By Chukwuma Muanya, The Guardian Newspaper
They have put their lives on the line. They are most likely to contract one of the deadliest diseases in human history yet they remain at the frontlines. Indeed, medical doctors, nurses and other health workers are at the front line of the war against the dreaded coronavirus (COVID-19).
Also, several studies have shown that the most vulnerable to COVID-19 are the elderly and health workers including doctors, nurses and other allied health professionals.
Speaking on the challenges and experience of health workers in their efforts to help contain COVID-19 in Nigeria, President, Nigerian Association of Resident Doctors (NARD), Dr. Aliyu Sokomba, said: “To start with, we are faced with a new disease, a global pandemic, with rapidly evolving features and dynamics. We are responding on the background of the very weak and poorly funded healthcare system, poor infrastructure, inadequate manpower, absence of training of Health Care Workers (HCW) and capacity building among others; absence of useful demographics of healthcare facilities and even citizens.
“It was the norm for Government officials and the elite to access healthcare abroad and allow the weak and poor to grapple with the dysfunctional healthcare system. Hence the experience became that of lack of capacity to do prompt laboratory testing and confirmation of COVID-19. Samples taken last about three to four days before the result is given and absence of basic Personal Protective Equipment (PPEs) for HCW as well as having a demoralised workforce already battling with paltry hazard allowance and absence of life insurance policy.”
Asked if he was not afraid of contracting the virus, Sokomba declared: “Everyone is afraid. Sure we are. It is a new disease with no cure yet. But if we are trained and protected, it is possible to render excellent services without being infected. That is our hope. However, where HCW infection sadly does occur, we should seek some solace in Life Insurance policies, commensurate hazard allowances and medals of honour which we pray should be given to HCW by the Governments.”
Nevertheless, the NARD President said the calling of health care workers demands that they sacrifice for the health of their patients and give their very best, affirming, “we are willing to do so.
“But you agree with me that it is ‘senseless’ to engage in a battle/service for which we are ill-equipped. We just must get the requisite training and appropriate equipment for us to be able to render the necessary services to our patients.”
On the plans for special insurance cover for frontline health workers, Sokomba said there was nothing on the table yet. “Even the last Presidential broadcast hardly captured that. It is saddening that while the disease rages and HCW pay the supreme sacrifice, it is taking government ages to insure our lives; whereas if it were to be monies for elections, allowances for the executive and lawmakers, it is sorted and paid upfront even before the activities are embarked upon. We need the media and CSOs to help us in this regard,” he appealed.
Asked what he would have done differently in the efforts to contain COVID-19 if he were the Minister of Health, Sokomba said: “The steps taken are fair and scientific in a number of cases. However, I will take advantage of the situation to build a working healthcare system for Nigeria.
“We should upgrade the laboratories of all tertiary health institutions to be able to test for COVID-19 as well as other specialised tests. Meanwhile every state should have at least one reference laboratory.
“Isolation facilities should be integrated into functioning tertiary health institutions so that they can be useful to us even after the pandemic (the make shift ones in stadiums will have to go with the current pandemic).
“There is a large pool of young doctors/HCW post-graduation, House job and National Youth Service Corps (NYSC) that should be engaged, trained, incentivised, insured and deployed. They will remain a future asset of trained workforce for Nigeria in the future.”
He urged Nigerians to adhere to the World Health Organisation’s (WHO) guidelines for tackling the virus, saying that is the best way to go.
“Let us keep to the WHO recommendations but customise where necessary – social distancing, increased testing with less than 48 hours turn around time, improved isolation and treatment facilities in every state and preferably in every tertiary health institutions and insured HCW with commensurate hazard allowance.”
On his part, the Lagos State Chairman of the National Association of Nurses and Midwives (NANM), Israel Blessing said, “the experience of our nurses on the field in the last few weeks has brought to fore, pertinent and apparent questions that should be addressed as Lagos State is steadily moving to the third stage of COVID-19 pandemic outbreak, which is community transmission.”
She stated that the leadership of the association has great concerns for the working environment the nurses have found themselves, availability of PPE and welfare packages for health care workers.
According to her, the shortage of these items is worrisome. She urged the State Government to beef up security as the rate of hoodlums’ attacks and armed robbery on some of our members was on the rise probably due to hunger, restlessness and possibilities of psychological disturbances, occasioned by the lockdown.
Blessing stressed that most of the expected PPE needed to combat COVID-19 were not available for use hence nurses were being exposed to unnecessary risk, adding that nurses suffer avoidable consequences arising from poor conditions of service and lack of recognition.
