THIS past week has seen the highest number of COVID-19 infections being reported in Zimbabwe. The figures have gone beyond 2400, with a tilt in the balance of cases towards more local than imported. Indeed, Zimbabwe is witnessing community transmission which has the potential to explode into a full-blown disaster in the following few weeks. Regrettably, fatalities from the disease have also gone up, and stand officially at 34.
By Dr Grant Murewanhema
Our healthcare system is extremely fragile at the moment, and continues to fall by the day. Nurses are in their fourth week of an incapacitating industrial action, crippling the major hospitals in Harare, Bulawayo and other cities. The strike by nurses has seen an alarming number of adverse maternal and child outcomes, with unconfirmed reports of more mothers dying from avoidable pregnancy-related causes.
A recent tweet by a young medical officer that he had witnessed 2 uterine ruptures, 2 stillbirths and a maternal death all in one morning was way too depressing.
Nurses are the backbone of patient care in Zimbabwe and beyond, and their absence has a detrimental effect on delivery of quality and timely healthcare for patients. Additionally, the majority of the Zimbabwean population is living in absolute poverty, with no medical insurance, and rely on government hospitals. Unfortunately, there has been no response from the responsible authorities, which may precipitate a protracted industrial action, similar or worse than one which occurred slightly over a decade ago.
Worrisome is the increasing number of healthcare workers contracting COVID-19 in Zimbabwe. Healthcare practitioners constitute at least 10% of the total burden of confirmed cases so far, which is quite high compared to other African countries.
Among the infected cadres are nurses, doctors, pharmacists, and other ancillary staff. Zvishavane District Hospital has seen one of the most worrying scenarios this week, with over 70 of its staff testing positive for SARS-CoV-2. Mpilo, United Bulawayo Hospitals, Parirenyatwa and Sally Mugabe Hospitals have all witnessed an increasing number of healthcare worker infections. A number of student nurses tested positive for the virus at United Bulawayo Hospitals a few weeks ago.
The increasing number of healthcare workers testing positive for COVID-19 is a great cause for concern. Fear and anxiety levels are increasing among these cadres. News of deaths of their counterparts from the Black, Asian and Minority Ethnic communities in the diaspora are still fresh in the minds of many, and serves to compound the fears. Many have started questioning whether its really worth it to contract the dreaded virus for meagre earnings. The level of distrust and dissatisfaction among healthcare workers and hostility towards government has been demonstrated to increase significantly in disaster times, and this was witnessed in some countries during the ebola viral disease outbreaks of the past.
An urgent enquiry into why we are having such an unfortunate scenario is warranted, and hopefully one that can come up with useful mitigating recommendations.
Possible contributory factors include inadequate infection prevention and control protocols, lack of adequate personal protective equipment, dealing with patients whose status is unknown, and low risk perception. Other factors could be the use of overcrowded public transport, working several shifts in different places to make ends meet, or community transmission in a country where the true burden of COVID-19 is unknown.
In a country which has suffered massive brain drain over the past 2 decades, losing thousands of skilled healthcare practitioners to better paying countries, seriousness is required in dealing with a potential disaster. Zimbabwe is a country that cannot afford to lose its nurses, doctors and key staff in the health sector to COVID-19. The COVID-19 task-force must urgently engage key stakeholders in the health sector and supporting partners to devise strategies to minimise further healthcare worker infections. Government must also come in to urgently address the grievances by the nurses, which are shared by their other counterparts.