African Public Health Network Newsletter #4
Editorial by Chineze Nwankwo
Hello all,
It has been a great year for APHN. We have had interesting seminars and events so far into the year. Listed here are some of them:
- Breast Cancer Awareness: African Perspective
2. Information session with Dr. Frehiwot Nigatu, who currently serves as Executive Director for the International Institute of Primary Health Care of Ethiopia (IPHC-E).
3. Speaker Series on the lessons learned in Low-and Middle-Income Countries during the COVID-19 pandemic with our first speaker being Dr. Nnaemeka Ndodo
A networking event was also hosted and we heard from three JHSPH alumni about how to navigate life after the MPH!
Tune in on the podcast to listen to these events and hear from these amazing speakers at https://anchor.fm/aphn
Covid 19 vaccination and African Refugees
by Sadya Tarannum
The number of forcibly displaced people is increasing day by day due to international politics, war conflict, etc. Like any other country, Africa also received refugees from other countries.
In September 2021 there were around 933 thousand refugees from South Sudan. Other countries of origin of refugees in Africa are Congo and Burundi (1). In Africa, WHOs overall figure for fully vaccinated is currently 4.4%. Initially, Africa struggled to get a supply of vaccines. But their situation improved in July and August by receiving supplies of vaccines from wealthier countries still failed to cover the whole of Africa (2 ). On the opposite side of the coin, rising food prices and loss of income due to Covid 19 cause child anemia and shortage of food. This crucial thing also needs to be addressed (3).
Challenges that we need to address while vaccination:
1. Ignorance about Covid 19 and outcome.
2. Not adequate supply of vaccines.
3. Other problems such as housing, food poverty, and unemployment that is sometimes more important than vaccination.
4. Lack of resources (Doctors, nurses, community workers, social workers, health facilities, etc.)
5. They are living in highly populated areas. So, the disease can spread very easily from one to another.
6. Strong belief about traditional treatment that make sometimes problems to bring them into health care facilities.
7. Number of health care facilities is not adequate with the number of refugees. Sometimes they have to travel a long way to find what is near.
8. Lack of communication between them and with the real world.
What we can do:
1. Make them aware of Covid 19 and the importance of vaccination.
2. Connect them with the proper department to ensure their other basic needs.
3. Improve communication and health resources.
4. Identify the most vulnerable patients such as pregnant women and elderly people.
So, it is essential to first ensure refugees’ basic needs such as food, shelter, employment, etc. It is also important to make them understand the importance of vaccination. We also don’t have enough supply of vaccines to vaccinate all. In this critical situation, we need to focus on this target population because it is their right to get vaccinated. We need to make an effective plan to overcome this situation. Government, private and UN organizations should play an important role to manage this situation.
References:
1. Simona Varrella, Number of refugees in Uganda 2021, by country of origin, Statita, Oct 27, 2021.
2. Peter Mwai, Covid 19 vaccination more than 50 nations have missed a target set by the WHO, BBC reality check, 20 February 2021.
3. Refugees in Africa even more vulnerable than ever amid Covid crisis, 9 July 2020, Humanitarian Aid.
“Of Breasts”
by Elise Tirza Ohene — Kyei
One of the first patients I ever cried about was a woman in her early forties who died of breast cancer. At the time, I was a first or second-year medical student, doing a 6-week internship at the 37 Military Hospital.
She was a lovely woman, always ready with a joke. I didn’t like the surgical unit much, but she was one of the few patients that gave me a reason to head early to work every morning. And although the nurses terrorized me, it was a joy to check on her before our morning rounds started.
She was a simple traditional woman, constantly asking me if I had a boyfriend and if he was taking care of me or asking me if I could cook the strangest meals on earth. Because she reasoned that if I was going to become a doctor, then men would be intimidated. so if I could at least woo them with cooking, then I could snag them before I became a doctor.
She amused me thoroughly.
The day she came in, she could not breathe properly. Her right breast was a sight to behold — and no, not a good one!
She was already in the late stages of her breast cancer fight. (Stage IV breast cancer, with metastasis to multiple organs, notable of which was her lungs…)
This was what led to the difficulty in breathing, which finally forced her husband to bring her to the hospital.
The skin maceration had not made him bring her. The pus that had soaked whatever dressing they had put on it, had not forced him to bring her either. Just like many of our patients, they had waited till it was almost the very end.
She had been diagnosed about two years prior, she recounted to me — Because I didn’t understand how she had stayed home and allowed it to get this bad.
She wasn’t a rich woman — nothing close. But she had the National Health Insurance and could at the time of diagnosis afford the mastectomy offered, after which she’d planned on maybe relying on extended family to pay for chemo.
But her husband said No.
No to surgery on her breasts. No to whatever treatment options she’d been offered.
“Obaa de3 wonni nufu aah d3n na wo w)?” She said this with sadness. It was hard to miss it. But then she added loudly in a very mirthful way… as if she’d just caught on that her gloom was evident:
“Ose s3 mekotwa me nofo no aah, d3n na )b3 nom?” (He said that if I went to cut off my breasts, what would he have to suck on?)
