Door-to-door screening, testing required: Matara

THE Covid-19 pandemic has rattled the country’s health system, which has over the years crumbled under the weight of economic pressures and lack of funding. With only a few isolation centres ready to deal with the scourge, Zimbabwe is faced with the mammoth task of dealing with a rising number of cases and a weak health sector. The country’s tracing and testing processes have come under spotlight as many cases are possibly going undetected, raising fears of a widespread outbreak. Doctors and health practitioners working on the frontline have taken the government to task over the lack of personal protective equipment (PPEs). Last week, the Zimbabwe Association of Doctors for Human Rights (ZADHR) sued government over the lack of PPEs. Zimbabwe Independent reporter, Nyasha Chingono (NC) spoke to ZADHR, secretary-general Norman Matara (NM) on the doctors’ assessment of the health situation and possible remedies. Below are excerpts of the interview:

NC: You have been very vocal on issues surrounding the Covid-19 pandemic. Do you believe the figures being reported by the Ministry Health and Child Care are accurate?

NM: We believe the Ministry of Health and Child Care is accurately reporting the figures as per the tests that have been conducted so far. We are, however, concerned with the low number of tests that have been conducted to date and we fear the figures that we have may not be a true representation of the situation on the ground. The ministry has promised to decentralise the testing process and increase the number of tests to at least 1 000 per day. We hope this process is given the urgency it clearly deserves.

NC: We know that our health delivery system is weak, but how dire could the situation get?

NM: Unfortunately, the Covid-19 pandemic has hit us at a time when our health sector is at its weakest. Decades of neglect and chronic underfunding of the health system, coupled with an increasing double burden of disease (both communicable and non-communicable disease) have stretched the thin resources that we have in the health sector.
Basic sundries and medicines are nearly always out of stock, hospital equipment is old and often broken down. In public institutions, intensive care facilities are non-existent; the same applies to provincial and district hospitals. If cases increase, the system will be overwhelmed and there is a probability of an upsurge in morbidity and mortality due to Covid-19. First World countries have struggled to deal with a full-blown outbreak despite better and well-functioning systems, so preventing a full-blown outbreak is our only cheaper and viable option.

NC: What additional measures can be taken in case of a widespread pandemic in Zimbabwe?

NM: The government must launch a widespread massive door-to-door screening and testing programme for Covid-19, particularly during the 21-day lockdown period and beyond, to identify cases and isolate cases, as well as conduct contact tracing.

There is a need to strengthen the health system by incentivising health workers adequately, building their capacity in infection prevention and control through nationwide health workers with training on management protocols, intensive care, and treatment of Covid-19.

We should also roll out an urgent and ambitious infrastructure project to develop state-of-the-art health facilities appropriate for infectious diseases, which are targeted to serve all Zimbabweans in all provinces and not just the political elite.

We should also attend to other facets of the health system such as drugs, technologies, health fee waivers, and ensure appropriate leadership and governance of the system from national, provincial, district and community level.

NC: Is there wisdom in confirmed cases being treated from home, or should patients be forced into isolation centres?

NM: The majority of people with Covid-19 have mild symptoms and are able to recover at home without medical care.
Those with moderate to severe disease and those with higher risk of developing complications should be treated by a health worker and monitored in isolation centres.

NC: Is it true that some private institutions are treating Covid-19 patients, thereby putting official figures into question?

NM: We have received reports of such allegations, but at the moment we have no evidence to confirm or dismiss the claims. As an organisation, we have written to the permanent secretary in the Ministry of Health to investigate these claims and make public her findings for the nation to regain trust and confidence with the system.

NC: Has the lockdown been effective so far. If not, what needs to be done?

NM: The effectiveness of this lockdown cannot be ascertained at the moment. Major drawbacks include the economic crisis that force citizens to queue in search of basic commodities like mealie-meal, thereby breaching the social distancing rules. In addition, we did not fully utilise the lockdown to intensify our case-finding through massive testing and contact tracing.

