With the twin plague of COVID-19 and Lassa fever claiming the lives of Nigerians and dozens of health workers, the shortage of personal protective equipment amongst health workers is raising concerns, Daily Trust reports.
When Dr Chugbo Emeka, 51, died in Lagos this Wednesday after being exposed to a COVID-19 patient he was treating in his private hospital, it brought home the reality that doctors and other health workers are daily at risk of losing their lives in the course of their jobs.
Dr. Emeka’s death follows that of the COVID-19 index case in Katsina, Dr Aliyu Yakubu, who had returned to the state from Lagos.
Of the 188 people killed by Lassa fever, 10 are health workers, President, National Association of Resident Doctors, Dr. Aliyu Sokomba, had said during a live TV programme this week, following the death of Dr. Dzuana Philips in Benue State from the deadly fever.
Following Dr. Emeka’s death in Lagos, the state government is warning all private hospitals from treating COVID-10 cases in their hospitals and instead to refer them to the government designated isolation centres.
However, findings by Daily Trust Saturday shows that even those working in public hospitals do not have sufficient protection from the daily hazards of their jobs.
Limited PPEs in Kano as doctors cry for life insurance
In Kano, Daily Trust on Saturday gathered that all frontline healthcare workers at the state isolation and test centres have access to PPEs provided by the state government.
Though every member of the frontline staff comprising doctors, nurses and laboratory scientists at the test centres at the moment has access to a complete set of disposable protective kits, the kits are not nearly enough in case of a surge in community infection in the state.
The kit set includes a N95 facemask, an apron, a head cover, pair of goggles, boots and double gloves, which is the standard recommended protection for healthcare service providers during pandemic.
However, Chairman, Nigerian Medical Association Kano State chapter, Dr Sanusi Mohammed Bala said the government needs to provide all medical personnel in the state with PPEs, arguing that they are all at risk of contracting coronavirus through unsuspecting patients in the medical wards.
He said now, all medical staff in the state, with the exception of those drafted to the COVID-19 response team at the state isolation centre, are responsible for their personal protection in the line of duty even as the government remains adamant in making provision for reasonable hazard allowance.
“All doctors are on the frontline,” he said. “The dichotomy of saying those taking care of COVID-19 patients are in the frontline is wrong because everybody is involved in this crisis. Those that see the patients in the hospitals are also in the frontline because that’s where the cases you don’t know go to.”
To demonstrate his point, Bala points out how the index case in the state was a patient who went to a private hospital and exposed both health workers and other patients.
“In the isolation centre you know that this case is positive coming to you and all those protective kits you must wear them, but in hospitals you just have to put some level of vigilance because any patient that comes to you could test positive for coronavirus,” he said.
President, Association of Resident Doctors, Aminu Kano Teaching Hospital chapter, Dr Abubakar Nagoma Usman, echoes Dr Bala in the urgent need to kit all medical workers with PPEs.
“There are threats of contracting the disease and if we are left alone we will die with the disease because of the shortage of manpower, the doctors are not enough, and there is shortage of protective equipment,” he said.
He also harps on the need for life insurance for health workers, considering the paltry hazard allowance they receive.
“Doctors or health workers in Nigeria are being paid N5000 as part of their allowances in their salaries, so the thinking is that we are being paid to do the work we have been paid for that hazard. N5000 only you can imagine how you expose yourself, contract the disease and die,” he said.
Dr. Bala of NMA, for instance, thinks that hazard allowance is paltry.
“That N5,000 they give you monthly is equivalent to the cost of N95 face mask that you use for one day which means if you are using your money to buy N95 mask for the five days you come to work, you will see that you spend almost N100, 000 to get that for a period, [20 days],” he said.
“On the television you see everyday ministers and commissioners wearing N95 face masks in meetings, while we in hospitals don’t have such facilities. So we are not provided with protection kits, what we are struggling to do now is to use our money to buy them,” Dr Bala said.
A health worker at one of Kano’s major hospitals said before the outbreak in the state, the hospital authorities had used medical scrubs to sew facemasks for health worker, who knew that those masks would offer absolutely no protection from the virus.
For Dr. Usman, instituting life insurance for health workers is necessary to carter for the family of deceased medical workers.
“Recently, we lost a doctor from this same department of mine, we lost a doctor to Lassa fever in January and up till today, nothing has been done for his family,” he said. “Life insurance is all that is needed for health workers. Give them life insurance, give them the protection, give them what is their due,” he said.
However, the Director, Centre for Infectious Diseases and Control, Aminu Kano Teaching Hospital, Professor Isa Abubakar Sadiq, who is also a member of the state taskforce committee for COVID-19 cited Governor Abdullahi Umar Ganduje as saying that frontline services is a voluntary work for humanity though there are provisions for some incentives.
While calling on health workers to remain resolute in saving humanity from the pandemic, Sadiq, urged the government to rise to its responsibility by ensuring adequate provision of necessary materials for effective service delivery.
“It is only possible to give our best if authorities provide the necessary apparatuses such as the PPEs, drugs and other consumables for adequate management of patients. Authorities can also provide motivation including monetary incentives for doctors in the frontline,” he said.
In Lagos, which has been in the tick of the COVID-19 pandemic for weeks with the highest number of cases in the country, the situation is not very different from Kano.
Managing Director of the Mainland Infectious Disease Hospital, Yaba, Dr Bowale Abimbola said it is impossible to treat COVID-19 or Lassa fever without PPE, which the isolation centre has in sufficient quantity.
But outside the isolation centre, the situation was perilous for health workers who go to work poorly kitted for the challenges they have to face. A nurse who works at a General Hospital in Lagos Island told our correspondent that in the last two weeks, gloves, facemasks and other protective gears were being rationed because they are not enough for health workers until they protested.
