Monday, April 20, 2020

Lets’ marshal our collective resources to combat COVID-19 pandemic in South Sudan

By John Apuruot Akec*

“My heart is in Africa. I am worried. The only reason why the reported cases of coronavirus disease in Africa is low now is most likely because there has not been wide testing of people. The disease is going to bite hard on the continent. I see dead bodies in the street of Africa,” Melinda Gates told CNN’s interviewer two weeks ago. And she is right to be worried.

For once, Mrs. Gates is worried like countless other voices are, because of the well known dire state of health care and social protection systems in most African countries. These weak systems will not easily cope with the pandemic of scale of COVID-19 that has overwhelmed even the health care services of the more technologically advanced and financially resourced countries. And worried we must all be.
The recent scenes of people having to store the bodies of their loved ones at home for days, before their burial in Ecuador in Latin America, as well as the long queues at the cemeteries due to COVID-19 fatalities, serves as a horrific warning to us all about what might be in store for many countries of Sub-Sahara Africa, if nothing is done to prepare these countries to fend off the pandemic.
And when COVID-19 finally breaks out in Africa, as Mrs. Gates, the World Health Organisation, the UN, and analysts fear is going to materialize in the next few weeks and months, the fatalities from COVID-19 pandemic will be like nothing we have experienced in our lifetime.

The new SARS-coronavirus-COV2, shortly referred to as COVID-19, was first reported in Chinese city of Wuhan in December 2019. By Sunday 19th April 2020, it has spread to 208 countries and territories, infecting 2,331,099 and causing the death 160,952 people globally, and still counting.
But the history of pandemics is rife with scary tales and horrible statistics.

For example, by 2012 HIV/Aid claimed 35 million lives in its 30 years of spread, mostly in Africa. HIV/Aids epidemics was preceded by the Spanish influenza that broke out in the US in 1918, just at the end of the First World War. By 1920, it had infected 500 million individuals and killed 50 million people globally, three times the casualties of the the First World War. Before that, was the Third Plague in 1855 that killed 10 million in India. This was also preceded by Black Death which ravaged the world for 7 years from 1346 to 1353, and killed a staggering 200 million people, equivalent to half of the population of the world which was 400 million at the time. Hence, we have every reason to be scared, but above all, to act in order to reduce fatalities in our country. 

Poor infrastructure, weak bureaucracy, and undeveloped health care system in South Sudan will pose multiple threats to lives in the face of impending COVID-19 pandemic. According to credible sources, the number of beds in Juba Teaching Hospital does not exceed 40. That 90 percent of health care in the country is provide by NGOs and private clinics. Many of these private clinics are under resourced in terms of equipment, staffing, and bed capacity.

Every year, universities graduate over 100 medical doctors, but very few of these graduates are employed by the Ministry of Health due to inadequate budgetary allocation and poor planning. And those few employed by the Ministry of Health are underpaid, and eventually get poached by international NGOs that offer better remuneration. Donor medical assistance to the country is channeled through NGOs because of the perceived incapacity of public heath care system to manage funds and deliver services to donors’ satisfaction. If COVID-19 breaks out, neither the Ministry of Health, nor private clinics, nor NGOs will be equipped enough to manage and treat serious cases that require hospitalisation. The consequences will be catastrophic for the country.

Following the increasing concern about the threat of pandemic, South Sudan took a series of preventive measures since 23rd March 2020, that included: closing the Juba International Airport to international passenger flights, closing of international border crossings to movement of people except cargo. Subsequent circulars followed which included the reduction of official working hours by half, closure of shops with exception of those selling food, medicines, or fuel. As of 14 April 2020, air and land passenger transportation between capital Juba and states, and between states and other states were suspended.

On the other hand, the University of Juba has formed a COVID-19 Response Committee with the goal of contributing to national response against the pandemic. The Committee made a presentation to the High Level Taskforce on COVID-19 on 7th April 2020 expressing University of Juba position, and making several recommendations to government Taskforce on how the national response to COVID-19 can be improved.

