For many health workers of Arua Regional Referral Hospital (ARRH), 24th April 2020 is a day they will always remember with some trepidation. On that day, the hospital received its first COVID-19 patient and the health workers were understandably scared.
With the country under total lockdown and news channels beaming with constant pictures of death and sickness from all over the world, it was now the turn for ARRH health workers to play their part in the enduring COVID-19 tragedy.
"It was a trying time in our work. The beginning was difficult, and we were all scared. Several hospital staff were not willing to work especially in the treatment unit," says Silver Collines Okiror, an Enrolled Nurse at ARRH. A few, including Okiror accepted to work because as he puts it, "we are committed to saving lives and we love our work."
However, accepting to work came at a great social cost to Okiror and his colleagues who volunteered. They were stigmatised and discriminated against by the scared staff and the public. "We were not allowed to even access other hospital premises, and we had to stay away from our families for close to two weeks," Okiror remembers.
Luckily, this situation was under constant watch by the Ministry of Health and with support from the World Health Organization (WHO), mitigating interventions were urgently planned and immediately implemented.
"We had to quickly train health workers on COVID-19 Infection Prevention and Control, provide them with adequate Personal Protective Equipment, and orient them on the current treatment regiments for the patients," says Dr Bongomin Bodo the technical lead for COVID-19 case management at the WHO Country Office. Of course, previous work and experience from the various Ebola outbreaks in Uganda had a lot to do with the quick orientation and confidence building.
The deployment of a WHO technical expert in IPC to provide mentorship to the Arua Hospital team greatly strengthened their case management capacity.
With this training and materials support, several health workers at ARRH gained knowledge and confidence to treat COVID-19 patients. They immediately joined the response thereafter and the results out of this investment were quick to show.
"Once the patient is received and the disinfection is done, the patient's history and baseline parameters are taken. They are educated on the COVID-19 preventive measures and the daily routine they need to follow to quickly recover such as daily exercising," explains Mathew Oyoku a medical clinical officer with apparent confidence. "We are now confident about doing this work. We normally hold end-of-shift meetings and conduct weekly Continuing Medical Education sessions to stay informed and to ensure that we protect ourselves properly," he adds.
In Uganda, all 15 referral hospitals are managing COVID-19 patients. For ARRH, as of 21st October 2020, a cumulative total of 165 patients had been admitted, 126 treated and discharged with no death. The level of care and professional conduct of the ARRH health workers has been appreciated by the patients and must be a contributing factor in their quick recovery.
"They took my history and other vitals and reminded me of the preventive measures to take while at the treatment unit. I was later shown to my room and informed about the number of times my sample would be tested before I am declared cured. I learnt that if I followed all the directives, I would recover very fast. I recovered in nine days and I was discharged," says Lilly Rose Ojos, a COVID-19 recovered patient.
Preparation of Uganda's regional referral hospitals and the health workers to be able to admit and treat COVID-19 patients came at a considerable price to the Government of Uganda, WHO and partners. But with COVID-19 causing considerable death and suffering all over the world, it is a price that had to be paid.
"With support from DANIDA, DFID and Irish Aid, we have invested over 2.2 million USD in Infection Prevention and Control, training of health workers and provision of supplies such as PPEs," says Dr Yonas Tegegn Woldemariam the WHO Representative in Uganda.
He adds that the financial support by these development partners has not only slowed COVID-19 spread in Uganda, at least for now but greatly enhanced the country's capacity to deal with the epidemic. "Diagnosing the disease is fairly quicker, health workers are more knowledgeable about IPC and patient care and the public has a higher understating of what they need to do to prevent and control the spread of COVID-19," says Dr Tegegn.
As the number of COVID-19 patients increases across the country, there is a need for training and equipping of health workers so that they safely and effectively carry out their duties. There is therefore an urgent need for more resource and investment in this area of work.
For ARRH, one thing is for sure: there is a committed and well-prepared health workforce, ready to serve, care and save lives. As Silver Collines Okiror the enrolled nurse observes: "It has not been easy for me, but I have gained a lot of knowledge and experience out of this COVID-19 response."