Calm, Composed and Connected against COVID-19

The outbreak of COVID-19 came at a time when no one was prepared for it. The hospital is being supported by the Ministry of Health (MoH) and supplied with personal protective equipment (PPE). For now, we have adequate PPE but it won’t be enough. The MoH is working hard to start manufacturing in-country in Uganda and we have received donations of PPE from other individuals, as well as vehicles for transporting samples to testing centre. Our response is limited by a lack of testing facilities and this is having a big impact. We need rapid test kits to reduce turnaround time and improve the management of cases. The government is currently emphasising the need to improve sample testing as there is only one testing centre, as well as trying to introduce an antibody test. We are seeing innovative approaches to antibody testing coming up, but there will likely be a big challenge in implementation.

We recently received some basic training organised by the MOH to help us become more prepared and we have established a COVID-19 isolation ward and designated quarantine area staffed solely by those who have volunteered to do so. Those working on the isolation ward are leading the response and we are hoping to become experts on the pandemic and its management. So far, the cases we have treated have not been too complicated and most patients have been discharged. The majority of patients who have been admitted have been found to have other conditions with similar symptoms and so we have been dispensing medication and treatments such as antibiotics and vitamins.

Thankfully, as a unit, we have had no positive cases among staff, and we are taking all of the necessary precautionary measures and we feel united.

Stigmatisation, however, is becoming a huge problem for both our team and our patients. The mental health department has been working closely with us, offering its support to address the psychosocial impact of COVID-19 on both staff and patients. We are also working to sensitise the community through education as we continue to discharge patients from the isolation ward. However, many patients live very far away, and this makes the implementation of community re-entry plans quite challenging. It relies on the support of local leaders. Community members are aware of the situation and all know the importance of handwashing, but they are worried about the prospect of being in isolation for 14 days and the impact this might have on their families and businesses.

In Uganda, one of our main concerns has been with members of the community who travel a lot or have a lot of contact with others. For example, we have been working to control the movement of truck drivers as they have been found to be disproportionately affected by the virus and could be responsible for spreading it from one community to the next. In early May, we received a Ugandan truck driver who had tested positive for COVID-19 in Sudan and was intercepted at Elego, a border point between Uganda and Sudan. The patient was admitted with complaint of a cough, sore throat, runny nose and mild fever. He was very uncooperative at admission but with subsequent psychosocial counseling and good management, he is now stable and his condition is improving thanks to effective treatment. Those he has been in contact with have been traced and all have been put under quarantine.

The high rate of positive tests among truck drivers is a big concern, both for the drivers themselves and in terms of the impact this has on sex workers. So far, we have admitted one sex worker to the isolation unit. We are trying to support them as best we can during this period so that they do not have put themselves in high-risk situations. As a district, we are working to support those on the street, and this includes street children – a group that we are particularly worried about. Efforts are being made to provide them with temporary shelter.

While we face challenges and have limited resources, we continue to use our usual ‘Three Cs’ approach, staying Calm, Composed and Connected. As we are yet to face as many positive cases as other countries, we are using technology to communicate with our colleagues overseas and share learning. While we do face challenges with telecommunications – we are currently using Zoom on our personal mobile phones, though this is not sustainable in the longer term – it is really valuable to hear about the experience of those in the UK. From where we are, it seems that health workers in the UK are fighting a battle that they are not about to win unless something changes. We are in this together, from the UK to Uganda, everyone in the world is affected.