She said the consequences of not placing appropriate values on nurses according to their worth have become so glaring and playing itself out in the current dispensation, “as we continuously witness a lot of nurses being neglected, ignored and not catered for while they put in their best daily, in line of duty in diverse hospital settings.”
He said they were pained to appeal for support from the management of health service delivery of the state for easy transportation, provision of consumables, supplies and feeding for nurses since they now run 24-48 hours duty in different health care facilities.
She said it was quite unfortunate and very disappointing that despite promises of robust packages for health workers in Nigeria, nothing has been done till date.
Blessing said as an association, NANM feels that nurses must not be made sacrificial lambs simply because ours is a noble profession in which the interest of our clients come first.
“It is important to let you know that we need to be alive and in good health to be able to carry out our roles efficiently and effectively,” she noted.
Blessing called for improvement in the provision and supply of PPE, which include surgical masks, latex and elbow gloves, disposable gowns, sanitisers, head covers, boots, eye goggles, disinfectants, antiseptics etc; oncretised arrangements for insurance cover for nurses; upward review of the present ridiculous hazard allowance for all health care workers; and workable arrangements on transportation to and from work for nurses and other health workers within the lockdown period, among others.
President, Nigerian Medical Association (NMA), Dr. Francis Adedayo Faduyile, told The Guardian that “the welfare and well being of Nigerian doctors and other healthcare professionals should not be toyed with at any point especially this critical period.”
He, however, regretted that the Nigerian government has neglected this over the years leading to worsening statistics in respect of brain drain.
National President of NANNM and Vice President of Nigeria Labour Congress (NLC), Abdrafiiu Alani Adeniji, said that even before the COVID-19 pandemic, there has been lack of adequate policies to empower Nigeria nurses and midwives.
“Health policies have always been lopsided without the involvement of nurses and midwives and therefore such policies are very inimical to the professional growth and development. The policy on nursing education for example is not supportive of nurses agenda and placement and recognition is against nurses and midwives. The duration of education of nurses and other health care professionals at the university is same and only a year lesser than medical doctors but in public service placement nurses are the least placed yet nothing has been done to this,” he said.
Adeniji said there was no strategic plan towards combating COVID-19 in the country. He explained: “Whereas nurses are the number one frontline profession in issue of pandemic and infectious diseases management, they are often the first contact professional that the patient meets and stays longer with than any other health care professional. Equally, the enormity of nursing services are more in volume than that of all other health care professionals put together yet there is no involvement of nurses and midwives in the planning of Covid-19 intervention programme. Therefore, the policies and planning lack essential ingredients that will make it efficient. This poses challenge of job dissatisfaction to nurses.”
On what he could be done differently at the moment, the nurse said: “Firstly, convene a meeting to serve as advisory of the representatives of professional and trade unions in health sector. This will give technical guidance and provide reality on the true reflection of the challenges militating against war being waged to combat COVID-19.
“As a matter of urgency, there is the need to change our policy on the disease’s surveillance, contact tracing, increasing testing capacity and increasing number of volunteers as well as engaging the front line professionals adequately to face the war of combatting COVID-19.
“Also, this is the time to meet the various pending needs of health workers like paying the Federal health workers’ withheld two months salary, increasing the hazard allowances of health workers and do that equitably and justifiably among the health care professionals. Life is unique and the worth of life is not different from one person to the other.
“The Federal Government should finalise tangible insurance scheme for the health care professionals. This will motivate the professionals to perform excellently.”
Adeni said the best way to tackle coronavirus is to be business-like and critical at curtailing communal spreading. “Monitor and trace contact and for Nigerians to be sincere enough to declare their medical history as well as travel history to easily single out index cases. It will also be essential to firm up the treatment schedule and open up treatment centre to ensure there is adequate facility to accommodate and treat victims of COVID-19,” he noted.
Other health professionals who spoke with The Guardian from across the states lamented the state of affairs in the health care system especially as regards the welfare of health workers. Below are the reports:
Rivers Health Workers Exude Passion But Lack PPE
From Ann Godwin, Port Harcourt
Health workers in Rivers State show great passion and commitment to their jobs. But they are confronted with several challenges, which apparently impede their services.
Findings showed that they are willing to make more sacrifices to save lives if adequate facilities are put in place by the Government, especially the personal protective equipment (PPE) and other incentives.
In an interview with The Guardian, the State Chairman of the NMA, Dr. Adebiyi Obelebra, said health workers in the state had not been finding things easy.