“But after the health workers protested, they supplied the equipment and we now have more than enough to work with,” she said.
A radiographer said in the private hospital she works, she uses PPE anytime there is a suspected case of COVID-19 as she has to be in very close proximity of a patient in the discharge of her duties.
However, the Lagos Chairman of the Association of General and Private Medical practitioners of Nigeria, Dr Tunji Akintade, said private hospitals in Lagos do not have access to the PPEs.
“As the head of the private sector (medical), I have written a letter to the governor through the commissioner that we need the support of the government in this direction. It is not available even if you have your money and want to buy. The Government has a way of getting it. We don’t need to have the entire PPE but we need sanitizers, N95 masks and other protectives. Some of our staff need the normal facemasks since they will be dealing with patients directly. I believe the Government is delaying the provision of the PPE and they are invariably aiding the community spread of the infection. Since we asked for it, we have not been able to get it,” he said.
He said they lodged a request since April 3 when they discovered there is communal transmission of the coronavirus.
“I am very sure that the letter we sent to the commissioner has not got to Governor Babajide Sanwo-Olu because I know that if he has seen it, he would have responded promptly to that request,” he said.
Although, he added, there is a likelihood that the commissioner did not even get the letter. “But, I have followed-up, sent a text; I’ve sent a copy of the letter through WhatsApp of the commissioner,” he said.
He said the lack of PPE now puts health workers at risk as patients have been known to lie about their symptoms and travel history.
He too, like Dr. Usman and Dr. Bala complained about the scant hazard allowance.
“If somebody has died out of non-provision of PPE, what will they now use the hazard allowance to do?” he asked rhetorically. “There is a standard way of calculating hazard. Government has a document for it. The insurance has a standard rate depending on what the person is exposed to. What is the worth of a human being to us?”
Dr Akintade advised state governors to consider health system as a unit, regardless of whether it is public or private. “Whether there is an epidemic or not, it is not right to distinguish between public and private practice because it is a unit. It is the total number of doctors and nurses that we have that we will use in enumerating what is needed, not the number of hospitals but the number of personnel,” he said.
Nurses and cleaners at a state government hospital in Kaduna showed our correspondent an improvised facemask made from plain fabric which they claimed the hospital management distributed to healthcare workers almost three weeks ago.
“Since then, no one has said anything and we are expected to wash and reuse the mask since it is made of fabric,” a nurse said.
A doctor at one of the state’s military hospitals told our correspondents that hospital managements are now getting creative by making their own facemasks, which is sold to staff and patients. He said that the N95 masks have ran out in most hospitals.
Our correspondent observed some hospital cleaners and attendants with imported surgical masks that look worn because they have been washed.
“We cannot be buying masks daily so what we do is that we wash them and dry them so we can reuse them,” of them said.
Another Medical doctor at a private hospital in Kaduna said even before the pandemic, doctors and other health workers had battled with the country’s poor health system but said it is now worst due to the pandemic and Lassa fever. He described as unfortunate that government’s attention was on isolation centres forgetting that asymptomatic patients may visit any of the general or private hospitals in the state.
He said right now, private hospitals where faced with financial challenges due to poor patronage as most residents in the state fear that hospitals could be the easiest place to contact the disease.
“With a lot of patients coming in with suspected cases of COVID-19, healthcare providers are usually the first contact with patient, though there are reusable masks, but what we are seeing now is people are reusing the disposable masks and their employers are encouraging it. This is catastrophic if the virus reaches a stage of community transmission. We may lose a lot of health workers if something urgent is not done,” he said.
In Edo PPEs are also in short supply. In all the government hospitals visited, medical personnel were seen with personal protective equipment but a nurse at one of the government hospitals said, “The state government provides PPE but they are not enough to last the whole day.”
While they have to use a single glove per patient now, unlike before, her colleagues are not too disposed to using facemasks, as it is believed to have come from China.
“This week we have received supply of personal protective equipment but they may not be enough due to the prevailing situation. I think government should increase the supply though COVID-19 treatment is taken all the attention,” a doctor said.
“Our worry is that many doctors have contracted the disease but were are being careful while attending to patients,” another doctor said.
In Benue, a resident doctor at the Benue State University Teaching Hospital (BSUTH), Dr Matthew Iorfa, said PPEs are in short supply globally, especially in developing nation.
Iorfa however admitted that BSUTH provided him and some colleagues with the PPEs while others didn’t get.
Ruth Aondowase Zindzi, a nurse with BSUTH, said many clinics in the hospital currently closed down to ensure social distancing which is part of ensuring the safety of workers and patients, adding that in terms of personal safety, she had not heard nurses complaining of lack of PPE.
She said, “Naturally, the fear is there. However, as a nurse, whenever I’m called to duty like soldiers, I’m ready despite any barrier that might be. We don’t have enough PPE. We’re always ready and just prayed that the government doesn’t fail us when the time arises. It is better to sacrifice yourself singularly than run away from the fight in the event of an outbreak in the state.”
On his part, State Epidemiologist, Dr. Sam Ngishe, explained that government has taken necessary steps and is still doing so to ensure the lives of medical personnel are protected in the state by providing PPE, fast mask and other protective items for them to work with.
With Nigeria facing the twin demons of COVID-19 and Lassa fever, amid increasing cases of community transmission, unless these issues are addressed, the fates of Dr Chugbo Emeka and Dzuana Philips, who have lost their lives might be visited on other health workers.
Not all of them will receive the recognition Dr Stella Adadevoh, who lost her life in stemming an Ebola outbreak in 2014 has had.