All the women on the ward burst out in laughter.
I couldn’t even fake the laughter. I was bitter towards this man — this man that I had never even met. I had so many questions! And without even meeting him, I had already labeled him a murderer. Later, she mentioned that he didn’t trust orthodox medicine, and so thought that the diagnosis was inaccurate.
I’m older now, and although I know that there are so many similar men out there, I know also, that Aunty Ami should have taken her life into her own hands. Maybe if she had, she would be alive today.
Alive to hear that I finally got married as she advised. To hear that I didn’t have to give up school or have to woo him with cooking skills like she thought I’d have to.
Aunty Ami died very dramatically one late afternoon at the ward’s visiting time. It was the first time I saw her husband. He was the one who alerted the nurses about her unresponsiveness.
He was in tears when we got to the ward. Men don’t often show emotion in hospitals. The hallways are often littered with women or children, wailing about someone’s death or disease. But this man wailed, watching us initiate CPR.
He screamed, and he begged. If life was in our hands, there’s no doubt we would have let her live, just for the sake of this man’s fears.
By the time it was my turn to take over the chest compressions. I was furious! I don’t show rage often, and even when I do, it’s often in silent tears in my pillow. But this woman’s chest got my rage that day!
My eyes were blurred with tears, and all the while, I was saying “Aunty Ami, come back”
It was a lost cause.
Right from the beginning, it was already a lost cause. We went on for maybe ten minutes, but she was gone. And we knew that our CPR at that point, was only to show her husband that we had tried our possible best.
I took my gloves off as if I had just performed some Grey’s Anatomy Surgery, where my patient didn’t make it. I eyed the grieving man in the corner, and if looks could kill, he would have followed his wife that minute!
The soup he’d brought her had spilled next to him, but he didn’t care. He was on his knees on that dirty ward, screaming “Ao Ami! Ami!”
The doctor gave me a mouthful the minute I walked into the doctors’ room! For showing my emotions in front of patients — a trait I still haven’t mastered. (Poker face is not for me.)For not realizing that the way that woman came in, she was lucky to have lived four weeks on that ward. For performing CPR in a frenzy, as if the patient was my mother. For looking at that man as if he was the reason she died. He really lashed out at me.
He had me asking myself questions all night.
Maybe I can be a bit of a crybaby. But very rarely in front of people. And I asked myself the whole way home, and the whole night, why I embarrassed myself crying like an idiot over a woman we all knew was going to die sooner than later.
But by morning, I knew why.
It was not her death that made me cry so much. It was how preventable the death was. How easily she could have lived!
It was the shouts of her husband that outraged me… Shouts of a man who had trivialized the health of his wife, only to show so much drama at her death!
But maybe he didn’t know. I give him the benefit of a doubt. Because maybe back then, awareness was not enough. If he came in today though, he would have had it from me!
It’s breast cancer awareness month. Most hospitals have free screening programs. Please take advantage of those. Get screened. Tell your loved ones to get screened. Escort your loved ones. Make it a party, ladies… call your girlfriends and show up at a free clinic and get this done. You might not have cancer… but someone might. And they will find out and get it checked.
I remember whining about so many women coming to get their breasts checked at the clinic a couple of years ago. (Sorry, I was overworked and unpaid lol) I don’t know what prompted me to be sensible — Maybe it was Kafui, cos she was often that godsend jolt of sense to me — but she reminded me, that I was the bridge between someone and a death sentence.
I was saving lives, I told myself from that point on… Helping prevent breast cancer.
You’re making sure no one ends up like Aunty Ami.
I think about her from time to time. Would she have opened another shop in Makola? Would she have left her husband? Would she have shown up at my wedding? Would she have continued with the jokes? I will never know.
Orthodox medicine is not perfect. What on this God’s earth is perfect?
But many of the things have been researched and shown to work. I hope you don’t sit at home, without noticing something wrong with your breasts. I hope you get screened or take a friend to get screened. And I hope that you never trivialize anyone’s health in your life.
Because wow… how will you live with the guilt that you were their murderer?
“Obaa de3 wonni nufu aah d3n na wo w)” — As a woman without breasts, what do you have?
COVID-19 VACCINE INEQUITY AND DISTRIBUTION IN THE FACE OF A NEW VARIANT: ESPECIALLY WITH THE RISING CALL FOR BOOSTER SHOTS IN DEVELOPED COUNTRIES. THIS IS VERY INCONSIDERATE AND WILL NOT END THE PANDEMIC.
by Chineze Nwankwo
The uprising news articles and social media posts for dates as to when the Covid-19 booster shots would be approved to be administered has drowned out the urgent need and cries of Covid-19 vaccine unfair distribution and lack in the low- and middle-income countries. Currently, the FDA has approved booster shots for those classified as high-risk in the US, however, the majority (millions) of the world’s population remain unvaccinated.
The unfair distribution of the Covid-19 vaccine has led to a severe lack in many countries and this is due to the developed countries which only account for a fifth of the world’s population purchasing more than half of the Covid-19 vaccines produced for distribution in their countries[i] [ii]. These low- and middle-income countries that make up most of the world’s population (about 81%) are left to scramble for a third of the remaining vaccine and depend on the World’s Health Organization (WHO) or the benevolence of other nations to provide the rest[i] [ii].
