Guest Spot

‘We need institutional quarantine as well’

The novel coronavirus continues to hit hard the country, with each day scores of cases being recorded. It has not just affected ordinary people-the young, old, professionals and even healthcare workers (HCW) have been hit. In this interview, our Mzuzu Bureau Supervisor JOSEPH MWALE engaged president of the Physicians Assistants Union of Malawi (Paum), SOLOMON CHOMBA, on how best Malawi can deal with the issue.

Healthcare workers (HCW) seem seriously affected as well with Covid-19, what went wrong?

HCW infection rate is increasing at an alarming rate. Some of the reasons behind include inadequate PPE, failure of HCW to understand that their fellow HCW can equally infect them just like patients who have received a lot of attention by HCW as agents of infection and not themselves, Covid-19 prevention relaxation by most health care workers and the community due to the prevailing myths about its prevalence in our country, lack of disclosure of infected healthcare workers in various facilities risking other uninfected healthcare workers to get infected through their routine work interaction, that is, during handovers, ward reviews and departmental meetings and the tendency of hospital managers to force HCW to work in unsafe environment with the purpose of covering shortage despite having no required PPE.

On the myths, what needs to be done?

What needs to be done is to firstly clear the existing myths of Covid-19 by reaffirming the existence of Covid-19 in our community through apolitical Covid-19 awareness messages to both HCW and the community. Now that elections are gone, I would request government to put up measures of winning the lost public trust on the reality of

Covi- 19 in our country and also ask government to lead an exemplary life by following all Covid-19 prevention measures. Government has to make use of local community health organizations to disseminate Covid-19 messages and prevention measures.

We are talking about HCW getting infected as well, and numbers don’t look good. What is specifically happening in health facilities?

Managers of health facilities should be transparent enough on disclosing Covid-19 status of their employees as done by Dr Mbendera of Nkhata Bay DHO. This is important for HCW to know and appreciate the existence of Covid-19 at their workplace and adopt ways of preventing cross infection from their fellow disclosed infected HCW staff. On the other hand, once disclosure has been made early enough, contact tracing becomes so easy and quick hence early control of the further spread of the virus unlike when the disclosure has been blocked by managers with reasons of avoiding stigma and discrimination. Managers of various health facilities should never force healthcare workers to work in an environment which is unsafe for reasons of covering shortage. Much as we appreciate the need to offer health services, managers have to understand that for HCW to offer a good service, they need to be psychologically motivated and prepared for that work by providing them with all necessary PPE unlike forcing them to do something they are not comfortable to do at that time due to the unsafe working environment. Health workers are reminded to keep themselves away from all unsafe environment for their safety and safety of patients they are serving.

There are suggestions that we need institutional quarantine. What has gone wrong with self-quarantine?

Self quarantine in my opinion poses a higher risk of infecting family members and friends coming in and out of a patients quarantine home which is his or her usual residential place. The best option is institutional quarantine where patients can easily be monitored and enforced to follow quarantine recommendations and procedures which cannot be ably done under self-quarantine. It is evident that most of Covid-19 positive patients under self-quarantine do not actually stay home, but are seen moving around in market places and interacting with friends posing a serious danger of further spreading Covid-19.

Additionally these patients especially the symptomatic ones develop high fevers and some nasty symptoms which can ably be attended to at an institutional quarantine unlike self-quarantine.

Institutional quarantine will surely need a lot. What role can Government play in this?

Government has to recruit additional clinical staff which has stagnated for a long time unlike nursing staff who have all along benefited with a lion’s share. These staff are crucial in monitoring and managing institutionalized quarantined patients in need of a clinical decision and management plan unlike the current situation where the same clinician attends to the general wards at the same time is asked to attend to quarantined patients. This is a serious danger of Covid-19 contagion.

Government has to make and enforce a deliberate policy of healthcare workers working shifts to reduce exposure time to Covid-19 and allow them to rest. Government should provide palatable meals, good entertainment equipment/facilities, that is, internet availability, television and radio facilities to reduce boredom and psychological stress associated with Covid-19 diagnosis and quarantine. There has to be a good sleeping environment and beddings. Talk time allowance must be provided to enable the patients to continue engaging with their family members as a psycho-social therapy to psycho-social effects of Covid-19 diagnosis.

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