The forgotten first line: response to COVID-19 in Lubumbashi, Democratic Republic of Congo

This blog is a part of #COVID19Africa Series. Click for French version

The first line of care, the front line, is the patients’ first point of contact, the coordinator of care, the interface between the community and the health system, and is responsible for the health of a specific population. In much of sub-Sahara Africa and more particularly in the Democratic Republic of Congo (DRC), health policies are based on first line healthcare, represented by the health centres. As a result, primary care plays a central role in the health system.

The world is currently waging war against the COVID-19 pandemic. The first COVID-19-case in the country, imported from France, was confirmed by the Congolese Minister of Health on 10 March 2020 in Kinshasa, the capital and home to 10 million people. The third case – an official who returned from France – died on 12 March. This created widespread panic, not only among the population but also among the authorities. Initially COVID-19 was a matter for the Ministry of Health, but the President of the Republic took over and declared a state of emergency. Restrictions recommended by the WHO were imposed, including hand washing, wearing gloves and masks, maintaining at least 1 metre distance from anyone coughing or sneezing, sneezing or coughing in the fold of one’s elbow, etc.

Because of the increasing number of cases and deaths, the lockdown of Kinshasa and the closure of the country’s borders were imposed. Different national and local political authorities (provinces, communities) quickly took over, effectively side-lining the Ministry of Health in the emergency response. No guidelines or means have so far been given to the health districts. The broadcast media constantly transmit preventive advice. Currently there are 161 confirmed COVID-19 cases, 18 deaths, and 5 cured; 5 of the 26 provinces are affected.

The economic activities of the Haut-Katanga province include mining, which brings foreigners, including Chinese people to the region. Lubumbashi, capital of the province and nicknamed the copper capital, does not have any confirmed COVID-19 case yet. The Provincial Minister of Health regularly meets with the divisional health managers and the provincial health inspectorate, the chief medical officers of the health districts, members of the academic bodies and the health partners (NGOs and private organisations) who work in Lubumbashi, to develop an emergency response plan to COVID-19. A multisectoral response committee has been set up. A two-day confinement (23-24 March 2020), decreed by the Governor of the province, was enforced by the military and the police in Lubumbashi. The Bakata-Katanga, an insurgent group of secessionists from Katanga, saw the lockdown as an opportunity to attack the towns in the province at the end of March.

The health districts and teams in Lubumbashi have received no guidelines, financial support, or input for the emergency response to the COVID-19 pandemic. They have no health information tools such as case definition forms, guidelines about case triage, registration, decision trees, treatment options, referral, death protocols, etc. There is a shortage of medicines, masks, gloves, screening tests and there are no vaccines. Locally produced handwashing devices cost 25-40 US$ and the few health facilities that were able to acquire them put them at the entrance. The masks cost 0.35 to 1.00 US$ and are worn on a voluntary basis.

The first line of care seems to be “forgotten” in the response to COVID-19, as in the case of the Tshamilemba Health Centre, the only public health facility out of a hundred in the Tshamilemba Health District (one of eleven districts of Lubumbashi). The centre has 10 doctors, 15 nurses and 3 administrative staff, none of whom are trained in or protected against COVID-19. These health workers have no specific equipment to deal with this disease and do not know whether an emergency response plan to COVID-19 exists.

The lockdown also exposed the problem with urban health personnel: none of the staff live anywhere near the health centre. Those on duty the night before the lockdown had to work for two consecutive days before they were relieved because none of the other staff could reach the centre due to the roadblocks by the policy and the military.

The people of Lubumbashi are misinformed and there is complete panic. In addition to other health problems and killer diseases such as malaria, and the low socio-economic status (living on less than 1$/day), the increase in the price of food and basic necessities comes as an extra blow to an already impoverished population. Essential and generic drugs, mainly from China and India, have become expensive. Burglaries by armed bandits and awareness raising with inaccurate information about COVID-19 increase anxiety and terror among the population. The popular perception of COVID-19 is that it is caused by a demonic spirit.

The COVID-19 vaccine that we want to test in Africa is seen as “a drug meant to kill African women”. The public believes that such a vaccine should first be tested in countries with a high COVID-19 death toll such as France and Italy.

Politicians have side-lined and forgotten the first line of care in their response to COVID-19, a disease that will stay with us for a long time. Maintaining vigilance in the face of other problems like famine and other deadly diseases and a collaboration with primary care can reinforce the response against COVID-19 in the DRC.

 

Biography

Didier Chuy Kalombola is a doctor with a Master Public Health from the Institute of Tropical Medicine Antwerp. He is currently conducting research on the stewardship of urban health systems.

Bart Criel is a medical doctor and currently professor at the Public Health Department of the Institute of Tropical Medicine Antwerp, Belgium.

Conflict of Interests: None

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