Media attention as COVID-19 has invaded the world has largely focused on urban centres, a fear justified by the greatest number of cases in cities. However, as the pandemic slows down, it becomes increasingly transparent that COVID-19 not In September, photographer Chris Allen and Sean Christie documented the experiences, successes and classes learned in rural the South African province of KwaZulu-Natal, where a combined network arrived to combat COVID. 19.
“This is another truth in rural South Africa,” says dr. Rosie Burton, a specialist in infectious diseases at MSF, who worked on the epidemic in district hospitals in 3 other provinces.
“What the epidemic has done in a position like rural KwaZulu-Natal is to spread the terrible inequality in the fitness system. At the same time, some incredible projects have been introduced in rural areas,” he says.
Burton’s colleague Dr. Liesbet Ohler works in KwaZulu-Natal, Eshowe City, and says that urban and rural environments have no unusual challenges, such as stigma, high levels of concern among fitness staff, and disorders similar to oxygen provision in hospitals, however, that differences go beyond the unusual.
“The distances between clinics are greater, there are fewer fitness resources and governance systems are at various levels, to name a few of the challenges. Strategies that have worked in cities are not necessarily appropriate,” he says.
Original thinking takes place in low-income contexts, as do strong alliances in every degree of society, “because there’s simply no way you’re prepared to deal with such an immediate epidemic if not everyone goes in the same direction,” according to Ohler.
Collaborating on prevention
In the last week of March, KwaZulu-Natal accounted for 16 of the 85 cases shown of COVID-19 in South Africa and, with others still traveling with few restrictions, it was only a matter of time before COVID-19 entered sub-UMlalazi. KwaZulu-Natal district, where MSF has been operating since 2011.
“We needed to put preventive measures into effect without delay,” says George Mapiye, SPS Deputy Field Coordinator.
To ensure that practices are widely adopted, MSF convened a diverse, multisectoral emergency reaction committee, which met weekly over the first few months.
“Through this committee, we have ensured that communities are informed and that a plan is established for pension payment days, when thousands of others flock to the city. The Muslim network has played a role in enabling the use of its public advertising. “formula for spreading public aptitude messages,” mapiye explains.
“MSF approached us to use our public confrontation system, in which we abandoned the azan (called to prayer). We were satisfied and, through our own organizations, we were very active in obtaining and distributing food aid. Save lives, that’s the total idea,” Mehmood Deedat, president of Eshowe’s Muslim network.
Fighting stigma in clinics
“During those early days, we noticed high degrees of concern among health care personnel in Eshowe and surrounding areas, as well as a general concern that visiting the clinic may increase the threat of getting COVID-19. Therefore, it is vital to make sure that clinics had a strategy in a position to separate COVID suspects from other doctors,” Says Ohler.
MSF has helped the Ministry of Health establish outdoor facilities at clinics: triage issues where anyone who needs to enter is tested using a screening tool, and potential COVID-19 patients are referred to a separate store for testing.
Sabelo Zulu, a worker at the Shintsha Health Initiative (SHINE), a long-time PARTNER at MSF, says the outdoor screening procedure at local clinics is based on people’s veracity about how they feel.
He says that many people, fearing the stigma of being admitted to the hospital by COVID-19, “could honestly answer test questions.
To counter this, educators queue outside, percentage of data and alleviate their fears.
Zulu said the resolution that the clinic’s TB Control Officers take care of the facilities was strategic.
“The symptoms of COVID-19 and tuberculosis are very similar, and if the user does not perceive the sophisticated differences, there is a threat that TB symptoms are with COVID-19 and no other people with tuberculosis are diagnosed. “Explains.
Normally, TB officials in clinics teach TB professionals, provide screening services, collect sputum samples, organize initiation of treatment and compliance counseling, etc.
Working with classic leaders to succeed in communities
“There were so many rumors when this started, because other people saw death on television. When they were told there would be evidence, other older people thought the government was going to (inject) the disease, and they hid. In this place, other people accept and pay attention to classical leaders, and when they are sick, many of our other people first turn to a classic healer,” says Bhekuyise Shandu, who is induna (classic leader) and inyanga. (classic healer) in the Mbongolwane region.
“When MSF first came to this position to fight HIV, they worked with us, indunas for percentage data with others, and educating classical healers to transmit HIV data,” Shandu says. fitness unit on government standards on mourning and burial COVID-19, hygiene practices, anti-stigmatization messages, etc.
“COVID-19 means we have to bury otherwise. Normally, funeral rituals are carried out over several days: animals are slaughtered and many others come to pay their respects. Now the coffin has to pass to the cemetery from the morgue. “, and up to 50 others can attend with social remoteness,” Shandu says.
“Our other people have accepted those settings and are watching them, we’re chasing them,” he says.
Adapting care to patients at increased risk of infection
People living with a chronic disease and weakened immune formula are at increased risk of COVID-19 dying, and South Africa is a country with approximately 7. 7 million people living with HIV and about 301,000 people with active TB. , one of the most important questions for the medical network was how to protect others living with HIV and tuberculosis from the threat of infection in fitness facilities, while at the same time ensuring an important aptitude for those other vulnerable people. Are the populations maintained?
