In order to try to encourage a higher number of page views for this blog we have decided that it is time to have a competition with an eye watering prize, an all-expenses paid* trip to a remote desert hospital where you can experience at first hand both the satisfaction and the challenges of providing health care in an austere environment. To enter is simple, all you have to do is look at the picture above which shows some of the donations of useful equipment and supplies received by the hospital for the Covid pandemic and put an X in the place where you think the Covid-19 vaccine is hidden. The lucky winner is the person whose X is closest to the actual position of the vaccines.
*the trip includes full board and lodgings in Bardai for a 7 day visit and the necessary invitation letters but excludes the cost of a visa, international and internal charter flights to and from Bardai. It is also necessary to be in possession of a yellow fever vaccination certificate, a negative Covid PCR. and, recently added by the Ministry of Health, proof of Covid-19 vaccination. Always read the small print. Who ever said competitions were fair.
We have been aware of this risk from the outset, 18 months ago. At that time, it was unclear how easily the virus would spread and which age groups were affected. So, we prepared for the worst, with the help of BMS and the local authorities we created an isolation unit, and got supplies, of oxygen masks, pulse oximeters, cleaning materials, local made personal protective equipment and essential supportive drugs including dexamethasone ready. We got new small generators so that we could have oxygen 24 hours a day from our 3 functioning oxygen concentrators. At the same time health education messages were also made throughout the area, using mobile phones with local language films and with face to face, hopefully socially distanced, meetings. We made the clinical diagnoses of the first cases in June of 2021, there was one death but thankfully probably due to the young age of the Chadian population, (50% under 18 years), and the fact that most of life is lived out of doors, there was not a major epidemic. For various reasons a large part of the population refused to admit that we had cases and we had no possibility of laboratory testing so could not 100% prove the diagnosis. Although we could take a specimen it had to be kept cold and get to the lab at Ndjamena in less than 48 hours, and that was just impossible. So officially there was no Covid in Bardai.
Despite that the Ministry of Health sent more supplies including the in-vogue Chloroquine and Azithromycin treatment, hand gels an extra oxygen concentrator a non-invasive ventilation machine (CPAP) and training materials.
Throughout the first half of 2021 whilst we were in the UK it sounds as if there have been a number of our friends and colleagues who have has unusually heavy coughs and colds which have taken much longer than usual to get over, it always sounded like Covid to us, especially as we were aware of the growing number of cases and deaths in southern Libya. Fortunately during our time in the UK we had been able to receive 2 doses of vaccine.
Just after we returned from the UK in July a final piece of kit arrived, the most expensive yet, a Gene Expert PCR machine and associated protective equipment for the laboratory personnel. It has been sent so that we can look for Covid cases, and at the same time it can be used for tuberculosis testing and for monitoring HIV cases. It coincided with an outbreak of the more infectious delta variant in Libya and a number of weddings in Bardai. Soon afterwards people started coughing but the enthusiasm for testing in the local population is not great, most often patients refuse the test and return home saying its just a bad cold. Over the past 3 weeks we have tested just a handful of suspects and confirmed 3 cases. There must be many more in town, but thankfully so far this time, no complications.
We would never have imagined that we would have so much equipment and supplies to deal with the pandemic, the Ministry of Health, WHO and BMS have really done a good job in getting us prepared. However, in the face of a full local epidemic we have far too few nurses, and our supplies of single use PPI would soon run out. It would be so much better if our nurses were vaccinated, we would still need to take precautions but the risk of infection and possible transmission to other vulnerable patients would be so much less.
The truth is that despite all the efforts to prepare a diagnostic and treatment centre it would be so much better if we could prevent Covid by vaccination. Frustratingly, one year after the President of South Africa called for a TRIPS (patents) Waiver, the talks at the World Trade Organisation are still stalled and vaccines are still being sold at unnecessarily high prices. In the competition for the restricted supply it seems that booster doses of vaccines to ensure immunity amongst the vulnerable in the west is a higher priority than protecting the elderly, the vulnerable and health care workers in Africa with their first and second doses. Like the competition above, it is not fair, you have no doubt guessed that there is no vaccine hidden in the picture at the start of the blog, so you can’t win. The vaccine hasn’t arrived in Bardai yet, hopefully it will soon, and there will be enough of it to be useful.
Why is it that potential low-cost producers in South Africa and elsewhere are having such difficulty getting access to the necessary technology and patent permissions to increase the vaccine supply? Future generations are likely to view this is a crime against humanity, albeit one done stealthfully by vested interests, rather than the usual bombs and guns.
Which side of history would you like to be on? Are we a society of sheep or goats?
“For I was hungry and you gave me food,
I was thirsty and you gave me drink,
I was a stranger and you welcomed me,
I was naked and you gave me clothing,
I was in danger of Covid and you gave me a vaccine.”
Matt 25 (35-36) slightly altered NRSV
