From the frontline: Medics keep virus at bay

The coronavirus is reshaping the world. To many lay people, frontline workers are the medics donning the hazmat suits, and the police.

But in the Kenya of coronavirus, the frontline cadre includes factory workers who ensure a 24-hour supply of essential items to keep the virus at bay. 

Makers of the now-compulsory face masks and journalists who bring update you on life-saving information also make the list. 

In hospitals, where many confirmed Covid-19 cases end up, the frontline staff are not just doctors and nurses. There are also laboratory technicians, housekeepers, cleaners and guards.

Alice Kariuki is for instance the housekeeping manager at Aga Khan University Hospital, one of the accredited centres for Covid-19 testing.

Kariuki ensures that patients, staff, and visitors are safe in one of Kenya's largest hospitals. Her work is critical.

The infection control specialist ensures the entire hospital is sanitised every 15 minutes. 

Her team has identified more than 17 high-touch areas that are decontaminated with concentrated sodium hypochloride solution (seven tablets to one litre of water) four times hourly.

"We decontaminate the entire hospital but more frequently the high touch areas where somebody is most likely to touch if they are in a hospital," Kariuki says. 

"These include computer keyboards, telephone handsets, table surfaces, beds, lifts, side rails, and  light switches."

The measures are adapted from the World Health Organisation's hospital hygiene and infection control recommendations and more emphasised in the face of Covid-19.

Kariuki's team also disinfects equipment brought into patient rooms — stethoscopes, pens, themometers, etc — using 70 per cent ethyl alcohol.

Floors are cleaned throughout using a sodium hypochlorite solution of one tablet to 1.5 litres of water. 

"The hospital is definitely safer than most public places. This is how we want to keep it. It's a normal procedure even before Covid-19 because there are other infectious diseases that we treat like TB," the housekeeper says. 

The team's most critical role is disinfecting the isolation rooms where Covid-19 patients are admitted. 

"The linen is changed by the nursing division twice a day, or more depending on the state of the patient. They're then put in a red bag labelled 'infectious linen', and placed on a separate trolley and taken to a segregated area," Kariuki explains. 

"The red bag is not opened because it is soluble - it dissolves in the washing machine." 

The linen is washed at a temperature of 80 degrees Celsius.

When the patient is discharged, the isolation room is given a thorough washover. First, all the linen and curtains are stripped and washed.

As is normal, cleaners don full personal protective gear before collecting the separate buckets and disinfectants for the rooms. 

"We begin cleaning the ceiling, then the walls coming down. We clean and disinfect everything including the bed and the trash bins," Kariuki explains. 

The room remains unoccupied for at least two hours before a new patient is admitted.

Martin Njoroge, translator for deaf people 

Njoroge, a Nakuru-based Kenya Sign Language instructor, says many deaf people were arrested when the daily curfew started on March 27 because they did not know what was happening.

Njoroge, who is himself deaf, says until recently, many deaf people thought they were safe because Covid-19 comes from "eating dead bats". Fake news has forced so many of them to miss key health elements, he says.

"For example, many believed that eating oranges and garlic and taking a lot of water will prevent corona, which is not scientifically true," he says.

In February, Njoroge decided to begin sensitising his community. 

"I started making short videos with the correct information which I would share on my social media pages. The videos explain what the virus is, how it is spread and how to protect oneself using the ways given by health practitioners and the government."

The 29-year-old instructor posts the videos every day. He is not paid.

Njoroge is also acts as a counsellor because although Kenya has many psychologists, most do not understand the Kenya Sign Language.

He says most deaf people deeply fear contracting Covid-19, knowing they will not receive proper treatment because the majority of nurses and doctors cannot communicate with them. 

"The biggest issue is the communication barrier with the health officials and so any deaf person would fear the notion of getting into this hospital and being mishandled since no workers understand sign language."

Njoroge's videos are the main source of news for many deaf people because the cameras do not zoom in on the sign language interpreters during press conferences.

The last Kenya National survey for Persons with Disability done in 2008 showed that Kenya has about 600,000 deaf people. The current estimate, according to Njoroge, is one million people.

"I used to see my siblings communicate and I wondered how come they talk and hear and I don't have the same ability. My parents explained to me that God created me like this," says the father of one, who was born deaf.

Njoroge is an instructor at Horizon Sign Language Training Institute, which he co-founded  with Lawrence Musili and Zablon Kengara. 

Dr Margarita Mwai, head of Accidents and Emergencies at Aga Khan Hospital, Nairobi

Since the onset of Covid-19, Dr Mwai is always on call 24 hours a day. One of her priorities is to ensure her hospital staff are safe and confident of their safety.

She says when Covid-19 was reported in Kenya, there was fear among all health workers, knowing they are most at risk because they work in hospitals.

"They were concerned - how do we protect ourselves? Do we have enough equipment? But since we heightened these measures and procured more than enough PPEs, that anxiety is gone."

The head of accidents and emergency unit at the Aga Khan Hospital in Nairobi says: "If they are safe and comfortable, then they provide good care to our clients, without fear."

The hospital has upgraded its protocols. Apart from the normal triage for patients, everybody is screened, including visitors, for Covid-19.

The screening desk at the entrance is manned by a nurse and a doctor.

Screening involves a questionnaire, temperature check and measurement of oxygen saturation.

"Those presenting a high risk, are guided for a Covid-19 test," says Dr Mwai.

Everyone at the hospital, including visitors, must now wear masks at all times.

The doctor prays that Kenyans take seriously the measures given by the Ministry of Health.

"When you see the numbers in other countries and we know that here, we can only care for a few people, you wonder what would happen if we get such numbers?

Faith Muigai, quality assurance specialist

If the infection rate in Kenya increases, the country’s health care system could reach its limit this year. Thereafter patients will spill into tents in schools and stadiums. Such a grim possibility keeps Faith Muigai awake at night.

Faith is part of the team working away from the limelight to ensure health facilities have enough capacity for patients. She also ensures they have all equipment that medics and the patients require.

“I lead a healthcare programme that serves as a trip adviser to evaluate healthcare organisations' capabilities and readiness to deliver high-quality services,” she says.

Faith is the regional director for the SafeCare Programme with PharmAccess Foundation, an international certification programme for health facilities.

SafeCare is helping facilities assess their preparedness to handle an influx of patients and still provide them with the best care possible during the Covid-19 outbreak. The programme is also assisting hospitals to fix gaps, if any.

Geoffrey Simon Kioko, clinical psychologist

The nationwide curfew, social distancing and daily bombardment with coronavirus news have created hordes of non-virus patients. 

Psychologists are inundated with calls of people breaking down with fear of infection, fear of death, and fear of losing their livelihood. 

"Many people also call with extreme psychological stress and panic based on the news making rounds on social media," says clinical psychologist Geoffrey Simon Kioko. 

Kioko is leading 50 other registered counsellors and psychologists under the banner of Caring Hearts Community Services, to offering free counselling to the public, government, and corporates daily between 2pm and 7pm. 

"Some people feel trapped at home.  For others, the income has been cut off, and there is also a significant rise in domestic violence," he says. 

Caring Hearts began the free services last week and has provided a list of phone numbers that people can call and receive help. The numbers are 0726775121, 0721605346, and 0731727644. 

Kioko says elderly people are more anxious and fearful, as most of the information suggests they are the more likely to die if infected.

"We are also providing support to people in the frontline like medics and journalists. They face fatigue, burnout, frustration and the fear of contracting or guilt of transmitting infection," he says. 

The 50 psychologists are spread across Kenya. The team, a product of the Word in Season Ministry, has applied for a toll-free number, which Kenyans can freely call.

- mwaniki fm