The first recommendation is that lockdown policies need to be informed by South Sudan’s unique socioeconomic conditions, cultural values, and demographic patterns. For example, the fact that 70% of South Sudanese population are below 30 years of age, and that 81% of our citizens live in rural areas can be used to design targeted epidemic control policies. The University of Juba has undertaken a rapid socio-economic impact of COVID-19 study, and will soon share the results with the High Level Taskforce.

Second recommendation is that social distancing and lockdown policies are mere mechanisms to delay the transmission of COVID-19 in the country and “flatten the epidemic curve.” But these measures are not the only means of combating the pandemic. Inevitably, the rates of infections are going to rise; and if our health care system cannot support large number of the critically ill patients, hundreds and thousands of lives can be lost.

The University of Juba preliminary position paper urged High Level Taskforce on COVID-19 to mobilise adequate resources as early as possible for tracing, testing, and treating the cases when the outbreak occurs. The report estimates that South Sudan needs at least USD 60 million to prepare for the outbreak. This preparedness budget includes building makeshift emergency hospital facilities with a capacity of 1000 beds, 1000 ventilators, 100 intensive care units, 3000 protective gears for frontline health workers, among others. It also included the cost of hiring 50 medical consultants, 300 mid-level and junior doctors, 500 nurses, 200 lab and support technicians, and 50 staff for managing COVID-19 emergency response centre.

Thirdly, that the government needs to mobilise all government ministries, commissions, UN agencies, international and national NGOs, business community, academia, and civil society; and pool the available resources, as well as repurposing all institutional capabilities in order to jointly fight the virus.

Here, the High Level Taskforce is urged to pursue this goal with vision, heightened sense of purpose, transparency, and urgency. Right now, every organisation and institution in South Sudan, including international NGOs, development partners, and UN agencies are pursuing their separate COVID-19 responses. This will lead to duplication of efforts and waste of resources, while achieving nothing significant.

As Mark Twain once noted, the best way to get ahead is to get started. For COVID-19, a time wasted in inaction means thousands of lives will be needlessly lost. We have seen how in the most resourced countries, government foresight and taking action in a timely manner, contributes immensely to reducing the death toll due to the pandemic. We wish we acted earlier, is a common sigh of regret heard, time and again, coming from key political decision-makers around the globe. We do not want to be on that list.

Thankfully, it has been agreed last week by the High Level Taskforce on COVID-19 to divide Juba into 5 zones, and that in each zone, selected clinics will test patients showing flu-like symptoms for COVID-19. This will allow the country to test up to 500 cases of COVID-19 in one week. This will assure us there are no active COVID-19 cases in the community, or otherwise. Let us then mobilise human resources to implement this plan. Next, let us open a COVID-19 account that will be prudently and transparently managed so that the citizens, businesses, and well wishers can deposit their contributions towards the response in that account. Next, let us ask for medical doctors, nurses, lab technicians, and laypersons from all walks of life, be that in the country or outside the country, to register their interest in joining the fight against COVID-19 pandemic. 

The University of Juba is going to get that organised during this passing week. Next, let us agree on the salary and financial support package for our health workers who will be the foot-soldiers in the war against COVID-19. Furthermore, lets us think about health workers and medical personnel’s protective gear, their mobility, their accommodation, their sustenance, and the equipment they will need to successfully manage the deadly and contagious virus. And equally important, let us think about how we are going to materially support the hundreds of volunteers that we will need to assist us to defeat the epidemic. In other words, thoughtful, targeted, comprehensive, and prompt action will speak louder than words.

 *Professor John Apuruot Akec is the Vice Chancellor of the University of Juba, South Sudan; and chairman of University of Juba COVID-19 Response Committee.

