Dr Ann W. MUMINA is the medical coordinator for MSF in Niger. In this interview, she explains the importance of working with communities to strengthen our response to the COVID-19 pandemic, through the example of Niger.
What is the situation today in Niger with the COVID-19 pandemic and what are your concerns?
Five weeks after the first coronavirus case was reported in the capital Niamey, the country today has close to 750 people registered as positive for COVID-19 (As of 3 May 2020). Thirty-six have died. Although Niamey is now the epicentre of the disease, this has not prevented the epidemic to spread to other regions of the country. In such a situation, we face several challenges, in addition to the difficult access to protective equipment, as everywhere else in the world.
The first challenge is people’s suspicion about the existence of this disease. There are many rumours and speculation about COVID-19, and we have to be very transparent about data and measures that are taken.
The second challenge is more specific to the city of Niamey, where the majority of cases are now concentrated. While we have just finished building a treatment centre for COVID-19 patients, in support of the Nigerien authorities, MSF is also supporting the Ministry of Health, through the SAMU’s call centre, 24 hours a day, seven days a week, as well as mobile teams in five communes in Niamey. The aim is to improve the identification and follow-up of COVID-19 confirmed patients. But here again, to call this number, it is essential that the population is informed and has confidence in the response given by experienced medical teams.
Another big concern to me and a major challenge is related to the upcoming spike in malnutrition and malaria, which is expected to begin in June, as it does every year. A major concern is that all the energy focused on the response to COVID-19 will delay the efforts to be implemented in areas that are particularly affected by infant mortality. And reverting again on the confidence, it is also important that mothers aren't afraid to seek help when their children present symptoms other than those of the coronavirus. Or we risk missing out on many patients, which could be catastrophic in the region.
Also, in areas affected by violence and displacement, such as in the Diffa region, on the border with Nigeria, or in Tillabéry, in the three-border area, we are concerned about the way COVID- 19 could affect the most precarious populations. For example, for internally displaced people who live in camps and have already difficult access to health care.
Rumours and misinformation seem to take up more and more space when it comes to COVID-19, what can be done about it?
It is essential today to be close to the communities so that they are an active part of the response so that they take ownership and relay the various prevention messages and this particularly in this context of disinformation. For this, we can draw on our experience in the Zinder region, where we have developed a large community program to reduce infant mortality. For several years now, MSF in collaboration with the Ministry of Health, have been working with communities in two ways on the issues of malnutrition and childhood diseases. The first is part of our Integrated Management of Illnesses strategy at the community level in the Magaria zone: we train community health workers, from the villages, identified by the community, so that these persons can quickly take care of simple cases and refer the most complicated cases to a health centre. If patients are quickly taken care, it prevents the symptoms from worsening, ensuring a faster recovery and therefore a decrease in the number of deaths.
The second part is about our health promotion activities. Here, we also train people in the community to proactively raise awareness of health-related issues. The objective is to encourage the population to adopt good practices to avoid disease risks.
We have therefore also adapted these activities to support the response to COVID-19 and we have organized training on the specifics of this illness for the people who make up our community prevention network. Still, in Magaria, we have equipped 19 integrated health centres with water points and hand wash stations. Dozens of other centres in the Diffa, Agadez and Maradi regions have also been equipped.
In Niamey, where we are starting activities in the treatment centre for COVID-19, more than 170 people have been recruited and trained to treat patients, among them 20 people will be in charge of health promotion. These agents will accompany patients during their care, inform them about the disease and the preventive measures to adopt and try to reassure patients and their families to counteract a certain palpable sense of panic among some.
Ramadan started a few days ago, what impact could it have on the spread of the virus?
It is necessary for all of us, caregivers and traditional and religious leaders, to communicate with people to explain the issues, in particular, the measures to prevent the spread of the disease, to ease possible tensions that may arise. To do so, a dialogue is essential with certain key people such as imams or religious guides.
For some people, there is also a concern that fasting may also weaken the immune system, which may lead to a risk of developing more severe forms of coronavirus. During this period, it will, therefore, be necessary to be particularly attentive to the most vulnerable people.
In early May, MSF will open a 50-to 100-bed treatment centre in the Hôpital National Lamordé of Niamey for COVID-19’s patients. MSF also supports the emergency medical service’s call centre, 24 hours a day, 7 days a week, and the response teams in five communes of the city to strengthen the response capacity of the MoH. In our regular projects, MSF teams are working on the preparation of the response to COVID-19 pandemic in the regions of Zinder (Zinder and Magaria), Maradi (Maradi and Madarounfa), Agadez, Diffa. We are there adapting and implementing triage, isolation room, and infection prevention control measures and health promotion activities in our supported health structures (hospitals, centres de santé and cases de santé) and references from remote areas to health structures. We also have Covid-19 activities on some external axis, where we run preventive decentralised care. In some regions, we also support the Ministry of Public Health in the transport of samples