This blog is a part of # COVID19Africa Series. Click for French version.
Despite the rhetoric and the experience gained during the Ebola epidemic, the implementation of these (hard) lessons learned in the Guinean health system still leaves a lot to be desired. Although all Ebola treatment centres are still in place, the number of COVID-19 cases increased from 111 to 1710 between 4 April and 4 May 2020, exceeding the capacity of Donka Hospital (the main national treatment centre for COVID-19). Several patients spent the weekend of 25 April in the hospital’s corridors, emphasising the need for care capacity to be ramped up. The treatment used is hydroxychloroquine combined with azithromycin.
The management of the pandemic remains centralised despite the fact that intake, care, and contact tracing capacity of the current system are low. The health staff in the primary health care facilities and district hospitals can be deployed to help relieve the pressure on Donka Hospital in Conakry, the epicentre of the disease.
At the time of our previous blog in early April. there was only one laboratory using the PCR method. Today there are 3 in Conakry, and 1 in the provinces. Instead of one sampling site, there are now about 10. Laboratory technicians are being trained. While the low number of cases a few weeks ago meant that results were reported within 48 hours, the current influx causes reporting delays of 3 days or more. At the beginning of April, there was only 1 treatment centre; now there are 3, including 2 in Conakry. Additional centres are planned. Because there is usually extensive travel between prefectures, the capital has been in lockdown since mid-April; those wanting to leave need authorisation, dependent on a negative COVID-19 test. The wearing of face masks was made mandatory on April 19, 2020 and appears to be strictly respected, at least in places where patrols check adherence. The recently established scientific committee said that a full quarantine is impossible to enforce in Conakry due to poverty and promiscuity.
As of 4th of May 2020, there were 1710 confirmed COVID-19 cases, 450 patients cured, and 9 hospital deaths, including a minister, the chairman of a public institution, and senior civil servants. These deaths have triggered a vast amount of fake news and rumours that “the Coronavirus is a rich man’s disease”, but have also demonstrated that the virus spares no one and that everyone can die regardless of their means and social rank.
The COVID-19 pandemic also causes other problems such as low attendance at health centres and hospitals. The fear of contracting the disease deters patients from seeking medical care. HIV patients and those with mental health disorders continue to visit the health centres, but TB patients don’t and as a consequence, have been without medication since early April. Furious patients, who up to now strictly adhered to their medication regimens, threaten doctors. The shortage of medication is said to be due to the closure of the borders and the disruption of air transport. However, there are some structural problems as well, like the failure to anticipate needs at the time of ordering. Even MSF (Doctors without Borders), that always responds fast in an emergency, was unable to meet the needs of the facilities it supported.
Although the management of the epidemic is extremely centralised, the first line of health care and its different staff categories (doctors, nurses, midwifes and laboratory technicians) are organising themselves. Training is being set up for health centre staff and community health workers. Protective gear is supplied to health care workers and the health centres distribute this free of charge to certain groups of patients, such as the chronically ill and the elderly with comorbidities. Local radio stations broadcast coronavirus spots in the local language. Community health workers supervised by care providers go door-to-door to inform households and some have set up security cordons at the entrance to cities with the support of prefects and mayors.
Finally, the North and the South have been in touch via email and Skype. About thirty Guinean general practitioners exchange views with their counterparts in 2 French nursing homes and with a dozen medical health centres in Belgium. These exchanges are mutually beneficial and enable participants to share intervention strategies, documents, and practices related to screening, contact tracing, care organisation, management of the containment system, and collaboration between hospitals and the first line of health care. They help break the isolation of doctors living in rural Guinea, and provide emotional support for those suffering from fear, stress, and burnout. Some 20 HIV/AIDS patients on ARV treatment in France, Belgium, Ivory Coast and Senegal, currently in Guinea but unable to leave the country because the borders were closed, were included in the cohort followed-up by these doctors, and could benefit from the flexibility of the national HIV and Hepatitis programme that supplies their health centres.
Guinean, Belgian and French general practitioners together overcome the obstacles associated with treatment regimens (triple therapy) that often differ from one country to the next. Substitutions for ARVs are decided upon in consultation with specialists. The continuity of care of ARV patients living elsewhere in the country is also affected by the containment measures but is being monitored in Conakry. Arrangements have been made with the Freight Transport Association to deliver patients’ medicines.
The overall outlook is not bright but the first line of health care, whether it has been involved in the development of the emergency response by health authorities or not, occupies a prominent place in these times of crisis, and is trying to provide accessible and acceptable solutions for its patients.
About the author :
Abdoulaye Sow is a general practitioner, public health expert and Director of the Guinean NGO Fraternité Médicale Guinée. He is supporting first line healthcare services and involved in the training of family doctors in Guinea.
Bart Criel is a medical doctor, public health expert, and currently Professor at the Public Health Department of the Institute of Tropical Medicine Antwerp, Belgium.
Competing interests: None