When the first Covid-19 case was confirmed in Uganda in March 2020, our world became one of isolation, panic and uncertainty, but Kisoro regional refferal hospital is celebrating a pandemic success. The pandemic helped the hospital realign its general operations and improve case response and management, writes FRANK KISAKYE.
The Covid-19 response in Kigezi sub-region has impressed Unicef, which is coordinating the equitable distribution of coronavirus vaccines across the globe and has invested over Shs 100 million in Kisoro district and over Shs 400 million in the sub-region to scale up the Covid-19 response.
Unicef has called for the replication of Kisoro’s response mechanism in other vaccination worst-performing districts in Uganda.
Kisoro district has so far vaccinated 139,000 people against a target of 138,000. About 110,000 have got the second dose against the target of 148,000. The district is now inching towards administering the booster shot.
Being a transit and border district of two countries – the Democratic Republic of the Congo (DRC) in the west and Rwanda in the south, it was only a matter of time before the district registered its first case a few weeks after the country’s first case in March 2020.
Kigezi is the second-best performing region after Kampala in terms of vaccination coverage. Kampala has registered a 105 percent success rate for the first dose coverage and 62 percent for the second vaccination dose while Kigezi has registered 88 percent for the first dose and 43 percent for the second dose as of March 27 2022, according to the ministry of Health.
According to Dr. Michael Baganizi, the medical superintendent of Kisoro hospital, the government did not inject time and resources into the training of health workers at the referral hospital and some Covid-19 cases were mismanaged during transfer to Kabale hospital, which had been designated to handle Covid cases.
“I think referral hospitals need to be supported to be able to completely and confidently handle cases and be able to evacuate patients. Some cases were mismanaged. Some health workers didn’t know how to provide proper airways…Unlike Ebola which happens in one spot only and the whole country mobilizes to go to that spot [but] with Covid-19, the pandemic is happening all over the country. It needs to be thought through in the future…” he said, adding, “Home management ended up being self-management because there was no capacity to follow up every day. It was not possible. People managed themselves, there was a lot of advice from social media, radios and people ended up using so many (remedies). The repercussions of using all those things shall be seen in five or 10 years – the effects of self-medication,” Baganizi said.
At one point the hospital was overwhelmed by patients in need of oxygen from the usual two-to-three patients to 15 including 50 others admitted against an anticipated 14 patients.
But 10 intervention areas of action developed for Covid-19 response including screening and crowd control have since been maintained at Kisoro hospital.
Baganizi said before Covid-19, the hospital was a social gathering. Locals met there and chit-chatted giving a false impression that the hospital had a big number of patients.
“There are certain things, which happen when you least expect them. For example, when the disease came, the not-so-sick people ran away from the hospital, they stopped coming to the hospital. So that reduced the numbers. At some point due to limited manpower, we stopped separating Covid-19 cases. You would manage patients on this side and then manage Covid cases. At that time [medical students] were not at school so we made an appeal for them to come and work. Some of them came and worked and that had a multiplier effect…” Baganizi said.
“…on resource management, we learnt many things here. We had things we had never put in place. One of them is crowd control – the whole hospital was full of people. Every spot was [occupied with] people. Sometimes, we wanted to see patients but we had to go through [crowds]. We couldn’t limit the numbers because we felt it would be insensitive but when Covid came, it was necessary and we felt it was doable…Now people know entering Kisoro hospital is very difficult…Then a patient would have four to five people managing him or her and then the whole village would come to the hospital. The limitation of the crowd helped the hospital reduce water costs, wear and tear and improve security – the theft of patient property reduced,” he added.
Because Covid management required tracking of treatment and usable items such as personal protection equipment (PPEs) every Friday, the district has maintained this and extended it to other drugs. This has since controlled drug thefts. According to Baganizi, the community has helped the hospital solve some problems brought on by delayed funding from the government. He said at the start, the hospital had one oxygen concentrator and five oxygen cylinders but now they have 40 cylinders and 12 concentrators all mobilized from the community.
Catherine Ntabadde, Unicef’s senior communications specialist, said as an implementing partner, they are taking stock of the successes in Kigezi sub-region.
“We note that they are doing very well and the things we have been able to support in the district are social mobilization. We have engaged the community through different approaches, radio stations, house to house sessions, and communication in local languages, technical and religious leaders. These approaches have proved to be useful and effective in mobilizing the masses. As we have realized, there is a reduction in cases within the community but it doesn’t mean that the pandemic is over, we encourage communities within to get vaccines,” Ntabadde said.
MODERNA CONCERNS
Interestingly, only Kisoro district has registered concerns with Moderna vaccines in Kigezi sub-region, which consists of Kabale, Kanungu, Rukungiri, and Kisoro districts.
According to Baganizi, several vaccinated people have recorded simulations of the Covid-19 infection for three to four days and that could have triggered some deaths. These concerns have now ramped up vaccine hesitancy, especially at a time when the government is pushing for the vaccination of children aged 12 years and above.
Like Kisoro, Rukugiri district has registered great strides in vaccination. Rukungiri district health officer Akasima Mucunguzi said people have an “unquenched demand for the vaccines.” The district has so far vaccinated 150,000 against a target of 158,000 out of an estimated population of 360,000.
Emmanuel Ainebyoona, the ministry of Health spokesperson, said 18 million vaccine doses have been dispensed – 14 million (first doses) and four million second doses while another five million have taken the single-shot Johnson &Johnson vaccine.
fkisakye@observer.ug
