“The West has been fearful for Africa” - a Namibian medic tells us what it's really like on Africa's Covid frontline

Julius Kwedhi is from Namibia, a middle income African country with a population of 2.5 million. He studied medicine in Russia and then returned to his country to complete his medical training. He's now serving on the Covid rapid response team there. So, is Africa really coping worse with Covid than the rest of the world?

 

What's the weather like in Namibia? 

It's winter right now. Over the past few days, it's been getting warmer. It's quite mild and pleasant now. The temperature is now 13 degrees, the maximum was 24 degrees. For the past few days I would go to work wearing long johns underneath my scrubs. Two weeks ago I would have to wear two pairs of socks. 

 

Where do you live, and where did you train?

I trained as a doctor at Moscow's Sechenov Medical University. I've been back in Namibia for more than a year now. I live in Windhoek - pronounced Vindhook - the capital. I'm waiting to sit the medical board exam that foreign trained medical graduates have to pass in order to start practicing as doctors in order to do an internship. It's a highly politicized entrance exam so out of 450, only 27 passed.  

They need doctors in Namibia which is why, even though we did not pass the exam, we were given the opportunity to volunteer to work on the frontline of Covid response, with a special name called Health Programme Officers. So the majority of Covid response health care workers are the medical graduates who were made to fail. We are the ones on the frontline, working together with some doctors who finished the internship, we call them medical officers, and doctors who have been practicing for some years. At least we are getting a monthly income. 

 

Tell us about the situation with Covid in Namibia. It seems they shut the country down in March when there were hardly any cases, then they opened it up again and cases started to snowball. 

It was quite strict. People were not allowed to travel without permission. To travel out of the city or from other parts of the country to another part of the country, you'd have to go to the police to get permission. When you drive by a road block or checkpoint, if you don't have a valid permission, then they'll turn you back to where you came from. 

Schools were shut down. People have all been allowed to eat in restaurants although some were shut down. Some businesses remained open. Essential services remained open. People were discouraged from going out, even to the supermarket. Only one person per household could go, which was really not practical. 

There was a curfew, if you were driving past certain hours of the night, they would fine you. They restricted the number of people in cars. A five seater could only take four people. Sometimes it would only take five people. It decreased the travelling, because the police would beat up people who they deemed had broken the laws of the lockdown.

Alcohol was banned. People who brewed alcohol were beaten up by... it's not really by police. It's actually the soldiers. The military was released to patrol. That lasted from March 27 up to early June. It was quite a long time. 

 

The first reported cases were imported cases, a Romanian couple who flew in. My wife was on that plane, she was sitting a few rows from the couple. They did contact tracing, they were calling my wife for seven days to find out if she was symptomatic. She was not. And then after that, new cases came in, from people who flew in from South Africa. And then other cases came in through the port of entry, with ships from the west coast of Africa. So Walvis Bay became the hotspot.

Cases have just been going up:  ten a day, then twenty a day, thirty a day, forty a day. It's unbelievable! That happened around June. Cases were just going up exponentially.

At first, the politicians were saying there's no known cases of community acquired transmission; then later on, they had to admit that there was. This really happened after the lockdown was relaxed because like everywhere else in the world, there was a balance between locking down to prevent the spread and then leading to more economic downfall, and opening up and risking rising infections. 

I guess like most countries they opened up because a lot of people lost their jobs because there was a decrease income in the workplaces, because not many people were going to the shops.  

The government issued some sort of a relief package. It was a bit laughable because they were promising to give the people who lost their jobs a one-off payment of 750 Namibian dollars, that's about USD 50. Not everybody got that by the way, because the process was so lengthy and so complicated. The criteria for applying were published through SMS. It seems they were unattainable for some people.

 

How are people reacting to Covid? Do they take it seriously?

The government has done a good job of creating hysteria. People are scared. But social distancing isn't practiced.  It's not in the culture. When we hear that we've had one hundred cases of Covid today, we are all shocked. But then you go out and people are standing in groups. You can't go into a shop without a mask, whether it's a pharmacy, a service station or even a bank. You have to fill a paper, get your temperature taken, give your name.  But before people get into the shop, they are queueing outside, and there's no social distancing, so the whole purpose is defeated. 

 

What are your responsibilities?

