GYN CHRONICLES
Healthcare In The
Advent Of Coronavirus
space suits and I can only salute the people
who take part in these surgeries as even
in normal circumstances these are very
stressful situations and now add a Hazmat
suit on top of it all.
The issue that has not been dealt with is
the issue of stigma. There seems to be a
divide in the level of acceptance of both
patients and their care providers. There is
the group that really appreciates what the
healthcare fraternity is doing and literally
risking their lives to aid patients. Very
unfortunately there is the ugly side, and
I’m saddened at how basic some Kenyans
can be.
I’ve really scratched my head on what
would be appropriate but seeing as
everything is still Covid-19 let’s
continue the conversation. For most the
shock is over, we already know Coronavirus
is in Kenya and by now maybe have one or
two friends or relatives who have suffered
in one way or another. Kenyans with our
“peculiar” habits have had to be repeatedly
cautioned by the authorities. I hope none
of you has been caught loitering past 7:00
pm and put in quarantine for the offence.
What does reproductive health look like in
the advent of Coronavirus? Unfortunately
some of us are dinosaurs and will need a
lot of help to optimally operate with the
new infection prevention procedures. The
first advice everyone was given was stay at
home. Well, how do you see your doctor
when you are at home? Telemedicine is
the way to go. You can either zoom chat or
have just a simple telephone conversation
with the patient.
Despite the security challenges posed by
zoom it is still a very good platform to
relay information. To increase your safety
always update the app to ensure you have
the latest version with increased security
features and control access into your
meeting room. If resources allow probably
invest in the paid version and if zoom is
not your thing there are numerous other
apps that you can use instead.
The role of this initial teleconference
is more for screening to ensure that
only patients who really need to come
to hospital come and those who can be
managed at home still have access to some
form of healthcare. It is yet to be seen how
the market will behave and some hospitals
are offering this at a discounted rate.
For me a doctor’s visit is an intellectual
discourse and the liability remains the
same and probably even higher as there
is now a greater chance of a medical error.
There is a huge saving to the client in
terms of transport and time. I would still
entertain these visits at a similar charge
I would like to take this opportunity to
thank Kenyans for their overwhelming
support for both the healthcare community
and the Government of Kenya
in the fight against our common enemy
-coronavirus. This is the first time in a
long time we feel appreciated by the people
we serve.
Dr. Maureen Owiti
or minor discount. A new field may come
up. Litigation may ensue for misdiagnosis
but in the prevailing circumstances we
maintain that only really sick people
should come to hospital.
The other challenge would be how willing
are clients to pay and do they feel they
are getting the same standard of care as
a physical consult and if tests are required
all we have done is limited the interaction
with the doctor one would still have to
either go to a lab or some enterprising
hospital/lab may start home collection for
samples.
Reduce visitors to your home to only those
people that you must see. Remember the
elderly are more vulnerable to Coronavirus
and therefore it is your duty to advise them.
I saw a beautiful article on the challenge
of advising parents hope you can pick up
some tips from it.
If after the teleconference it is determined
the patient still needs to come in for a
physical visit the considerations to bear in
mind are the protective measures in place
for both the healthcare worker and most
importantly the patient. Right now I think
every institution whether it’s a bank, salon
or DSTV agent is insisting on some form
of hand hygiene, such as: hand washing,
but use of hand sanitizers seems to be
more popular. This is reflected even in the
supermarket.
Most companies that were producing
cleansing agents or beauty products now
have a brand of hand sanitizer on the
shelves. These are the companies that
will survive they have quickly adapted
themselves to the prevailing conditions.
Don’t know what will happen when Covid
ends (a very long way away!!) but they had
their pre-Covid-19 brands and I feel even
in the post Covid-19 era hand hygiene will
still be paramount. If you are like the rest
of us mere mortals and not making a kill
on producing hand sanitizers relax there
are enough fish in the sea just need to
think a little harder but more importantly
at least attempt to implement your ideas.
Back to clinical matters. In big institutions
there are elaborate ways of ensuring
patrons are “sanitized” prior to entry
into the esteemed establishments. Some
have disinfectant sprays/walkways with
an elaborate thermal scanner. In smaller
institutions you have the proverbial soldier
with the thermal gun and some hand
sanitizer. Some people have automatic
dispensers but most places you have the
manual pump with release of some form
of sanitizer. Hoping most have genuine
sanitizers we know that unfortunately
some counterfeit products may be out
there as unscrupulous people try to make
a quick buck.
Those institutions which have invested
in technology especially digital records
will have patients seen without a paper
trail from triage to doctor, lab, imaging,
pharmacy and finally the cashier.
Regardless some human interaction will
occur and patients will have a clinical
triage. Don’t be alarmed in case they are
in full Personal Protective equipment
(PPE) as the people manning triages
are the real frontline. They are exposed
to all clients both sick and healthy. All
triages have a special focus on Covid-19
screening, but currently this seems useless
though I would not presently advocate for
the suspension of the Covid-19 triage,
but the stark reality is that the current
carrier of coronavirus is healthy with no
temperature spikes.
As mentioned because we have many
asymptomatic patients with Coronavirus,
the government is requesting for all
admissions to undergo a Covid-19 test.
This sounds fantastic and I would add my
voice to making it mandatory for ALL
healthcare workers coming in contact
with patients to likewise undergo regular
testing. I might be lynched by colleagues,
but in the end if we really care about
our families back home it’s ensuring we
constantly use appropriate PPEs and
routinely undergo testing if we are coming
in contact with patients.
The interesting reality is that especially in
private settings the cost of these tests will
have to be borne by the patient so better
pray you have a fantastic insurance cover
that will not decline payments on basis
that this is a disaster.
We really hope that the uptake of mass
testing increases tenfold so we can test at
least 5000 people per day. This would give
us a better reflection of what is actually
happening in the community especially
with the current “community spread.”
Fortunately we as the healthcare fraternity
have envisioned that coronavirus positive
people may have some other medical
emergency. There are specialized wards
and units which have been receiving
patients and these patients have had
normal deliveries, caesarean sections,
orthopaedic and even neurosurgery to
name a few. The teams are dressed in full
Health care workers and survivors of
Coronavirus have been facing attacks
from their communities who call them
“watu wa Corona!” and don’t want them
to stay in the neighborhood for fear they
will pass the disease to them. While
their fears may be valid the idea would
be to see what support is necessary to
ensure the transmission cycle is broken
and the community is safe rather than
ostracizing innocent members of society.
A lot of education needs to be put in place
to ensure that the community is more
accommodating of other members.
I would like to take this opportunity to
thank Kenyans for their overwhelming
support for both the healthcare community
and the Government of Kenya in the fight
against our common enemy -coronavirus.
This is the first time in a long time we feel
appreciated by the people we serve.
I can only hope against hope that by the
time my next article is due something
wonderful would have happened and we
will have eradicated Coronavirus. My
more practical side says a tall order but it
is by having unrealistic dreams and goals
that we achieve great things. In the words
of one of Kenya’s greatest sons No Human
Is Limited!
Dr. Maureen Owiti is a practicing
Obstetrician Gynaecologist and fertility
consultant based in Nairobi. You can
commune with her on this or related
matters via email at: Drmaureenowiti@
gmail.com.
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