COVID-19 has affected millions all over the world. Like many other organisations responding to the pandemic, Doctors Without Borders/Médecins Sans Frontières (MSF) is faced with challenges—from the global shortage of PPEs to lack of transportation. Despite these obstacles, MSF finds ways to care for the most vulnerable: children, refugees, people living with HIV, high-risk groups, and more.
Gaps in COVID-19 response
Dr. Yuely Capileño is a medical doctor and project medical referent in Iraq, where there are over 4,800 confirmed cases. He shares, “We know that COVID-19 is something new. So, currently there is a big gap [when it comes to] the evidence-based medicine for COVID-19.”
In Mosul, where Capileño works, MSF has donated 62 beds to a building run by the Ministry of Health in Al Salam hospital complex, for the isolation of suspected and confirmed COVID-19 patients. He says, “We need strong infection prevention and control compliance, and personal protective equipment. But everywhere in the world, [there’s a shortage of] PPEs. So we have to rationalise the use of the PPEs, [and] not compromise the safety of the staff handling patients as well. We have to be creative and resourceful in making improvised PPEs, like face shields and coveralls.”
Across the seven states where MSF works in Nigeria, the organisation is providing technical support to the Ministry of Health and the Nigeria Centre for Disease Control, as they set up isolation centres for patients. Nurse and project medical referent Rodel Lambatin admits, “I was really overwhelmed during the past couple of weeks because we are not actually prepared on how to respond to COVID-19. [None] of us have the experience for this kind of outbreak. So we just do our best every day.”
Sometimes, simply getting to work is a challenge. Sharon Macaranas, admin manager in Mosul, Iraq, says, “The national staff are really dedicated to come to work. Even [if] there are no cars, [and] they have to walk. Even with the curfew, with the lockdown, they come to work.”
For Yan Debry Syauta, Deputy Logistic Coordinator Supply, the challenge is even greater. “I took my holiday [in Indonesia] a month ago, but I could not go back to my mission [in Uzbekistan] due to the travel restrictions. My work is mainly to ensure the cargo from Amsterdam gets delivered on time and local purchases follow the MSF procedure. Because of the COVID-19 pandemic, I have to follow up with my team from Indonesia, talk about the priorities and challenges, and try to find solutions.”
Overcoming challenges to provide care for the most vulnerable
Amid all the challenges, MSF teams continue to find ways to care for those in most urgent need.
In Bamenda, Cameroon, MSF set up isolation and treatment wards in regional hospitals for suspected and confirmed COVID-19 patients, and trained medical and non-medical staff to run the units. MSF also strengthened measures to prevent the spread of COVID-19 in the health facilities we support. The procedures for ambulance service were adapted for COVID-19 response.
Dr. Karina Aguilar, surgeon and project medical referent, shares, “I have a very good team on the ground and we can easily find people who will be willing to help, to go to the frontlines. You see them working to the bone, because they know it means life or death for their countrymen.”
There are currently over 36,000 confirmed cases in Bangladesh, and some cases have been confirmed in the Rohingya refugee camp, where Imee Japitana is working as nurse and project medical referent. MSF teams are also carrying out health promotion activities.
Kawsar Mohammad Shamim, water and sanitation manager and Opu Biswas, nurse supervisor, demonstrate how to put on personal protective equipment (PPE) to newly recruited hygiene agents at MSF’s Rubber Garden COVID-19 treatment centre, in Cox’s Bazar, Bangladesh. © Daniella Ritzau-Reid/MSF
Japitana shares, “On a regular day, the hospital [would be] running smoothly. We had enough staff in different wards, including the intensive care units. Then we had a measles outbreak beginning of this year. The paediatric ward was full of patients. So it was very, very difficult, especially for the nurses, because some of the patients referred to our hospital were serious cases already. [Our] staff were overstretched. When we started to communicate to the team about the COVID-19 response, everybody was just really scared to be assigned there. I think what helped them really is also being able to be open to them and update them about the situation. We are trying to adjust day by day.”
Who are the most vulnerable?
Even before the pandemic began, MSF was already responding to the health needs of many vulnerable populations. COVID-19 complicates their situations.
In South Sudan, MSF teams are providing trainings, and working on preparedness for COVID-19 in all project locations across the country, as well as on preventive measures, to be able to isolate and treat suspected COVID-19 patients who may eventually approach our health facilities.
Dr. Shirly Pador is a doctor at the mission in Jonglei. She shares, “Some of our patients walk hours just to the hospital. They even walk for one day, two days, just to access secondary-level of care. For miles on end, we are the only secondary facility that they can access.”
COVID-19 is just one of many threats these patients face. Pador shares, “We see about 300 outpatient consultations every day. We also provide services to children [younger] than five years old with severe acute malnutrition. That's aside from TB, HIV, malaria, kala-azar and other conditions. A lot of our [patients] belong to the high-risk groups or the immunocompromised relative to getting COVID-19. The population we serve are constantly exposed to violence, and they do not have access to basic necessities like food, and water and health care. It will be very challenging if we get COVID-19 here.”
Mother Gbessay came to the paediatric unit of MSF Kenema Hospital with her daughter Anile, pictured at 18 months old. She came to the hospital four days earlier; she was very dehydrated, with high fever and diarrhoea. She was soon treated with a blood transfusion and slowly recovered. © Vincenzo Livieri/MSF
In Sierra Leone’s Kenema District, MSF completed rehabilitation work at the government hospital so that it could become a COVID-19 treatment centre. ICU nurse Jerwin Capuras says, “We are very concerned with the little ones. [Working in] a pediatric emergency hospital, we have a lot of patients with severe malaria, [or] severe acute malnutrition. These patients are very immunocompromised. They really need to be protected. We save a lot of babies. Sadly, we also lose some babies.”
In Nigeria, MSF is undertaking community-based health promotion activities, and setting up handwashing points and isolation areas in local communities and IDP camps. Lambatin says, “Thousands of our patients are settled in the informal camps without any good access to health, water, sanitation, and hygiene. We push people to do proper handwashing. [But] how can they do it if they don’t have water in the first place? They don’t have good shelter, so if there are communicable diseases, it’s easier for the disease to spread in the community.”
Violence in Cameroon has escalated sharply in recent years, forcing hundreds of thousands of people from their homes and leaving them in dire need of assistance long before the pandemic started. Aguilar says, “Imagine the people in conflict, Cameroonians who fled because their house got burned down, or their place is where the conflict is. So you're not sure if they have water, food, electricity. What can we do is [provide] PPEs, work on disinfection and proper hygiene for the team, and the proper isolation for the patients.”
Despite all the emerging challenges, MSF continues its work.