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The Covid-19 Pandemic through a Frontliner’s Eyes

The COVID-19 pandemic has changed lives, economies and so much more.

However, there remained a people that could not keep themselves locked away as many of us did because it was their job to be on the frontline.

Medical practitioners fought in there various ways and some of these are those from UMC Victoria Hospital. It joined the fight against COVID-19 despite few private facilities doing so because they believe it is worth it and as those in the medical profession, they were only responding to the need at hand.

Just like everywhere else, the pandemic presented a need beyond what they can fully take on but they had to pull every last resource to save people.

“The government has done a very good job but there will be limitations on how much they can do so we cannot expect them to take care of everything. Others ought to do the best they can in whichever capacity and that is why the hospital stepped in,” Dr Anurag Shah, the CEO and MD, shared.

Dr. Edrin Jjuuko, the chief medical officer at the hospital, said initially, they were only taking care of non-COVID-19 patients.

“Owing to the lockdown, the hospital chose to reach out to its patients, both old and new through aggressive home-based care such as telemedicine consultations, drug deliveries, and basic tests. We also reached out to those on chronic treatment, some of whom needed emergency services hence the need to dispatch an ambulance to bring them to the facility. In our drive, we reached to people in a more than 1,000 km radius, even up to Iganga District.”

Dealing with suspects

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However, when the lockdown was lifted, interactions increased leading to a spike in community transmission.

The need for help was dire and the hospital could not turn a deaf ear pushing it into preparation to treat COVID-19 cases because with such transmissions, everyone is a suspect.

The preparations started with training the medical staff which was necessary because while the hospital had not yet started dealing with COVID-19 patients, with the rising numbers, it was just a matter of time.

“We knew that at a certain point, we would be treating COVID-19 patients. Therefore, capacity building was essential to teach our staff how to deal with suspects as well as protecting themselves as we waited for the test results,” said Shah.

Initial training took about a month with weekly sessions targeting unit in-charges who were expected to pass on the information to those under them.

All doctors were also expected to attend and their positive response helped as none of the hospital medical staff has been infected with the virus.

With trainings going on, Infection Prevention and Control (IPC) guidelines from Ministry of Health were adapted.

The hospital enhanced them in the unit to protect the staff as well as non-COVID-19 patients and in line with that, an isolation unit was established to keep suspects on one side and other hospital users on another.

Management was also able to bring in lots of protective gear which made it easy to enforce the regulations as one not only knew how to deal with or dress up when meeting a suspect but the gear was present.

Fully fledged treatment Centre

Eventually, the hospital was called upon to think about case management which they opted to do in the annex building (former Kadic Hospital).

This started the journey of preparation, seeing to it that patients would easily access oxygen, antibiotics, steroids, close monitoring, nebulization, and physiotherapy. That also called for ensuring there was always a team to see to all these needs.

Dr Anurag says while it has been a very challenging time, it is a joy to serve the community seeing that UMC Victoria Hospital was one of the first private health care provider to be accredited by MOH as a COVID-19 treatment unit.

“The accreditation is a long process whereby a medical facility applies to government and opens up their facility to them to review as well as make recommendations. Our annex facility was the best we could offer because apart from being in the middle of town, it is on an independent plot. That means that the other patients in the main wing of hospital are not in contact with COVID-19 patients“

In the case of UMC Victoria Hospital, the facility was inspected, recommendations regarding what needed to be worked on were given and once all was done and implemented, a license to operate a COVID-19 treatment unit was given.

The facility has admitted more than 130 patients in the last two months.

Criteria of admission

As per MoH guidelines, those with mild symptoms such as flu, loss of smell and taste can stay home as part of home-based care but they have to be attached to a COVID19 treatment unit for accountability. That is to avoid these patients from mixing with the community. The hospital is admitting moderate to severe cases, with emphasis on special care for those with other pre-existing conditions like heart disease, hypertension, diabetes etc.

UMC Victoria Hospital has become one of the largest private referral centres for COVID-19 treatment in Uganda, having established a total bed capacity of 45 treatment beds including 12 HDU/ICU beds.

Most patients feel better even after five days with the right intervention, but at the moment, the minimum number of days one can be admitted at the facility is 10 because it helps to avoid community transmissions.

Therefore, once patients stabilize, they are taken to rooms (private or shared) which the hospital created for recuperating, out of the ICU or HDU. Thereafter, they can go home and self-isolate though still under hospital care where medical personnel still check on them because if one has not tested negative, they can still infect others.

Challenges

The biggest challenge faced currently in the ever increasing patient numbers, with the 45 bed capacity also proving to be insufficient on some days. Another challenge is lack of medical equipment like ventilators which is preventing capacity addition.

Staff capacity: Initially, it was a challenge to ask the medical staff to treat COVID-19 patients because there is always a lot of fear towards a disease.

However, with continued training, thanks to KCCA and MoH who have been extremely helpful in giving more training to the medical staff on treating these patients, they have been equipped with skills which also help their attitude. As such, the mentality has changed and they appreciate that they are creating a positive change. Unlike in the beginning where the patients were few, they now work in shifts and stay on campus to avoid any external issues that would affect their performance.

Future

The hospital is optimistic about gradually increasing its capacity to be able to admit more people rather than turn them away.

There is also hope that the number of severe cases will reduce. They also hope that the vaccine will get to Uganda faster.

In the meanwhile kudos to all frontline health care workers in their brave fight against Covid-19.

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