Most counties ill-equipped to battle Covid-19 in third wave of viral attack

 

Reuben Githinji, a reporter with the Star while at an isolation room at Embu level five teaching and referral hospital before being transferred to Murang'a County. [Photo courtesy Reuben Githinji]

Kenyans are on their own as they face the third wave of Covid-19 pandemic.

This is if the situation at Kagundo Level Four Hospital in Machakos County is a reflection of the country’s public health system.

When The Standard visited the health facility on Sunday, patients recounted how they are forced to buy personal protective equipment (PPE) like gloves and masks if they are to be attended to, yet these are supposed to be provided by the county government.

“I came here yesterday but there were no gloves or masks... I bought gloves worth Sh2,400 and diclofenac that had been prescribed for me,” said Janice Mwanzia. “In this place, if you have no money (for the equipment), no one will attend to you.”

Mwende Mutua, a nurse in the facility, said the hospital reported six Covid-19 cases on Saturday. Since isolation beds were almost full, they could only accommodate three.

Safety concern

“We had to release the rest even after they begged to be given mattresses and be allowed to sleep on the floor,” she said. “Now I wonder if our communities are safe. Are our children and loved ones safe?”

Mutua said in the last one week, there have been no PPE.

“We are issued with one mask to serve all the six Covid-19 patients. Sometimes we recycle a mask for two or three days before we are issued with new ones, unless we buy for ourselves,” she said.

So dire is the situation in counties that getting a bed in the intensive care unit (ICU) or oxygen for a patient is a tall order.

For example in Embu County, it took combined efforts of colleagues for Robert Githinji, 48, to secure an ICU bed in neighbouring Murang’a County. Githinji had been in Embu Level Five Teaching and Referral Hospital for days with Covid-19 that caused him difficulty in breathing.

As the country battles the third wave, it appears counties either relaxed their preparedness or were never ready at all even after Sh5 billion was disbursed to them last year.

Vihiga is one of the counties which is unable to operationalise a five-bed ICU due to lack of oxygen. The oxygen unit, said the County Health Executive Amos Kutwa, will be ready by next month.

“The ICU facility will start functioning after the oxygen plant is completed. Such a facility without oxygen is useless and that is why we are working round the clock to ensure come the first week of April, we commission it as we prepare to deal with the third wave of Covid-19 infections,” said Kutwa.

Kakamega County has six operational ICU beds out of the available 16, according to the County Health Executive Collins Matemba.

“Currently, two beds are occupied while 10 others are not in use due to incomplete electrical and mechanical works that should make them fully functional,” said Matemba.

Busia Chief Officer for Health Isaac Omeri said the county has four functional ICU beds and that they were expecting one more from Ampath.

He said the county also received ventilators from USAid, which have enhanced the level of preparedness to deal with new infections.

The county, which borders Uganda, is experiencing a surge in infections in Matayos and Teso North constituencies.

The county has 415 isolation beds set aside to cater for Covid-19 cases, over and above the 300 beds President Uhuru Kenyatta directed every county to have by last June.

“We increased the number of beds as a stopgap measure in the event of the third wave of infections,” said Governor Sospeter Ojaamong’, whose county has five ICU beds to cater for severe corona cases.

The county has Covid-19 isolation centres at Agricultural Training Centre, St Monica Chakol Girls and at Alupe Hospital.

In Mombasa, Coast General Hospital Chief Executive Officer Iqbal Khandwalla said they were discouraging admissions of referrals for ICU services to free up space in readiness for any eventuality.

“Our aim is to make sure that we have enough space in our ICU for Mombasa residents. We have 12 ICU beds for Covid-19 patients and five of them are occupied,” he said.

The county reported the highest positivity rate of 50 per cent on March 15, according to data seen by The Standard. As of March 19, the county had 233 cumulative deaths, with 41 patients currently in hospitals.?

In Kilifi, Governor Amason Kingi’s administration last year installed 302 beds in isolation wards while Kwale also put up 300 such beds and 10 ICU beds in several facilities.

Kingi launched the Kilifi Medical Complex, which boasts of 106 beds with six ventilators. Jibana in Rabai has 30 beds with one ventilator.

Other Covid-19 Isolation satellite centres are Mbudzi with 40-bed capacity, Gede with 30 beds, Mtwapa with 60, Kambi ya Waya in Magarini has 30 while Misumarini in Kilifi South has six.

But like Mombasa, most of the isolation centres in Kilifi have been closed down following the drastic drop of Covid-19 cases and the rollout of home-based care.

Kwale Health Executive Francis Gwama said the county has not recorded any Covid-19 case and that all the 12 ICU beds in Msambweni were unoccupied.

In Taita Taveta, Health Executive John Mwangeka said the county has no ICU bed.

He said the new 160-bed capacity hospital being constructed in Mwatate was yet to be completed.

This poor status of public health in the county has caught the attention of political leaders in the area.

“We are doing badly on the health sector. Our public hospitals lack drugs, vital equipment like ICU and ventilators to save lives. We should stop playing politics with people’s lives.

“We cannot afford to see people dying. The county government should pull up its socks to equip hospitals with the vital equipment and drugs. We will continue speaking the truth until the county administration rectifies the situation for the benefit of the locals,” said county MP Lydia Haika.

The situation is no different in the Rift Valley where hospitals in Nakuru County are said to be almost full, according to a health official.