My job title is Health Program Officer. At first, I was working at the clinic. The early part of the lockdown it would be mostly people who had travelled, or had symptoms, and so their bosses would send them to be tested. We'd screen them, take down their their names, where they've travelled to, how long ago... Then we'd ask them about their chronic conditions, diabetes, heart disease, then take down their blood pressure, temperature, the oxygenation of their blood and then after that we'd swab them and send them home. If they need sick leave we give them sick leave. We'd send the sample to the lab, the lab sends back the results to the clinic and then we'd call the patients with their results. 

Now things are different because it's mostly community transmission. Those are the majority of people we are swabbing. 

Then we moved to the rapid response team, a lot of repatriation flights, Namibians coming back from abroad and also foreigners who live here. They would be taken to quarantine facilities. In the first four days we'd swab them. If there's anybody positive, they'd be taken to an isolation facility where positive cases are kept. The negatives, we'd swab them again on day 12. If they're negative, then they're released. Then the number in quarantined facility became more and more, the lab was overwhelmed, so results were sent instead of in 3 days, in five days, seven days, etc., until private laboratories were allowed to get involved, or finally saw an opportunity to make money. 

The private labs won't come for just one person. We'd go, we're representing the government, we test people for free. 

For those that are ill, I don't know what protocol is being used. I know that our government on the advice of the WHO has been reluctant to use hydroxychloroquine. I'm not even sure they have the antiviral Remdesevir. 

 

What's your typical day like at the moment? 

I wake up between six and seven, then shower, and then not much breakfast, then leave the facility. All healthcare professionals who are rapid response stay in one lodge. Each team includes three healthcare workers and one driver. Two teams are working. The first team on call is responsible for swabbing people. The second team is available to help if the second team is overwhelmed. Now they're responsible for calling people with their results. So you don't really rest until you have a day off. On average, we have one day off. 

It was quite busy. However, where I am now at the clinic, we have two day shifts, two night shifts, and then two days off. That's much better because when you work the night shift you have the whole morning to do stuff so you have literally four days off. 

Do you know anyone who has Covid? How's your health?

I don't know anyone who is symptomatic. My health is very good. We have some workers who got infected.

 

This question is a bit tricky. In Britain, they noticed that a disproportionately high number of people infected and ill from ethic minority background. Is it due to poverty and its effect on health or living condition, or due to a deficit in vitamin for people with darker skin who live in a Northern climate. What do you think of that? 

The West has been fearful for Africa. They thought if the African countries get infected, it's going to be worse than Europe because at first they were overwhelmed, so they thought we'll just be mowed down. 

Our health capacity is not prepared. With two thousand infected, it's nothing compared to what's happening in Europe. Or system is already crashing, in the sense that the results are taking too long to come through.  But the people here, the people that are hardest hit are not really the minority.

I have not followed the debate, I don't really know, how essential vitamin D is. The argument was against vitamin D. In the beginning of Covid, I used to think, knowing human pathology, how the body responds to viral infections, that you need to strengthen immunity. But it's actually the opposite, because you have to shut down immunity for a while, so as not to suffer this inflammatory reaction. So I would say probably the other side of the argument, why is it the minority, look at the adherence to social distancing, the use of masks. A lot of people especially here, the person has a mask, but it just covers the chin. 

 

A lot of the victims have been overweight older men...

Some of the people who die are young people. But when a person is overweight, it's usually because of fat. The fat pushes up against the diaphragm, and there is a low volume of the lung. Overweight people, usually they breathe heavily, they have low lung volume, plus an infection that is decreasing oxygen supply. That's what we call a double whammy. It would make things worse, especially for men, for whom fat is centralized on the stomach. 

 

Do you have any conclusions about Covid in Namibia and your experience on the front line?

It is, of course, a lot of work. The main issue is lack of preparedness, and also the lack of communication, especially from politicians. Now they allow people to only be quarantined for 10 days rather than 15 days s. They are to be swabbed only once, which I'm all for because it reduces the workload for us. But the problem is we didn't get communication before this was made public. 

Now we are receiving calls from people saying, "I've been here for ten days, I should be released", but we haven't been briefed ourselves. You only get information on the day something has to be done. 

At times we receive insults from people who are frustrated for being in the facility for so long. Some of them only want someone to listen to them. You say, "Yes, I understand, I agree. You shouldn't be here for so long. Yes, that's really true. I'll follow up on that." And then they say, "Thank you so much for listening!"

Our team is very good, although we don't have lunch breaks, things like that. I've been blessed to have a very dedicated team of health care workers. So it's very good in that sense!

We could have had it bad if our living conditions had been like in the Middle Ages or the Spanish Flu. The world is better prepared, even though there's a lot of politics going on. But even with the few resources that we have, so far so good!