NC: There are reports that the government is deliberately understating figures. Some say there have been deaths at Harare Central and Parirenyatwa hospitals. Is this true?

NM: We do not have conclusive evidence that points towards the understating of figures yet. However, we are concerned by social media claims made by a certain private practitioner who claimed to be treating Covid-19 patients. This claim raises doubt on the authenticity of the figures being peddled by the official sources. We have since written to government to clarify and we do hope they will respond soon

NC: There have been reports on social media of pneumonia cases in Gwanda. Have they been investigated?

NM: We have not received any report on the formal investigations into the Gwanda incidents yet. We also await the postmortem results of the patients who deceased in Gwanda, if any was done.

NC: The case of the deceased 79-year-old Bulawayo man has given rise to questions on whether doctors are actually well-versed with Covid-19, because some shortcomings were observed. Are doctors up to the task?

NM: Covid-19 is a new disease and medical professionals all over the world are learning about this disease with each passing day. There is a need for the Ministry of Health to roll out programmes that educate and capacitate health workers across the country on Covid-19 case definitions, diagnosis and management protocols.

NC: Last week, you sued the government over the lack of personal protective equipment (PPEs). Do you think the issue is being taken with the seriousness it deserves?

NM: The issue of PPE for health workers is a very serious matter. We have seen in some countries up to about 15% of all Covid-19 infections being health workers. This shows that health workers are at very high risk of contracting this disease.

The government’s response to providing health workers with necessary protective equipment has been lethargic and unsatisfactory. We have received many reports from our members complaining that they are working without adequate protection. The pleas of our members led us to file an urgent chamber application with the High Court in a bid to have the courts compel the government to provide all health workers with PPE.

NC: If your case fails, what other options do you have to force the government to provide PPEs?

NM: The case is still before the courts and it will be sub judice to comment at this point in time. However, as an advocacy organisation, we will use all the legal channels to compel the government to provide PPE for all health workers in Zimbabwe.

We also have a strong relationship with regional and international organisations that can help bring our case to the government. We also believe the government will find reason on the issues we raised and we will work jointly to ensure better protection of first-line defenders to Covid-19.

NC: Government has still not disbursed funds to fight Covid-19. What are your sentiments?

NM: This is a major setback and shows lack of political will and commitment to effectively combat this pandemic. Health financing is one of the World Health Organisation’s six pillars of a strong health system. The government should provide leadership and be the major stakeholder in financing this fight against Covid-19, rather than us having to rely on donations alone.

NC: Should case definition be reviewed as the country is missing some cases?

NM: The cases which are being missed have nothing to do with a problematic case definition. We need to relook at intensifying our surveillance particularly at ports of entry, roll out mass testing campaigns and ensure increased awareness of the case definitions amongst health practitioners.

NC: What is your take on testing suspected cases while patients are already critically ill or on their deathbeds?

NM: Early diagnosis and treatment are vital in reducing morbidity and mortality associated with Covid-19. It also allows those that are positive to be quickly isolated and their contacts traced, thereby reducing the chain of infections. It is unfortunate that there has been a case or cases that were diagnosed when the patient was already critically ill. We hope this was a learning curve and such incidents do not occur again in the future.

NC: Do you have confidence in Health minister Obadiah Moyo and the taskforce that has been created to spearhead the fight against Covid-19? If not, what can they do differently?

NM: We think that the Covid-19 taskforce has too many politicians and lacks technocrats in infectious disease specialists and epidemiologists. Epidemiologists should be assisting us in using statistical epidemiological models to predict how our Covid-19 graph will look like in the next three to six months. We will be able to know when the peak infections are expected, estimated number of people who will need intensive care, number of deaths, most affected areas in the country. Such information is very important in planning, preparedness, resource allocation and ultimately reducing morbidity and mortality from Covid-19. We hope the national taskforce is seeking advice from such intellectuals.

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