Friday, April 03, 2020

Expanding Our Nation’s Lab Testing Capacity in the Era of Pandemics

By John A. Akec*

The Future Begins Now, is the name of an Ohio-based US organisation that offers scholarships to young people. This is an echo of what was attributed to Mahatma Gandhi  that: the future begins in the presence. This saying makes great sense and applies to many contexts. The future prosperity of nations and individuals depends on the type and quality of investments they commit their resources to (in form of time and money) at the present. That is why our new motto at the University of Juba is: “inventing the future, transforming society.” The motto is a constant reminder to us that universities worldwide, not just in our country, are there to assist their nations navigate their ways into a safer and prosperous harbors that are still unknown. 

With the current Coronavirus pandemic, nations with lab capability are assisting their governments face the challenge posed by covid-19 to their populations. South Korea, for example, is among the countries that has been praised by the World Health Organisation (WHO) for its success in reducing community transmission of the virus through massive programme of testing, isolation, and tracking of the suspected cases. Thanks to South Korean past investment in its education system in the 1960s that has prepared their country to face up to the threats of covid-19 virus in 2020.  

The Director General of WHO, Tedros Adhanom Ghebreysus, has urged all countries to test, and treat every case of coronavirus. “No nation can fight coronavirus blind-folded,” he warned. This is one of the worst pandemics in living memory since the outbreak of Spanish flu in 1918. The Spanish flu that followed at the heel of the end of the First World War I (WWI) is reported to had infected 500 million and taking the lives of 50 million people worldwide, three times the number of deaths in the WWI. Hopefully, coronavirus will be contained before it reaches anything like Spanish influenza infection and death rates.

A report that was authored by epidemiologists from Imperial College and London’s School of Hygiene and Tropical Medicine, and published this week, warned that the pandemic could result in death of more than 250,000 people in the UK alone if serious measures are not taken to slow down the spread of coronavirus through the population. Amongst report’s recommendations included isolating people with cough and temperature at home for 14 days, quarantining of all members of families if one member shows the symptoms of the virus, social distancing through reduction of normal social contacts by three-quarters, social isolation of over 70s, and closure of schools and universities. 

As we go to press, there are 691,867 confirmed cases and 32,980 recorded deaths worldwide, which works out as 4.6 percent of confirmed cases. This virus is truly catastrophic and has stretched to the breaking point the capacity of even the well resourced of countries.

 Bill Gates has warned that the spread of the virus in Africa could be prove devastating. South Sudan is amongst a score of African countries that the WHO has categorised as lacking the capacity to test its population for coronavirus. This is shocking, but not surprising. We as a country had not done much to prepare our health system for minor epidemics, let alone the pandemics of covid-19 scale.

The University of Juba has joined the fight against COVID-19 pandemic by setting up a technical committees of experts and stakeholders on coronavirus that will make recommendations to University of Juba Community (students and staff), and the government Taskforce on COVID-19, based on emerging global understanding of  COVID-19 pandemic and the experiences gained elsewhere.

Mark Twain once said: “the secret of getting ahead is to get started.” And while we might not be best prepared as a country for the current coronavirus pandemic, we need not be caught up in the same position of unpreparedness in the future. And that is why we as University are planning to launch a School for Medical Laboratory Sciences in the academic year 2021/2022. We are doing this by partnering with Omdurman Ahlia University in Sudan to develop our curriculum and allow us to learn from their experience through staff and student exchange programme. Equally important, we have stepped up our efforts to expand our academic programmes into public health and nursing and other health allied sciences.

All the above is in line with our strategic goals of expanding quality higher education, transfer of know-how to key strategic sectors, and serving communities. In short, we want to invent the future and transform the society we live in by building our nation’s capacity to deliver quality medical services. So help us, O God.

*First appeared in Juvarsity, a Monthly News Bulletin of the University of Juba, Published by the Directorate of Planning, Innovation, and Quality Assurance. Vol 2 Issues No. 9, April 2020