Even though developed nations have administered the vaccine to more than half their populations, they are still requesting booster shots. This is because of the rise of the Delta variant and the need to open their economy. They seem to forget that we are still currently in a pandemic and even though their countries are vaccinated, the entire world needs to be vaccinated as well to end the pandemic. The constant discussion in the news as to when we should be allowed to get the booster shots are becoming quite insensitive and inconsiderate when some are neighboring countries and continents are yet to vaccinate millions of their population.
Currently, vaccines are being wasted daily in every state in the US. Doctors are appealing to reluctant patients to take them to no avail. A single vial of the Moderna vaccine contains about 10 doses with the Pfizer containing about 6 doses and once defrosted lasts for about 6 hours. Clinics and pharmacies no longer require appointments to administer the vaccines, walk-ins are allowed leading to no accountability in the number of doses or vials opened in a day causing wastage of vaccines.
Yet, in developing countries, the number of deaths keeps increasing daily, especially with the new advent of the Delta variant. Most individuals in the low- and middle-income countries only had 1.1% of their population taking vaccines such as AstraZeneca or Sinovac which a few months ago only had a 63.09% and 51% protective rate respectively against Covid-19 and currently provides little or no protection against the Delta strain[iii] [iv] [v]. My home country Nigeria only has and administers AstraZeneca and even that is not available to the majority of the population. I spent the better part of a week reaching out to colleagues and friends for information as to how to make an appointment for the vaccine as my parents and siblings are yet to be vaccinated. I still have not been able to get an appointment for them, yet I have been vaccinated for the past five months.
Some would argue that developed countries have done so much for the world in health care and aid and should not be demanded to provide to the world. Others might also argue that their countries are currently trying to solve their current issues of getting their reluctant population vaccinated to decrease the continued high prevalence of Covid-19 hospitalizations due to the Delta variant.
However, we need to stop thinking about only ourselves and begin to think about other individuals and nations. So, what happens if we end up vaccinating over 90% of our nation? Covid-19 is a constantly mutating virus that can easily be transmitted and does not discriminate. We are still in a pandemic. If we open the borders and allow international travel, the likelihood of transmission and infection is still very high. Also, with the constant mutation of the virus, the possibility of the current vaccine becoming obsolete or non-protective is very high.
The focus currently should be on the need for vaccine equity and distribution to countries that need it now. We should begin to raise the call and have discussions on various news outlets to ensure the issue is circulated. The need for booster shots should be placed on the back burner and the developed nations who purchased more than was necessary should begin donating their supplies to the low- and middle-income countries. A policy should be mandated by the WHO calling on the developed countries to donate their unused supply to countries that are in dire need of them.
Global immunity and the reduction of mortality worldwide from Covid-19 should be our primary goals. We need to begin thinking about the others if we want to return to relative normalcy. Only thinking about ourselves and placing our needs above others would not end this pandemic!
[i]Anna Rouw, Adam Wexler, Jennifer Kates, Josh Michaud. (2021, -03–17T16:39:34+00:00). Global COVID-19 Vaccine Access: A Snapshot of Inequality. https://www.kff.org/policy-watch/global-covid-19-vaccine-access-snapshot-of-inequality/
[ii] Figueroa, J. P., Bottazzi, M. E., Hotez, P., Batista, C., Ergonul, O., Gilbert, S., Gursel, M., Hassanain, M., Kim, J. H., Lall, B., Larson, H., Naniche, D., Sheahan, T., Shoham, S., Wilder-Smith, A., Strub-Wourgaft, N., Yadav, P., & Kang, G. (2021). Urgent needs of low-income and middle-income countries for COVID-19 vaccines and therapeutics. The Lancet (British Edition), 397(10274), 562–564. 10.1016/S0140–6736(21)00242–7
[iii] Ritchie, H., Ortiz-Ospina, E., Beltekian, D., Mathieu, E., Hasell, J., Macdonald, B., Giattino, C., Appel, C., Rodés-Guirao, L. & Roser, M. (2020). Coronavirus Pandemic (COVID-19). Our World in Data. https://ourworldindata.org/covid-vaccinations
[iv] WHO. The oxford/AstraZeneca COVID-19 vaccine: What you need to know. www.who.int Web site. https://www.who.int/news-room/feature-stories/detail/the-oxford-astrazeneca-covid-19-vaccine-what-you-need-to-know. Updated 2021. Accessed 10/3/, 2021.
[v] WHO. WHO validates sinovac COVID-19 vaccine for emergency use and issues interim policy recommendations. www.who.int Web site. https://www.who.int/news/item/01-06-2021-who-validates-sinovac-covid-19-vaccine-for-emergency-use-and-issues-interim-policy-recommendations. Updated 2021. Accessed 10/3/, 2021.
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Notes:
- Our yearly event Faces of Africa will be coming soon. Look out for the posters on Twitter, Instagram and Facebook pages.
