Uganda’s handling of the Covid-19 pandemic in the sub-Saharan region has gained worldwide commendations. Focusing on the Mental Health and Psychosocial Support (MHPSS) pillar, there are many highlights and lessons of Uganda’s frontline service providers fighting coronavirus stigma.
The novel coronavirus disease (Covid-19) pandemic has caused unprecedented fear and anxiety in Uganda and the rest of the world. In Hoima, for instance, individuals initially suspected of having coronavirus were publicly ridiculed by community members and called demeaning names “Abacorona,” loosely translated as “coronavirus carriers.”
In the weeks that followed the countrywide lockdown to stop further spread of the deadly virus, police reported increased number of domestic violence cases which, unfortunately, caused deaths in some parts of the country. False messages about the extent of coronavirus continue to spread like wildfire via the social media, creating more fear and anxiety among the population.
Dr Wilson Winston Muhwezi, a behavioural scientist at the school of Medicine at Makerere University College of Health Sciences, recently commented on the likely mental health and psychosocial impact of Covid-19 and notes that in the context of Covid-19, anxiety is high and expected.
“This being a new disease, people need explanation and re-assurance. A number of people may not easily cope and those who get mentally challenged need more specialized support.”
Uganda’s multi-pronged approach has ridden on a wave of a strong public awareness campaign through television, radio, social media and print media.
Meanwhile, we have also witnessed timely identification, referral and managing of suspected cases the through quarantining, isolation and treatment of positives cases at Mulago national referral hospital and Entebbe Grade B hospitals.
Importantly, a Mental Health and Psychosocial Support (MHPSS) pillar was purposively included in the ministry of Health-led Covid-19 national response strategy to handle behavioural change and stigma reduction interventions.
The MHPSS pillar team is composed of mental health professionals, community and clinical psychologists, healthcare workers, psychiatric nurses, social workers, counsellors and volunteers from both public health sector and Non-Governmental Organizations. They strive to address the unseen anxiety, confusion and depression building up as a result of social-economic disruption caused by coronavirus to individuals, their families and communities.
To understand the level of alertness, there are over 43 quarantine centres distributed countrywide, especially in high-risk areas of coronavirus infection like national border entry points. Dr Kenneth Okware Kalani, the coordinator MHPSS pillar, explains that appropriate information and messages are provided along the six-steps emerging procedures that are informing the process for developing a standard Covid-19 MHPSS protocol for Uganda.
The measures adopted by Uganda Covid-19 task force have been effective in keeping the numbers of individuals infected by coronavirus in Uganda low: 89 cases with no deaths and 52 recoveries.
This has been a result of the MHPSS participatory and intensive health education on Covid-19 and has reduced the levels of anxiety and stigma in communities even though there was that isolated case in Kalangala where a recovered person was disowned by some village mates.
But in Kayunga, Hoima and Adjumani districts, we have witnessed families and communities celebrate the return of people that defeated coronavirus. Findings from home visitation of discharged clients shows they are coping well with no major issues.
The MHPSS Pillar has also increased capacity in managing Covid-19 by training and deploying 10 psychiatric nurses at Mulago and Entebbe hospitals. The nurses have offered fulltime care and by the time of discharge, clients have claimed down, relaxed and ready to re-integrate with their families. In addition, the MHPSS team offers psychosocial support to doctors and health workers treating Covid-19 to prevent burnout and exhaustion due to intensity of care required by the clients.
The MHPSS pillar has received considerable support from sister departments like Butabika national referral mental health hospital, Makerere University department of mental health, Uganda Counseling Association, among others.
On a voluntary basis, these are supporting development of National Covid-19 MHPSS standard protocols, guidelines, manuals and tools for training frontline service provides so that the messages shared are consistent. The plan is to engage more partners for their input and buy-in as national reference materials.
Covid-19 being a new disease, spreading very fast with no cure, new information from scientists in managing the disease keeps coming in, which requires frontline service providers to constantly read to update themselves. This can be challenging when dealing with anxious and big numbers.
In the initial phase due to limited information and misconceptions about the coronavirus disease, communities were very hostile to individuals suspected of carrying the virus-like was the case in Hoima. The unregulated social media continues to share falsehoods which cause unnecessary anxiety and fear among the population.
At onset of the disease due big numbers in quarantine, it was overwhelm- ing to adequately provide the required psychotherapy and health education on Covid-19. This caused a lot of anxiety, anger and distress but was gradually put under control as the MHPSS pillar beefed up its capacity by increasing number of staff. Later it became possible to conduct one-on-one counselling sessions.
In support of World Health Organization (WHO) guidance to countries, it is critical to integrate mental health psychosocial support into medical interventions in managing viral infectious diseases of Covid-19 magnitude because community engagement plays a significant role in preventing further spread and helps in addressing stigma that usually accompany such diseases due to myths and lack of reliable, factual and readily available information during the emergency phase.
The author is a mental health consultant