Dr Brighton Chireka: Way Forward for Zimbabwe in the fight against COVID-19

By Dr Brighton Chireka

When news spread around the globe of a deadly virus, it was inevitable that in a matter of time, we too would have confirmed cases of COVID- 19 in Zimbabwe.

One would think that by then Zimbabwe would have been in a better position to learn from other nations and fight this pandemic effectively – but sadly this has not been the case.

We all know that this is a new virus that we do not know much about. We are receiving new information and learning as we go which means that whatever strategy we implement today must be reviewed on a regular basis to make sure that it remains relevant. 

I am going to share my observations and give suggestions that can be modified to suit the nation of Zimbabwe. I welcome debate on my suggestions so that we can come up with a robust strategy. I do appreciate that we cannot copy and paste because the situation in Matapi in Mbare is not the same as the situation in Canterbury in the United Kingdom.

However Zimbabwe must capitalise on its vantage point of having citizen health, science and economic experts all over the world. There is a great need to exchange notes so that Zimbabwe does not make the same mistakes that other nations have made.

The concern is that Zimbabwe does not have the luxury to make the same mistakes that other countries have made.  The biggest liability being unprecedented fatality rates given the current fragility of the health system

As some of you may know we formed a social media group to raise awareness of this global pandemic and reading from the comments one can see that the biggest concern our citizens have is the state of our health system. They are worried because our health system is not resilient.

We know without a shadow of doubt that when a crisis hits an ill-prepared health system, the result is the substantial loss of life, massive social disruption and collapse of even basic healthcare services. 

Health experts like Kruk and team define health system resilience as the capacity of health actors , institutions , and populations to prepare for and effectively respond to crises; maintain core functions when a crisis hits; and , informed by lessons learned during the crisis , reorganise if conditions require it.

A resilient health system should be able to protect human life and produce good health outcomes for all during a crisis and in its aftermath.

This resilient health system should be able to deliver everyday benefits and positive health outcomes. Such health systems offer double benefit which is improved performance in both bad times and good. Sadly our health system in Zimbabwe is nowhere near that.

Feedback from our group points to issues with trust in our country. Lack of trust with our health system is evident from what I would like to call “infodemic”. This is excessive amount of information about COVID-19 some which is correct and some which is hearsay , speculation and utter lies. This makes it difficult to know what exactly is happening in Zimbabwe.

Ideally in an outbreak like this Coronavirus people must have the trust and confidence in their health system. That trust and confidence comes from what the health system is delivering as information on a daily basis before the crisis.

Sadly in Zimbabwe people cannot trust our health system because it is failing to provide its citizens with safe and good quality healthcare on a daily basis. We cannot make our health system resilient within a day but together we can do something that will save many lives in this pandemic.

The Ministries of Health and that of Information in Zimbabwe must effectively communicate with their population. Failure to communicate effectively leads to loss of trust and reputation which can sadly lead to loss of lives.

They must proactively communicate what is known, what is unknown, and what is being done to trace all contacts of COVID-19, with the objectives of saving lives and minimising the impact of the outbreak. This will build trust in the response, and increases the probability that health advice will be followed.

It minimises and manages rumours and misunderstandings that undermine responses and may lead to further disease spread. This regular proactive communication and engagement with the public and at-risk populations can help alleviate confusion and avoid misunderstanding.

It is an open secret that countries all over the world are struggling to test everyone and also to provide adequate personal protective equipment (PPE) to their health workers. It then does not help Zimbabwe if it’s leaders come out on national television claiming that the country is well prepared and has enough testing kits to test everyone. That blatant dicing with the truth harbours mistrust which will make people not follow the guidelines resulting in the spread of the pandemic.

People are rightly worried by the low numbers of confirmed cases. Some are even thinking that the Government of Zimbabwe (GOZ) is hiding the figures.

This mistrust in the daily COVID-19 cases updates is now defeating the main reason for having those updates. Each time I share the daily updates , a debate erupts about how accurate the figures are and how the GOZ is hiding the true figures.

Ministry of health and Child Care (MOHCC) need to operate in an open and transparent way when it comes to the cases of COVID-19. MOHCC must work hand in glove with the people of Zimbabwe.

It should invite people to come for testing and also welcome those who think their loved ones may have COVID-19. The toll free number 2019 must be publicised widely and must be used by everyone to report anything to do with COVID-19. Citizens of Zimbabwe must also have trust and use the toll free numbers rather than first rushing to the social media.

I got worried when I read a case of a desperate person who was not able to breathe. Instead of getting help from the toll free number and get an ambulance the person had to resort to using the social media to get some help. This should not be the case.

People must know their emergency numbers and must have trust in using them. People will have trust in the toll free number if they have positive experience of using them. The toll free numbers must be widely known and must be easy to call and answered in a timely manner.

People must get the right advice from the toll free numbers and must be directed to the right service at the right time. This will build trust in our system and it’s not rocket science.

Symptoms of COVID-19 must be clearly spelt so that everyone understands them and knows what to do. We have several languages in Zimbabwe so we must scale up the translation of material on COVID-19 into local languages.

People do like to hear our local languages as evidenced by the video done by one school girl from Chipinge. Her amateur video done in Ndau language went viral and is one of the most watched video in our group.

Leadership must walk their talk and they must know how to walk that talk. Zimbabwe is in a lockdown at the moment. This means people must stay at home and avoid unnecessary movements.

We have police travelling crowded in their lorries going to reinforce compliance with the lockdown laws. It is common sense that you cannot reinforce a law that you are breaking. Social distancing applies to everyone so the police must practice it as they try to make everyone comply.

