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#COVID19: The case for the public’s health

Despite COVID19 state of emergency prohibiting a gathering of more than 4, Addis Abeba’s busiest open Market, Merkato, remains unrelentingly crowded. Picture: May 02/2020.
©Mussie Mulugeta/Addis standard

Sosena Kebede, MD, MPH

Addis Abeba, May 08/2020 – The cause for the relatively slow rise of the COVID-19 pandemic in some African countries including Ethiopia is not fully understood. Multiple theories circulate including the weather, the fact that Africa has a much larger youth population compared to European nations, possible partial immunity people may have from previous exposure to other ubiquitous infectious diseases, early interventions taken by African countries that have experience with previous management of similar epidemics, among others. There are also people who believe that their diet, lifestyle or belief systems have thus far protected them from this pandemic.

When I was a resident physician there was a patient who had in-hospital complication due to a medical error. Fortunately, she recovered from the complication and was eventually discharged home in good condition. I have since forgotten the case of that patient but what one of our attendings said about that case has stuck with me since-“sometimes our patients do well in spite of us“. The lesson I took from his observation was that sometimes outcomes may not be directly related to our obvious actions or inactions.

The point of the story is not to say we shouldn’t investigate the cause of an outcome, good or bad. However, our instincts to settle on an explanation over life events (or to outsource the explanation to spiritual forces) should not distract us from the lesson the event is trying to teach us.

They say never let a good crisis go to waste. So, while the pandemic is still raging across the globe, and countries like Ethiopia remain on high alert, (yet with some breathing room) there are opportunities for them to start writing the next chapter in the health outcome of the population. Here is a suggestion:

Prioritize investing in public health infrastructure starting with access to clean water and sanitation to all Ethiopians.

Improve the quality of health service delivery, and strengthen human resources for health.

Invest in community public health empowerment.

The last point deserves some expanding. Community public health engagement is a strategic process that equips people to address issues that affect their health and wellbeing. This process goes beyond delivering public health messages using various media. It is an active engagement with members of the community that includes involving them in risk assessment, building their capacity for analysis of the situation, giving audience to local wisdom, and inviting them to participate in problem solving. Public health empowered communities are not just public health informed people who may or may not follow policy directions. Empowered communities can be strong allies of healthcare providers, are more likely to be adherent to health policy recommendations, are often self-reliant and resilient citizens that can withstand current and future health crises.

The COVID-19 pandemic has already infected over 3.6 million people worldwide and has claimed the lives of over 258,000 people (as of 5/6/20). Countries like Ethiopia who have done commendable works in some public health interventions are still not out of danger zone yet. The cautious reminder is that even if the rise noted thus far is low the real number of cases is likely to be higher than reported. There is also a chance when the weather turns colder there may be a sharp rise in the number of cases. Regardless of the final outcome, pandemics like COVID-19 are crises that are here to remind us the fragility of Ethiopia’s public health infrastructure and the vulnerability of its mostly rural and poor 109 million people against the onslaught of infectious agents.

The work to invest in public health and in the community should be started now, yes, while in the middle of the pandemic, because if we wait, the urgency will be lost, politicians will forget, other priorities and demands will come up and many will pay with their lives. AS


Editor’s Note: Sosena Kebede, MD, MPH, is the founder and Executive Consultant of HealthCare Engagement, LLC that provides quality improvement services to health systems and patient engagement trainings to community members. She is an internal medicine physician who worked for the Johns Hopkins Health System (JHHS) for several years on various capacities including as an Assistant Professor of Medicine at the School of Medicine, as Health Policy Instructor at the Bloomberg School of Public Health, as Patient Safety and Quality Consultant at the Armstrong Institute for Patient Safety and Quality and as a Primary Care Physician at one of JHHS’ community physician sites.

She can be reached at soskeb@gmail.com

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