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Start where you are: Lessons on community-led COVID-19 relief efforts

Some PPE donated to healthcare workers at the isolation facilities. Photo source: Health Hub Africa

By Dr. Ron Ikpe (Guest Writer)

It was a Wednesday morning just like any other, the date was the 13th of March 2019. They all woke up like all the other residents of Lagos, went through their morning routines and left for their day’s work. The children went to school, the traders went to market, those who had small stores in front of their homes set out their wares, and those who had white collar jobs left for their offices.

No one had a premonition of what was about to happen. Without warning, a three storey building located at 53 Massey Street on Lagos Island, collapsed, killing about 18 people, injuring many more and leaving a lot of people stranded, homeless, and confused as to what to do next. We all watched with fear and sadness as the drama surrounding the collapse and rescue of victims unfolded. 

When disaster strikes: A community-led response
I belong to a group of healthcare professionals called Health Hub Africa founded by Dr. Kelechi Okoro. I often think of this group as one with a key role to play in the future of Nigerian healthcare, as it is made up of young health professionals striving individually and collectively to change the narrative of the Nigerian health workforce and healthcare space.

Members of Health Hub Africa at the collapsed Ita Faaji building site with victims. Photo source: Health Hub Africa

We wanted to contribute to the disaster relief measures which the Lagos State Government were putting in place . We identified some of the immediate needs of those affected by the collapse, such as hospital care, securing blood for transfusions, food and shelter. We also identified continued psychological support, and financial support as some of their longer term needs.

Given that we were still a relatively small group at Health Hub Africa, we quickly saw that we could do more if we involved others. We appealed to the general public via social media, and the response was amazing. Over the next few days, combining donations from personal funds and those from the general public, we raised a total of N1,049,800. In addition, we also received donations of food and other items from individuals and organizations. We paid for hospital items required to help treat victims, blood bank processes, and some medical bills, spending N482,000.

Image credit: Health Hub Africa

Through a coordinated effort with Heal for Africa, the group then visited Ita Faaji to see the extent of damage and condole with some of the victims. It was worth every second of our time. The appreciation on the faces of the women, men and children was something you couldn’t buy with money. They realized that people cared for them. We distributed food items and paid visits to the victims both in the hospital and the community. We got to see the temporary relief shelter that Lagos state government had provided.

After the visit, Health Hub Africa conducted a blood donation drive led by Blood Plus Ng at the General Hospital at Onikan. We continued to monitor and follow up with individuals who were hospitalized until the point of discharge. They were grateful for the care and support.

Health workers are having to use cloth face masks as their PPE. This is inadequate to protect healthworkers at the frontline. Photo source: Ron Ikpe

Responding to COVID-19 in Nigeria
In December 2019, the world woke up to a new disease called COVID-19, caused by a novel coronavirus first seen in the city of Wuhan, in China. Now a global pandemic, Nigeria currently has 627 cases.

Nigeria’s frail health system has historically suffered from poor funding, lack of equipment, and mass emigration of doctors. Around the country, news filtered in from health facilities of a lack of personal protective equipment (PPE) for health workers. Some doctors were even asked to use their hazard allowance for two months to procure PPE for themselves as their workplaces couldn’t guarantee that they could provide them. Hazard allowance comes to N5,000 per month, at least for doctors.

Health Hub Africa present relief materials at Ita Faaji in March 2019. Photo source: Health Hub Africa

Because the virus is spread via respiratory droplets, healthcare workers need physically protective kits, in addition to practicing other rules like social distancing, regular handwashing, and the use of hand sanitisers in the absence of soap and water. Understanding the nature of our work and concerned for our colleagues, in March, a few weeks after the first cases in Nigeria, Health Hub Africa decided to provide PPE from medical equipment vendors to some of our colleagues on the frontlines of fighting the pandemic.

Image credit: Health Hub Africa

We chose four centres based on information from colleagues that they lacked PPE despite being designated for the management of suspected or confirmed COVID-19 patients. They are: General Hospital, Gbagada, Lagos, Oyo Isolation Centre, Ibadan, Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, and the Abuja Isolation Centre, Gwagwalada, Abuja. At this point, all the victims from Ita Faaji who we had contact with had been settled and reintegrated back into the society, and we agreed that the money left could be put to use in COVID-19 support. The balance, just over N500,000, was used to buy face masks, shoe covers, hair covers, gloves, and hand sanitisers, which we distributed to the facilities.
We have realized that PPEs are still a critical need, and recently decided to launch a campaign to continue the donation drive for PPEs for health workers. The campaign was launched on April 20, 2020, and we encourage individuals to join this initiative, with the hashtag #ProtectTheFrontline. The campaign seeks to raise funds to buy PPEs as well as crowd source donations of PPE for frontline workers.

