COVID-19 puts the health system to test in Bababé, Mauritania

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

Mauritania reported the first cases of COVID-19 on 13 March 2020. To date, the country has 6 confirmed cases: 4 imported cases from Europe, 1 case of community transmission in the capital Nouakchott, 1 imported case from Senegal in Kaédi, a town in Southern Mauritania and 1 death at home. Kaédi and Nouakchott have been officially declared as epicentres of the COVID-19 outbreak in Mauritania.

On 15 March, the government imposed a first set of restrictions, including the closure of the borders, a curfew and quarantine. These measures have gradually been reinforced since, all over the country. The Ministry of Health and its partners have made the roll-out of a Preparedness and Response Plan their priority; while at regional level, a reinforced collaboration between the regional health and administrative bodies to implement the government’s guidelines has been set up.

As soon as the second COVID-19 case emerged, the Regional Directorate sent a batch of equipment to the rural district Bababé, consisting of 1 box (50) of surgical masks, 2 disposable gowns, 1 body bag, 1 ThermoFlash and 1 box of non-sterile gloves. A drop in the ocean, and entirely not enough to meet the real needs. A second consignment, still insufficient, included, besides the goods, a training session on prevention measures for 2 nurses out of 14 health facilities in total.[i]

What was the operational team’s response to these measures? The health team of Bababé decided to concentrate all its efforts on the COVID-19 crisis management. They reorganised the health centre to ensure appropriate reception and triage of patients, and infection prevention and control. As Bababé is located on the border with Senegal and many traders use this road every day, the team has set up a quarantine station with the help of the local authorities to intercept those coming from abroad. Currently, 16 people have been put into quarantine; and they are surveyed by a medical team. The local authorities are responsible for the supply of food and a hotline [ii] is set up. As there is a shortage of community workers, a group of women and youngsters, all volunteers, backed up by the nurses, are trained to help raise awareness.

The district, suffering from a weak health system, faces significant challenges such as lack of support in the identification and follow up of cases and the impact of containment measures. Instructions are often contradictory: isolation at home or at a specific site? Intake or referral of patients? These are matters for discussion. The team, ready and willing to take its responsibility, cannot protect themselves and is not equipped to fight the epidemic. The management of psychosocial needs and the anxiety of those in quarantine, the health workers and the community are not even considered.

How does the population deal with the situation? The Corona virus pandemic has become the main talking point in health facilities, on street corners and in the central market. However, people do not seem overly concerned about catching the disease and show signs of complete ignorance. Speculation and fake news are rife: “The virus only kills white people and the elderly”; “Black people are immune”; “The virus is sensitive to heat so we will be spared”; etc.

As for routine preventive actions, only non-contact greetings and handwashing are effectively practiced by the community. The partial containment measures such as a curfew from 6 p.m. to 6 a.m. and the closure of restaurants, continue to spark a lot of controversy.

Map of COVID-19 In Africa (from Africa CDC)
Map of COVID-19 In Africa (from Africa CDC)

Most of the population of rural Bababé live from one day to the other. Their main activities are petty trading, cart transport, porterage, and selling couscous at night (mainly by women). The latter brings in between 2,5 to 3,5 Euros a day, i.e. a significant financial gain, that ensures daily survival. With the curfew shortening their day, the restrictions undoubtedly have repercussions on their economic activities. Men in quarantine, who are head of families and farmers, don’t have an income anymore.

Although these measures are implemented around the world, their impact on the poorest communities is worrying. The complaints grow but at the end of the day people remain helpless and badly informed. They start to protest against the authorities. A question of survival for the former and of national security for the latter.

Instead of welcoming the restrictions as lifesavers, the local population organises themselves in small groups to reflect on how they can bypass these measures. Every day, after 6 p.m. some arrests are made because people are still selling their goods on the market, or because their discussions about their cattle dragged on longer than foreseen.

However, community initiatives have continued despite these setbacks. Village chiefs and community representatives organise a monitoring and early warning system. A WhatsApp group has been created to coordinate and share useful information and suppress rumours and fake news. Hygiene kits and single pedal handwashing devices are made available at health facilities, mosques, Koran schools, town halls and village associations. The community team, together with the nurses in charge of the health posts, raise awareness on preventive measures against COVID-19.

On the eve of a potentially great outbreak in Mauritania, the dynamic within the community is remarkable: all the local players organise themselves and focus resolutely on the community prevention with only one objective: zero cases of COVID-19!

 

Biography

Yahya Gnokane is a medical doctor and expert in health services organization. Since 2018, he is working for the AI-PASS program as a technical assistant in the district of Bababé.

Kirsten Accoe is a midwife and public health expert. She is faculty of the Public Health Department of the Institute of Tropical Medicine Antwerp since 2018 and is in charge of the scientific follow-up of the AI-PASS program in the Bababé district.

Bart Criel is a medical doctor and currently professor at the Public Health Department of the Institute of Tropical Medicine Antwerp, Belgium. He is coordinating the overall scientific follow-up of the AI-PASS program.

[i] Projet d’Appui Institutionnel au Programme d’Appui au Secteur de la Santé, funded by the EU and carried out by Enabel and the Institute of Tropical Medicine (ITM)

[ii] A hotline which communities and people in quarantine can call to get advice when worried and on when to go to the health facility.

Competing interests

Enabel is the Belgian development agency and in charge of the implementation of the AI-PASS programme via a contractual arrangement with the European Commission and currently supports the Mauritania government in controlling the COVID pandemic. Enabel has sub-contracted the scientific follow-up of the AI-PASS programme to the Department of Public Health of the Institute of Tropical Medicine Antwerp. In order to contain the occurrence of possible conflicts of interest, the three authors remained at all times critically reflective of their position in the AI-PASS programme.

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