His words: “I am grateful for this attention to health workers because oftentimes, this our job is like a thankless job. Well, from the days of Ebola, Lassa fever and now COVID-19, it has not been easy. There is no serious attention to the health care system in the country, not even the health workers.
“COVID-19 is getting attention because it is affecting everyone but the health workers have been on the receiving end. Some medical personnel have lost their lives to Lassa fever and Ebola because of lack of personal protective equipment and nobody cares.
“If you look at the statistics of Lassa fever, COVID-19 has not killed the way Lassa fever killed health workers because a lot of them do not have PPEs. If PPEs are available, doctors will have confidence to walk into any clinic to see the patients. If we have what we need to work with, doctors and nurses are ready to make the sacrifices; the hospitals need to be equipped up to standards to give us the platform to do our work without fear and we will put in our best if things are in place.”
Obelebra, who is the facility manager of the COVID-19 isolation centre in Eleme, Rivers State, added:
“Sometimes, it is painful for doctors, nurses to see our patients dying because you don’t have equipment. So many doctors and nurses have broken down mentally and emotionally seeing their patients die because of lack of equipment to work with. It’s so disheartening.”
She called for improved welfare for health workers, saying: “It’s ridiculous that at this age, the hazard allowance for doctors and nurses is just N5,000. How much is our senators earning? The government of Nigeria needs to give priority attention to the health system and the health workers.
“People can pay anything and go to court but the medical sector is neglected. PPE is in short supply; sometimes the health workers buy these things with their money. If we can get these things, we are ready to confront the pandemic. Other people can afford to be at home but we can’t. Health is more than wealth. You may have all the money but without health, you can’t enjoy it.”
On her part, a senior nurse at the Intensive Care Unit of University of Port Harcourt Teaching Hospital (UPTH), who craved anonymity, revealed that there were so much challenges and fear working in such centres because of lack of equipment to work with and poor diagnosis.
She however noted that they were doing their best to save lives with available resources.
“We are willing to continue rendering health care services but special attention should be given to providing enough materials to work with. At the moment, we need more ventilators in the ICU, more PPEs. We need all these things to continue to give our best services to the people and protect ourselves as well.”
She urged the Government to increase the hazard allowance to N100,000 “to help us build our confidence that our works are being recognised.
“Government can look into our case. We are sacrificing but at least, we need to be encouraged. What we are doing is a commitment to humanitarian services. You can see that while other people are at home, we are here in the forefront, doing our best.”
Also speaking, the Chairperson of Medical Women Association in Rivers State, Dr. Vetty Agala, reiterated that the major challenge facing health workers is lack of equipment to work with.
According to her, “prices of masks, gloves and other protective equipments have skyrocketed. We need adequate supply of these items in hospitals to enhance our services.”
She added: “The nation’s health care system is weak; the facilities are not of standard. The entire health care system needs revamping. There is shortage of human resources; there is need for training and retraining of health workers. The State Government also needs to support those into specialised areas to go for advanced learning so that they can return and add value to the system.
“Funding is also very vital. In the 2001 Abuja declaration, 15 per cent of the budget was suggested to go into the health care sector. But till today, we are struggling between 3.5 to 5 per cent. More money needs to be injected into the health sector.”
Also, a consultant Obstetrician, Dr. Eli Sukarime, said the job of health workers is very demanding, adding, “We are exposed, with no enough protective wears. Most of us are underpaid and not appreciated.”
Imo NMA Demands More PPE
From Charles Ogugbuaja, Owerri
Doctors, nurses and other health workers in Imo State have decried the non-provision of Personal Protection Equipment (PPE) for their usage while attending to suspected carriers of coronavirus. Most of health workers at designated hospitals and isolation centres, who spoke with The Guardian, said they were at heavy risk. They appealed to Governments at all levels in the country and well-meaning individuals and corporate institutions to come to their aid.
Imo State Chairman of the Nigeria Medical Association, Dr. Kyrian Duruewuru, said that reports reaching him indicated that the problem of scarcity of PPEs was very alarming and required special attention for the safety of health workers to be guaranteed.
He warned that it was unfair for health workers trying to save the lives of the infected people to be getting infected in the process.
Duruewuru disclosed that the Federal Medical Centre (FMC), Owerri; the Imo Specialist Hospital, Umuguma Road, Owerri; and the Imo State University Teaching Hospital (IMSUTH), Orlu had limited number of the PPEs presently.
He, therefore, called for the provision of hand gloves, face masks and other medical protective clothing.