MSF at Eshowe has developed a strategy to deliver medicines to solid and asymptomatic patients with chronic diseases in easily accessible control problems in their communities.
“We decided that there were approximately 19,000 other people on antiretroviral processing in our domain and developed a procedure to identify which of them would be eligible to obtain their drugs at network collection points. 1,500 have signed up for this service to date, saving them time and money,” says Ohler.
When MSF took the decision to deliver chronic drugs closer to homes, it was the continuation of a program introduced in 2019.
“MSF and the Ministry of Health had in the past established 12 fitness centres in rural communities, called Luyanda sites. Luyanda means “expanding or increasing “in isiZulu, and the concept is to expand access to HIV and tuberculosis for rural communities,” says Neliziwe Mazibuko, director of the SPS community program.
Luyanda sites served as convenient network collection points for chronic drugs during the maximum COVID-19 era, as they were all established with simple access to the mind, and it is also imaginable to buy the drugs at those sites for up to 2 days. . . In August, four other permanent sites were opened in Luyanda and another 21 chronic drug collection problems were established at network sites, such as schools, corridors and churches.
“It’s very ambitious, we’ve been working until 10 or 11 at night to set this up, but that’s a smart thing, because, to the extent that it’s a component of COVID’s response, other eligible people living in rural areas spaces with HIV, tuberculosis and noncommunicable diseases like diabetes can already sign up for this service and continue to gain advantages from delivering their chronic medications closer to home for a long time , after he left us COVID, ” says Mazibuko.
Identification and treatment of patients with COVID-19
The Mbongolwane District Hospital established through Benedictine missionaries in 1937 and assumed by the Ministry of Health in 1978. Located on the most sensitive of a hill in rural Zululand and still framed through the dual towers of St. Joseph’s Church, this 200-bed hospital serves a population of around 70,000.
After confirming positive cases in the region in July, MSF worked with the hospital’s control team to identify an effective patient system, including a “flu clinic” near hospital gates, where patients with or reporting symptoms of COVID-19 meet a doctor.
“For most people who come to the hospital, the story ends outdoors at the facility: they are noticed and cared for for a COVID-19 check or sent home with medication, and those they review are asked to isolate the the pager or, if they are sick, they are directed to the quarantine zone, which is supplied to provide oxygen therapy” , explains dr. Helene Muller.
“The formula works,” Muller continues, admits that “working in internal tents with full PPE is a nightmare on hot days!”
Although this formula worked to identify and separate patients with COVID-19, the control of patients with severe symptoms proved complicated in rural areas, says Buhle Nkomonde, an MSF nurse who worked at the COVID-19 MSF box hospital in Khayelitsha, Cape Town. before arriving in Mbongolwane.
“InKhayelitsha, the district hospital capable of referring HIV patients to a box hospital across the street, while all the positives here are transferred to another hospital 70 kilometers away on bad roads. Ideally, we want to think about tactics to develop the ability of rural district hospitals to treat patients with COVID-19 on site, because we assume there will be cases at a much larger drop point for longer, and we don’t know when the next pandemic will occur. Nkomonde said.
As of July 2, there were 53. 60 four cases shown of COVID-19 in KwaZulu-Natal, an increase of 420% in 20 days from 12,757 reported cases on July 4. 676% during the same period, from 531 to 3591, with four8 deaths recorded through COVID-19. The district is fortunate that the number of instances of COVID-19 peaked much earlier in many other parts of South Africa. when the epidemic began, it first shook the fitness care system, i. e. secondary care facilities.
Senamile Ndlazi experienced first-hand the demanding situations of getting attention for the COVID-19 at the time. The young woman works in a grocery store in the village of Eshowe, and when a colleague tested positive for COVID-19, everyone who communicated asked to come to the district hospital for a test.
“We didn’t have to control anyone at the time and yet we were checked out at work. Most of us tested positive,” he says.
Ndlazi and his colleagues were quarantined in the hospital for at least 14 days.
“My chest hurt, but it turns out they couldn’t do much for me. I stayed in bed for two weeks without treatment,” she says.
His mother, Nondumiso Ndlela, says the delight scares the whole family.
“After Senamile won her results, no one came here to examine or review the rest of the house, and we have other seniors and young people living here. COVID was late for Eshowe, but it seems that some parts of the local fitness formula were still not adequately prepared to deal with COVID-19 upon arrival. We can do more and we want to do it,” he says.
As the number of COVID-19 cases in Mbongolwane and Eshowe decreases, MSF has halted the maximum activities undertaken in the local reaction and once again returns to its main objective, which is to fight tuberculosis, a deadly respiratory pathogen that, like conrovarius, spreads through the air.
For Ohler and the MSF team in Eshowe, the COVID-19 epidemic has shown that in the past unimaginable feats could be imagined when other people and establishments painted together.
“Tuberculosis has been the number one death disease in the world for years, however, progress in tacking it has been slow, while in the six-month area, the world has developed testing at the point of service for COVID-19, multiple remedies likely to have a vaccine in record time. Locally, the reaction to COVID-19 combined a record number of actors in a reaction that, while difficult, has left the local fitness formula more powerful and more targeted to patients’ needs. “ohler says.
Distributed through the APO Group on behalf of Doctors Without Borders (MSF).
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