Feature Analysis: COVID-19 in Ethiopia: No care for the caregivers

By Siyanne Mekonnen @Siyaanne

Addis Abeba, October 08/2020 – Coronavirus or COVID-19 has brought an unprecedented strain on Ethiopia’s already frail healthcare system and the workers in it. Healthcare professionals have long been voicing their complaints about unfavorable working conditions in the face of the pandemic. The federal ministry of health has made some efforts to tackle some of the very common challenges related to the pandemic. Several universities have been involved in manufacturing masks and sanitizers. Ethiopia has received a lot of donations  from different sources. However, healthcare professionals who are battling the pandemic on the frontline still complain of a shortage of Personal Protective Equipment (PPE) among many other things.  Addis Standard has talked to some frontliners in an effort to help their voices be heard. There is a general feeling of jadedness but their dedication to their profession has not faltered.

When a patient arrives at the ER, there is no time to think about donning PPE, our first priority is to save lives so we treat the patient right away. We don’t stop and wait for PPE. This has resulted in many of my friends who work in governmental hospitals contracting the virus

Dr. Brook Genene

Most of their challenges are ones shared by the whole world during the pandemic – the shortage of PPE. “When a patient arrives at the ER, there is no time to think about donning PPE, our first priority is to save lives so we treat the patient right away. We don’t stop and wait for PPE. This has resulted in many of my friends who work in governmental hospitals contracting the virus.” said Dr. Brook Genene, a graduate General Practitioner from Black Lion Hospital.

It’s obvious that the healthcare workplace is particularly vulnerable to the risk of exposure to COVID-19. According to current knowledge, the two main routes of transmission are direct interaction with patients and contact with respiratory droplets in the space closely surrounding an infected person. Another health extension worker who Addis Standard talked to works at Addis Rayi health center in Addis Ketema sub city in Addis Abeba. Her job includes providing assessment, contact tracing and home to home care. She says, “While working in the ER we are not provided with proper PPE and we find out that the patients we treated have tested positive or died of the virus after we were exposed to them. On top of that, we do not get regular testing after exposure.”

All the other healthcare workers share similar concerns. Federal Ministry of Health (FMoH) has made several promises including providing Health insurance and several incentives for healthcare professionals at the beginning of the pandemic. According to the healthcare workers we talked to, none of those promises had been kept. A doctor from Dodola General Hospital in Arsi said that the nearest he had gotten to health insurance is, the hospital started offering free health coverage to its employees. However, this practice is common in most public hospitals in the country.

While working in the ER we are not provided with proper PPE and we find out that the patients we treated have tested positive or died of the virus after we were exposed to them. On top of that, we do not get regular testing after exposure.

In a recent statement by  FMoH, 1400 healthcare workers have tested positive for the virus and 2 have died. Healthcare workers, like any other people, have health problems that put them at risk of dying from COVID-19.  Every infected health worker means a further gap in the fight against the pandemic.

“We even buy masks for ourselves.” said a nurse who works at a private hospital designated as an isolation and treatment center. She explained how a number of patients who come to the hospital for various reasons end up testing positive after routine testing but results come days later after healthcare workers have been exposed.  “Every demand we make we are threatened by a lawsuit.” she says.  “We are not asking for a reward, this is our national duty and we took an oath”, she adds. Addis Standard spoke to deputy director of Food, Medicine and health administration control authority Debrework Getachew who said the agency ensures that private healthcare institutions provide PPE for its employees. The agency has given probations for private health institutions that failed to provide sufficient PPE to their workers after receiving complaints from healthcare workers.

Healthcare workers who are protecting others during this historic pandemic are risking their own health and what these professionals are asking for is the bare minimum. They face economic challenges of the pandemic just like everyone else. “My biggest fear is for my family to contract the virus because of me,” the nurse said. But she explained that she can’t afford to rent a separate house. She also explained that the staff members are prohibited from getting a test. If we want, we have to pay birr 500 to the hospital to get one.” The healthcare extension worker has also voiced similar comments about accessing testing after exposure. She said that they were told by the management that staff members are no longer allowed to conduct a testing. It’s not uncommon to hear statements like “You must be used to it by now” at Addis Rayi healthcare center according to the health extension worker. Addis Ketema is the hardest hit  sub city in Addis Abeba.

A Doctor who works at Adigrat General Hospital told Addis Standard that it has been 3 months since they were promised a payment for serving in Covid-19 stations. He said that the response they have gotten from the coordinator is that they are waiting for the FMoH to allocate budgets. Similarly, the Doctor from Dodola Hospital said “We tried to communicate with zone administration who answered by saying ‘We don’t have the budget’ “. The deputy communication head of FMoH said that the issue of incentives is being discussed by the council of ministers and directed us to Dr. Tegene who we tried to reach on the phone but without success.

Deputy communication head of FMoH said that the shortage of PPE is the challenge “even the United states is facing” but he was not willing to answer why there are no efforts to make up for it with incentives and a long lasting insurance plan to make work environments safer for healthcare professionals. This needs a long-term political commitment and sustained effort at all levels. Hence, the involvement of key stakeholders especially the health workers themselves in developing the strategy, formulating policy and implementing initiatives is essential. For instance, Dr. Samuel who took the initiative of providing free surgical treatment for fellow healthcare professionals and Dr. Birhanu who started a platform to advocate for better working conditions for healthcare professionals. One of the innovative financial incentives taken by FMoH is tax relief for healthcare professionals. Such initiatives are a good place to start but there should be policies to ensure that those on the frontlines of care in this crisis may access any care they may need.

Other efforts include integration of efforts between government sectors, donors, non-governmental organizations and the private sector to ensure the initiatives are sustainable.

The health system plays a significant role in national economic growth and societal well-being so it deserves attention as much as other sectors. This pandemic can be an opportunity to underscore the need for coordinated and sustainable investment in the health sector. AS