Covid-19 infections among health workers affecting quality of care

BY TONNY ABET

The rise in cases of Covid-19 infections among health workers is causing anxiety to the personnel and affecting the quality of care in health facilities across the country.
According to the Ministry of Health, at least 112 cases of Covid-19 infections had been registered among health workers by Tuesday.

Dr Susan Nakireka, a physician at Mengo hospital and the board chair of Uganda Non-Communicable Disease Alliance (UNCDA), said the quality of care to patients with diseases such as diabetes and hypertension, which manifest with Covid-19 like symptoms, was the most affected.

“When the lockdown was eased, the scare of the real Covid-19 came in when the deaths started being reported. We are seeing patients tossed up and down because they have symptoms similar to those of Covid-19 and yet they have other diseases. Care has generally gone down,” she said.

The August 31 report of assessment done by World Health Organisation (WHO) in 105 countries including Uganda, shows that Covid-19 affected in different ways, 69 per cent of non-communicable disease diagnosis and treatment.

Prof Peter Baguma, an expert in occupational health and safety and lecturer at Makerere University, told Daily Monitor yesterday that the decline in quality of care because of a pandemic is not new.

“With the increasing fear among health workers that they are going to be infected by the patients, some health care seekers who actually don’t have Covid-19 are likely going to go without effective treatment,” he said.

“This was the same case with pandemics such as Ebola and when HIV/Aids just came, where the health workers would fear and some patients left without treatment because the doctors had run away,” he added.
Prof Baguma said the health workers are no longer interacting freely with patients.

“They [health workers] keep a distance from the patient and this affects the quality of the interaction with any patient that is suspected to have Covid-19 even if they don’t actually have Covid-19,” he said, adding this affects the quality of treatment they give.

“Some of these fears are true where we don’t have enough personal protection equipment (PPEs). You hear that up to now some health facilities upcountry don’t have these PPES. It makes health workers have fears,” Prof Baguma said.

“What we are recommending is that there should be enough PPEs that is tested and known to be effective in preventing disease transmission. Sometimes you have this equipment that is not well made. We have to avoid the fake ones, some people may start producing the equipment from Kampala and the quality may not be maintained,” Prof Baguma said.
He asked the government to train the health workers on the use of the equipment and other infection prevention measures to boost their confidence.

Medical association speaks
Dr Mukuzi Muhereza, the secretary general of Uganda Medical Association (UMA), said the infections and reported deaths of medical workers are being caused by loopholes in government’s response strategies.

“The biggest problem is the circumstance where you can’t be protected from contracting the virus because of lack of PPEs and the other thing has been about salary and those affect the performance of health workers,” he said.

“Another big problem we have is that health workers are not being isolated. It was only in Lira where health workers were being isolated. The health workers managing Covid-19 patients were not supposed to be allowed to go home but now it is untenable,” he said.

The UMA secretary general said making the health workers blend with family members and the general public increases chances of infection in case they picked the virus from those being managed.
Dr Muhereza also said most health facilities are overwhelmed.

Mr Emmanuel Ainebyoona, the Health ministry’s spokesperson, said: “There is a plan to recruit more health workers and contact tracers to ensure that workload is reduced and everyone [contact to Covid-19 patients] is followed up based on the prevailing situation.”
The country has recorded a total of 3,288 and 33 deaths, according to the ministry.

Government actions

Dr Charles Olaro, the director of clinical services at Ministry of Health, told Daily Monitor in an interview that the ministry knows about the rising anxiety among health workers and that strategic actions are being taken to address the root cause.

The director said they are increasing the training for health workers in infection prevention, control and maintenance and adequate supply of PPEs for health workers.
“Health workers are a pillar in case of management. One of the key things is that we have developed a protocol to manage patients and given it to the health workers,” he said.

Dr Olaro said as the infections increase in communities, it is natural that the health workers will also become infected, adding that others will, however, get infected in their line of duty.

“So what we have done is introduce work shifts so that they have enough time to rest. The other thing we have done is encourage working in pairs to minimise the chances of making mistakes while handling patients so as to minimise the chance of getting infected,” he said.

“We are also training additional health workers so that each treatment centre has two teams so that a team works and leaves. This will minimise the burn out and fatigue that would make them infected,” he said.

Dr Olaro also said the director general is sending messages to health workers to remind them to be on higher alert, adding that each health facility has safety officers to ensure prevention measures are adhered to.