“We, doctors, nurses and other health workers are at heavy risk in Imo. We do not have them. Only few have them. At a first sight, you do not know who is carrying the disease or not. We need to be prepared at all times, but the PPEs are not there. The Governments should provide them and distribute to both public and private hospitals. That is part of what the governments should be doing to the health sector. This will help to prevent and control infectious diseases such as COVID -19.
“We are also urging all hands to be on deck now. Individuals and corporate bodies should come to the aid of persons working in the health sector, especially now that the pandemic is ravaging Nigeria and the world at large,” he said.
A nurse working in one of the health institutions, Chi Umuna, said: “We are really working and praying for our safety. We need the complete PPEs to attend to our patients now. The ones available now are not enough.”
We Want To Be Insured, Say Abia Health Workers
From Gordi Udeajah, Umuahia
There is still no confirmed case of COVID-19 in Abia State. The State Government has however proactively put established isolation centres at Aba and Umuahia in anticipation of possible outbreak. It has trained and deployed medical personnel to the facilities.
According to the State Health Commissioner, Dr. Joe Osuji, health workers in the State have been performing their normal duties, adding that those deployed to the isolation centres were on standby.
According to him, the State would do the needful when the need arises.
Health workers in the State who pleaded anonymity described working at this period of the pandemic as risky, adding that they expect to be fully insured by the State Government beside being equipped with personal protective equipment and paid lunch/ transport allowances.
‘We Are Not Concerned About Pay But How To Save Lives’
By NnamdiAkpa, Abakaliki
Ebonyi State Government has been implementing preventive and precautionary measures to make sure the deadly coronavirus pandemic does not enter the State.
The Commissioner for Health, Dr. Daniel Umezuruike, said that aside from the measures already put in place, the state Government has prioritised the welfare of the health workers in different locations of the state.
According to him, the health workers were divided into three sections – those working at the border areas, those going house to house to sensitise people, check their temperature and make sure they adhere to all preventive and precautionary measures and those working at the isolation centres.
He noted that the Government has mapped out funds to be paid as stipends to the health workers, adding that the local government areas would take care of the health workers going from house to house.
When The Guardian visited most of the border areas and the isolation centres, the health workers were seen discharging their duties.
A health worker who does not want her name in print confirmed they were being paid some stipends by the government, saying that although they were risking their lives, it was a sacrifice they needed to make to save the people of the state.
She noted that the money was not enough compared to the work they were doing, but said she was satisfied as she would be among those that would be remembered for their contributions to the fight against coronavirus.
Speaking in the same vein, a retired health worker who simply identified himself as Thomas, said he was happy to be among those saving the state at this period coronavirus was ravaging the whole world.
He stated that he was not bothered by the amount the state government was paying health workers but was more concerned with making sure that no case of coronavirus is recorded in the state.
He thanked the State Government for all the preventive and precautionary measures put in place to curtail the spread.
Taraba Isolation Centres Without Essential Facilities, Allege Health Workers
By Charles Akpeji, Jalingo
Though Taraba State is one of the few states that has not recorded any positive case since the outbreak of the novel coronavirus found its way into Nigeria, health workers have been keeping vigil at the two isolation centres located in Jalingo, the state capital.
Findings however showed that the State Government has not been able to equip the centres not to talk of providing protective equipment for the health workers. Consequently, some of the health workers have expressed worries that should the virus find its way into the state, the level of transmission would be overwhelming.
They also noted that their lives would be at serious risk as a result of the near absence of protective materials for them.
“As you have seen by yourself, can you boldly address this as an isolation centre compared to what we have been seeing in other states? Apart from these beds, can you show me any equipment that would make us function as medical personnel should there be any confirmed case?” a health worker in one of the isolation centres queried.
According to the source, all doctors and nurses deployed to the two isolation centres were drawn from government hospital.
He said: “Despite the fact that we have been assigned to these centres, we still go to our hospital wards to carry out our normal routine check. So from every indication, if there is any confirmed case of the virus, we shall be shuttling our hospitals and the centres to attend to both coronavirus patients and our normal patients in our hospital. So you can now see that we are being overworked.
“We have been praying and fasting that no case should be recorded in this state. Our joys knew no bound when the samples of the suspect in this state taken to the National Centre for Disease Control (NCDC) proved negative. Should the samples have proved positive some of us would have been left with no other option than to resign from our jobs and seek for greener pasture elsewhere, if not we might as well be infected in the course of our duties because of the negative attitude of our government.