A county health audit showed there are 22 ICU beds in both public and private facilities.

There are four ICU beds for Covid-19 cases at the Rift Valley Provincial General Hospital that are full. At least 21 patients are admitted at the PGH isolation unit.

Naivasha has two ICU beds that are currently occupied and has recorded 10 patients who are symptomatic.

“Our ICU beds are constrained due to the high number of patients in critical state. For example, PGH and Naivasha are full while public facilities are struggling,” said an official who requested anonymity.

War Memorial Hospital, a private facility, has isolation beds to handle Covid-19 patients but is full.

The facility’s matron, Patricia Musale, said more patients than they can handle were seeking admissions.

“Initially, we had three isolation beds that we increased to six, but they are all full,” said Musale.

However, the facility does not have an ICU to manage critically ill patients.

In Kericho, plans are underway to open Ainamoi Hospital to manage patients in need of specialised care.

Betty Lang’at, the county director of health services, said the facility had been converted to offer services to general patients. The county has 300 isolation beds and nine ICU beds.

“Our isolation centres are fitted with piped oxygen for easy management of patients with shortness of breath,” said Lang’at.

Samburu County Health Chief Officer Sam Nakope said there are five ICU beds at Maralal County Hospital for managing patients in need of specialised care. Nakope told The Standard that though there are no active cases, the locals have dropped Covid-19 containment measures that were aimed at breaking the chain of transmission.

In Baringo, most patients are managed under home-based care, according to county epidemiologist Robert Rono.

The county has 70 isolation beds at Mogotio Hospital and eight ICU beds. The ICU beds are at Mogotio and Kabarnet hospitals.

“Our isolation and ICU beds are not stretched so far. In case we get more cases, there is space for expansion,” said the doctor.

In Kiambu County, Governor James Nyoro announced that the Tigoni Level Four Hospital was being reserved for Covid-19 isolation as health facilities in the area continue to report increased infections.

And Nyeri Governor Mutahi Kahiga has suspended all county government meetings, trainings and any form of public gatherings for the next 30 days due to a surge in infections.

Kahiga said last Thursday that the county had an estimated positivity rate of 25 per cent, higher than the national average of 17 per cent.

“This is largely attributed to recent laxity in adherence to the prescribed protocols and public health measures,” the county boss told The Standard.

In Meru, Health Chief Officer James Kirimi said the county, which has four public ICU beds and nine public High Dependency Unit (HDU) beds, was facing an infection rate of 10 per cent, with the two prison facilities at Meru town and Kangeta in Igembe Central being hotspots of Covid-19 spread.

Meru County, with a population of over of 1.5 million, has nine ICU beds in public hospitals and five others at the Kiirua Mission Hospital that is run by the Catholic Diocese.

Non-operational

Health Cabinet Secretary Mutahi Kagwe was to launch the Meru ICU/HDU on Sunday but all engagements involving Governor Kiraitu Murungi were suspended when he contracted the viral disease.

Health Executive Misheck Mutuma said the county, which had only two Covid-19 cases by January, had experienced a rise.

In Murang’a, there are five Covid-19 patients at the Murang’a Critical Care Centre while another nine are in isolation bays.

Murang’a last year commissioned a 35-bed ICU centre that was constructed in 21 days under the supervision of the county personnel.

County Health and Sanitation Executive Joseph Mbai said the ICU facility has been a blessing to the locals as transportation of the sick to other hospitals stopped in May, last year.

“Majority of the patients who have used our ICU centre are from other counties,” said Mbai.

In Nandi, it has emerged an 11-bed intensive care unit is non-operational eight months after it was commissioned.

Members of the County Assembly Health Committee chaired by Paul Sanga raised concern over the idle facilities at a time when the county registered 83 Covid-19 cases on Sunday after an explosion of infections at the Kapsabet GK Prison.

According to Sanga, the ICU beds are lying idle due to shortage of ICU staff, including anaesthesiologists and ICU engineers, with the county requiring up to 15 ICU staff to run the units.

“The efficiency of the health department has been derailed by lack of staff at ICU department since it was launched. Now that we are in the midst of the ravaging pandemic, the equipment could have served residents in case of adverse infections,” he noted.

Last year, the assembly approved Sh151 million supplementary budget to facilitate the recruitment of more medical officers, purchase of PPE and equipping the ICU wards in the two health facilities.

Sanga said the oxygen processing plant, an element said to be vital in equipping the health facility handling Covid-19 cases, had broken down.

Tinderet MCA Kipkirui Chepkwony revealed that shortage of ICU staff has rendered the facility non-operational, thus forcing residents to seek ICU facilities in private hospitals in Eldoret.

“The health funds approved by the County Assembly were meant to equip the ICU to help patients in critical health condition. We have not seen the impact yet the county procured only three beds while the rest were donations. This raises questions on the county health expenses to operationalise the facilities,” said Chepkwony.

When The Standard reached out to Health Executive Ruth Koech on the state of ICU facilities, she declined to respond to our calls and only sent a text message indicating that the facilities had not had a Covid-19 patient requiring ICU admission.

[Reports by Graham Kajilwa, Renson Mnyamwezi, Robert Amalemba, Nathan Ochunge, Bernard Lusigi, Weldon Kipkemboi, Mercy Kahenda, Gilbert Kimutai, James Munyeki, Boniface Gikandi, Phares Mutembei and Edward Kosut]