Image credit: Nigeria Health Watch

In retrospect: The power of community response
A year after Ita Faaji, and a month after our contribution to support the COVID-19 response, I had the opportunity to reflect on what we had done. It highlighted the importance of coming together as a community to do something, no matter how small, no matter who you are, about the many challenges in our society. Our experience left me with the hope that if each of us, knowing and doing the right thing, come together with likeminded people to tackle issues close to our hearts, Nigeria can, and will, actually become a better place. Here are some of my other lessons:

  1. Collaboration: There is strength in numbers. Health Hub Africa has given me the opportunity to meet and collaborate with great minds on several projects, and support the work of other members and the incredible brands that they are building; Doctoora, Wellvis, Dr. Fidelis Egemba (Aprokodoctor) , Smile With Me Foundation, Firmcare Diagnostics, These are all run by Health Hub Africa members. There is a great need for healthcare workers, and for any community of practice in Nigeria, to come together to collaborate, to achieve greater impact.
  2. Accountability and Trust: Dealing with public funds is very sensitive. Integrity demands I should be accountable with any resources in my trust. It gave me profound joy to see members of the Nigerian public trust fellow Nigerians they had never met with their money, against many common stereotypes. Working with accountable individuals gave me hope that one day we will get things right in Nigeria. A community led response must be accountable to build trust.
  3. Community perception: Our contributions to some degree, contributed to a positive image of doctors and other healthcare workers. Contrary to the image of Nigerian doctors and health workers as people known mainly for incessant strike actions, our ability to mobilize as a community of health workers and reach out to solve challenges in our society provided a refreshingly different narrative. It is important for community led efforts to be perceived favourably by the communities they are working with to raise funds or to support.
  4. Determination: Where there is a will, there is always a way. Busy healthcare workers squeezed out time to coordinate all the activities, visit sites, donate blood, go to market to purchase items and ensure delivery to their various destinations. While government, donors and big businesses do their part, communities can also play an integral role in working together to keep the ground level response going.
  5. Humanity: We are humans first. This was my most profound lesson. The speed with which different people came together to help following the building collapse, without asking questions really touched me. For COVID-19, we must again come together and help. Many families are struggling with how to feed, health facilities still need PPE and other resources, prevention messages need to be carried to every part of our country. It is heartwarming to see initiatives springing up all around to respond to these pressing needs at community level. At a time like this, this is the only way to be human, and I hope we maintain it.
COVID-19 PPE for Oyo Isolation Centre being received. Photo source: Health Hub Africa

Challenges in community-led responses
Looking back, it’s obvious that not everything goes smoothly when working with a group to respond to a crises. We had several challenges; Coordination, especially with organisations that wanted to partner as regards relief items distributions. We bridged this by setting up a centralized working team; Time — Responding to crisis as a community is a voluntary activity and everyone may not be available to help at the same time. Most Health Hub Africa members are medical professionals who work almost round the clock, and this made it more challenging to respond. We resolved this by delegating only free persons for visits; finally, understanding what agencies had done was a challenge because information sharing between agencies was poor. This led to duplication of efforts in some scenarios which was a waste of time and resources.

Africa Health hub members donating medical consumables to Onikan General Hospital. Photo source: Health Hub Africa

Looking forward: Start where you are with what you have
We cannot solve all Nigeria’s problems individually, and at many points, we need the government to step in and act. In Ita Faaji, for instance, the government must enforce strict town planning and building laws to make sure these areas are safe for human habitation. Most of the buildings are ticking time bombs.
When COVID-19 hit, the many gaps it revealed highlighted the absence of plans for emergency preparedness in many areas including healthcare. Things are beginning to look up with the presence of the Nigeria Centre for Disease Control (NCDC) but more needs to be done and the necessary resources should be made available. As my colleague Dr. Ifeanyi Nsofor will always say, “Without health, we have nothing”. Again, the government at local, state and federal levels have the responsibility for ensuring and implementing robust plans for emergency preparedness.

Even as the government’s role is clear, COVID-19 has also brought out the best in many people, from influential individuals to big corporations, who have rallied round to try and stem the spread and ensure affected people get the best medical care. This is commendable and I hope these will continue post COVID-19.

But it’s not just for the big corporations or the billionaires alone. If you belong to any community in Nigeria, whether an association like Health Hub Africa, your church or mosque, your university, market association, or your estate, you have a role to play in making sure Nigerians stay safe and healthy as we all fight COVID-19 together. Start where you are with what you have.
Do you know of other community-led responses to COVID-19 that are yielding results? Let us know in the comments below or on our social media platforms; @nighealthwatch on Twitter and Nigeria Health Watch on Facebook.

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