Our borders are still open yet we are in a lockdown. We are sadly getting imported cases even if we are in this lockdown. Some argue that Citizens of Zimbabwe must be allowed to come back home but the same people did not allow our students who were in China.

Our students endured the pain of the lockdown in China but saved many lives by not coming back home. We need to close our borders for now so that we do not have new imported cases. If we allow people to come into Zimbabwe then we should quarantine them for at least 14 days.

We should take them to a designated centre where they will be monitored. We cannot allow them to self isolate at their homes as we do not have the capacity to monitor them. We know that our residential areas do not promote social isolation. Imagine those that share bathrooms and toilets.

People are getting agitated when they see more and more imported cases coming up when we are in a lockdown. If this is not addressed it will create mistrust and people will stop to obey the lockdown. We all have to play our part to make the lockdown work.

Employers , supermarkets , banks , health institutions and our policy makers as well as everyone must make sure that whatever they are doing or implementing is supporting the lockdown.

Our leaders must also comply with the lockdown laws. South Africa has had to suspend a senior official for breaking the rules of lockdown and in Scotland a senior health official had to resign after failing to comply. No one should be above the law. We are all in this together so we must play out part by making sure that we do not infect anyone as well as not getting infected.

Finalising on the issue of testing Zimbabwe must learn from other countries. We should be able to quickly identify and isolate a disease outbreak and target resources to it. For Zimbabwe to do this it must know the size of the problem they are dealing with.

Initially it is best to promote systematic testing and keep reviewing the criteria depending on your findings. Several countries were late in changing their criteria and Zimbabwe is falling into the same trap. History of travel must not be a requirement for testing when we have a pandemic that has affected almost every country in the world.

Testing should be decentralised so that we do not have delays in getting results which can put our health workers at risk. The COVID -19 case from Bulawayo exposed the lack of preparedness in our system. Our health workers are at high risk of getting infection because our definition of COVID-19 was rigid focussing too much on travel history.

The lack of local testing meant that patient had to die before the results were known. This means that some might have treated the deceased as something else instead of as a case of COVID-19. The panic caused by this needs to be addressed properly.

It is not a matter of just testing the contacts. Those contacts need psychological support to be able to manage in the days , weeks and months to come.

Our private doctors must be allowed to use technology to carry out their consultations. The laws in the country must allow the use of telemedicine and telephone triaging in the fight against COVID-19. We welcome the relaxation of laws to allow doctors to be able to use telemedicine in this crisis.

I am disappointed by the association of health funders which is refusing to recognise that remote consultation is effective , safe and must be funded for . Their refusal to pay for it shows that they do not want to move with times and fight this pandemic together. I urged the doctors in Zimbabwe to nevertheless go ahead and appropriately implement remote consultation.

Management of infectious diseases has always been for the government and local authorities but this COVID-19 has exposed the inadequacy of this arrangement. There is need to allow private sector to help in the fight against COVID-19 and future infectious diseases.

The GOZ must welcome the coming of the private sector to run St Annes in the fight against this pandemic. The process should be speeded up so that we do not lose lives due to red-tape. We need a few extra privately run infectious disease hospitals in Zimbabwe but not forgetting that prevention is our best weapon.

Zimbabwe should know its hotspots for infectious diseases such as Mbare area. Resources must be focussed in those areas. We need to have more washing facilities and testing as well as isolation of people who test positive.

Those that test positive in places like Mbare cannot effectively isolate themselves as their housing circumstances do not allow that. They must be taken to designated areas if they are stable enough to not needing hospitalisation.

Increased testing in the early stages of the outbreak in Zimbabwe will help in the fight against this Coronavirus. If we miss this window of opportunity then we will not be able to test all the many new cases that will come.

Lockdown was rushed without proper planning. Now that we are in this unplanned lockdown we now need to come up with solutions to deal with the negative impact of locking people without means of feeding themselves. There is need for a collective approach that will alleviate suffering among our people. What can government do to feed people who are not able to feed themselves?

What can banks do to those who are not able to service their loans and mortgages? What can supermarkets do to reduce the cost of basic foodstuff? What can those in the diaspora do to help their loved ones in Zimbabwe? Is it the right time to be profiteering?

Can we not all try to cut our profits and save more lives ? Afterall in the long run it would be preferable for businesses to have a live economically active consumer base than one that is dying or suffering the effects of COVID-19?

An approach will only become effective when the government shows exemplary caring and compassionate leadership by implementing policies that alleviate suffering of its people.

In conclusion let us have a continuously dynamic strategy and continuously improving testing criteria in the fight against COVID-19. For now let us try to test , trace and treat all possible cases of COVID-19 as we have this window of opportunity. Quickly identifying and isolating cases of COVID-19 will help us to target resources to it and stop the spread of this virus.

There is need for collaborative working making sure that all stakeholders are on board. We need to be adaptive and inclusive as well as collaborative in the ways we handle these outbreaks so that we can minimise the loss of lives and the disruption to our economy.

This calls for both vigorous public health response and a highly proactive and functioning healthcare delivery system. Our policies must make sure that our health workers are well resourced and motivated so that they show up for work that may be difficult and dangerous. Without our health workers we will not win this fight against pandemics such as COVID-19.

Dr Brighton Chireka is an International Health Consultant, GP Partner & Clinical lead of SKC CCG. He is a Fellow of the Faculty of Medical Leadership and Management. Dr Chireka is the Founding Chairperson of Zimbabwean Diaspora Health Alliance (ZDHA) and also a Founder Trustee of CC Foundation in Zimbabwe which offers scholarships to students from deprived backgrounds.