National Hospital.

The pressure on healthcare workers though was not a surprise. Data from the Ministry of Health show that internal conversations among the Covid-19 response teams already projected that April, May and June would see healthcare workers face the most pressure. Revised projections, still from MoH, pushed the peak of the disease further down to July, August and September.

The country’s total health workforce at both levels of government is currently estimated at 58,000, comprising medical specialists such as anaesthetists and physicians, medical officers, pharmacists, nurses, clinical officers, physiotherapists and medical lab technologists.

The 558 infected medical practitioners represent a 9.6 per cent infection rate among this critical group.

Although infection rates among this key group mirrors national rates, it is not enough to look at this in isolation of the number of people they come in contact with.

An asymptomatic nurse without PPE, say who is in charge of triaging at a busy public hospital, could see up to 100 patients during one shift, a number that could easily double if one was to pull a double shift.

Although this is hypothetical, the possibility remains real and just points to how crucial keeping health workers away from the virus is, if we are to successfully flatten the infection curve. And we can learn from other countries. 

In parts of Brazil, more than 1,000 health workers tested positive in early July.

Working without adequate protective equipment or access to enough tests, these workers may have inadvertently endangered the very communities they were trying to help.

Throughout the lifespan of the virus in the country, there have been candid discussions to keep not just healthcare workers, but those around them as well, away from infection. One of them was the isolation of front-line health workers at locations away from their families or the general population at least at the peak of the virus. After just weeks of trial, this was abandoned and soon, healthcare workers became part of transmission chains.

In early May, a front-line healthcare worker was part of a transmission chain that led to the infection of 14 individuals. Before being tested, the medic had had a total of 29 contacts. Five of these were household relatives. One of her friends who turned out positive had spent a weekend in the health worker’s household. The other of her friends infected her daughter and niece, with whom they live in the same house, as well as a neighbour.

Although this health worker could have been among the first to get infected, she was not the last. In Bomet, a 26-year-old nurse recalls the late night shifts, tirelessly working to save lives of patients at Longisa Hospital. He did all this with a single mask, which he would wear for more than 12 hours. A mask he would re-use for about a week.

The nurse told the Saturday Standard that he suspects it is through lack of proper protection that he might have contracted the novel coronavirus.

Putting their lives on the line for the greater good is a sacrifice that many health workers are confronting every day. And they have paid the ultimate price.

Lucyline remembers Gitonga fondly as a responsible father whose children never went back home for lack of school fees. He had made a home for them, they lacked nothing and had no significant social issues that would make their lives unbearable.

The children, she says, are often in tears. Their 22-year-old daughter is in college while the other two, a boy, 17, and 12-year-old girl are in high school.

“I am still counseling them, but what more can I do?” she poses. “They see me going to work at the health centre and they are worried, unsure of the future, and whether they will be orphaned if I get the virus at work... No one has talked about compensation.”

Health workers admitted due to Covid-19 have had to foot their own bills, with no special considerations like the risk of the disease being an unavoidable occupational hazard. 

[Additional reporting by Mercy Kahenda]