“We are not going to cease from praying and fasting pending when the World Health Organisation (WHO) finally declares the world and Nigeria in particular Covid-19 free because if not so, doctors in this state would be in trouble if there are confirmed cases.”
COVID-19 Outbreak Opportunity To Address Deficits In Cross River Health Sector, Says NMA
From Agosi Todo, Calabar
The Nigerian Medical Association (NMA), Cross River State chapter, has accused the state government of having only 33 doctors even as it bemoaned lack of equipped isolation centres to fight coronavirus pandemic.
NMA expressed disappointment over the manner the State Government was handling the health sector in the face of the pandemic.
In a statement signed by the State Chairman, Dr. Agam Ayuk, and the Secretary, Dr. Ezoke Epoke, the NMA said the state currently has no isolation centre, disclosing that the four-bed capacity Isolation Unit at the University of Calabar Teaching Hospital is the Infectious Disease Ward of the Department of Microbiology in the hospital.
They explained that a report submitted by the Central Working Committee of health professionals in the State to the Commissioner for Health, Dr. Betta Edu, had drawn the attention of the state government to the fact that the centre lacks basic facilities, equipment and accessories based on NCDC’s specifications.
Ayuk said the interview granted by the Commissioner for Health on AIT on April 14, 2020, where she claimed that the State Government has 105 doctors in its employ was grossly misleading and a misrepresentation of a critical issue in the State health sector.
“For the avoidance of doubt, we have attached the distribution of Cross River doctors across the various state facilities reaffirming our position of 33 doctors in the Cross River Civil Service.
“The number of doctors in the State Civil Service is the least in the country. A doctor in Cross River Civil Service earns 46-54 per cent of what his/her colleague earns across the country.
“Doctors in Cross River are the least paid by any State Government in the country. It is therefore difficult to engage or retain this critical workforce.
“We therefore call on the State Government to use this period of COVID-19 pandemic to address the human resource capacity and other deficits in the health sector.
“The capacity of UCTH Isolation Centre is grossly inadequate, hence, NMA recommends that the State Government should set up a more expansive and accommodating isolation centre as soon as possible,” NMA noted.
Ex-NMA President Tasks FG On Life Insurance For Health Workers
From John Akubo, Abuja
A former National President of the Nigerian Medical Association, Dr. Idris Omede, has challenged the Federal Government to fast track and commence its planned life insurance for health professionals in the fight to contain coronavirus pandemic.
Omede said insurance for health workers would provide risk or hazard support.
Speaking with The Guardian, the former Commissioner for Health in Kogi State also asked the Central Bank of Nigeria (CBN) to duly and promptly implement its planned interventions to improve health infrastructure, equipment and manpower in the country.
His words: “Medical and healthcare workers have been in the frontline in the commitment to containing the deadly COVID-19 virus in various states isolation centres across the nation, characterized by shortage of Personal Protection Equipment (PPEs), long working hours, and weak health system.
“These professionals are exposed to hazards that threaten their health and that of their families. While we continue to advocate and sensitise for prevention, we cannot completely delude the fact that the cases are on the rise without predictable date of the scourge reaching a peak and flattening. Herein lies the importance of suspecting, detecting, tracking, testing, isolation, caring and managing confirmed COVID-19 patients.”
He expressed concern that emphasis has been laid on public health facilities in terms of protective materials without recourse to the private health facilities that might be the initial contacts despite the ongoing sensitisation and awareness creation.
“This is because this highly contagious viral infection may present asymptomatically or symptomatically in private or public health sector. Inasmuch as researches are still ongoing on this novel disease, there are possibilities that some otherwise confirmed cases turned negative, become asymptomatic, but excreting the virus in their wastes such as urine or excreta for quite a while.
“This may further heighten community transmission. All these may create more burden and undue pressure on health facilities (private and public) and the private made to carry her cross.”
He called for the protection of health professionals, adding: “These professionals deserve respect, dignity, the right to protection, recognition and decent working conditions amongst others. This should be the norm for all those that are professionally exposed to this viral hazard in the cause of discharging their responsibilities and duties. Isolation centres should not be politically but functionally and technically inclined in infrastructure, equipment, including close circuit television CCTV and monitors, manpower and capacity building with training and retraining and minimal exposure of the working frontline team with members of the community.
“We are aware of the global shortage of most required vital equipment because most nations are affected by the pandemic with resultant high demand and reduced production.”
He challenged Nigerian Government to encourage indigenous production of some of the materials such as gloves, masks and sanitisers.
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