Thursday, 16 April 2020

Covid-19: Bassey Ndem highlights 4 reasons W.H.O's recommendation is untenable in Nigeria

Bassey Ndem (Arc.) 
16 April 2020 

While recommending context-dependent measures with which Nigeria can combat the ravaging Covid-19 pandemic, Bassey Ndem, a Nigerian architect resident in Calabar, Cross River capital city has highlighted four compelling reasons a wholesale adoption of the World Health Organisation's, W.H.O, precautionary measures may not be tenable in Nigeria. 

In an opinionated piece christened 'Covid-19 Nigeria : Let's ADAPT and not ADOPT', Ndem who is a foremost traditional ruler among the Efik of Nigeria's South-Southern extraction picked holes in the fundamental assumptions that underlie the hand-washing, social distancing, health institution and stay at home policy of the WHO. Ndem suggested seven ways with which WHO's proposal can be contextualised within Nigeria. 

According to him, 'Nigeria is making a mistake by the wholesale adoption of the policies announced by WHO rather than adapting those policies to fit our own peculiar environment and circumstances. This is not to say the measures do not work. Among the elite, these measures if stringently applied, will certainly reduce or stop spread of the virus. Among the vast majority of our people who dwell in urban sprawl and rural communities, the measures are unworkable for various reasons'. 

On frequent handwashing, Ndem observed that the assumption here is that 'we have access to pipe borne water, whereas most of our urban and rural dwellers rely on boreholes and wells. Parents send their children with buckets to BUY water daily, exposing them to contagion, and certainly cannot afford to waste money on washing hands'. 

On social distancing, Ndem faulted WHO thus, the assumption is that 'the majority live in nuclear family arrangements with  adequate space. The reality is that our urban poor live 20 or more in overcrowded compounds and share toilet, bathroom, and narrow passages that negate the possibility of social distancing. We also share crowded public transportation systems, overcrowded markets and other public spaces that are a necessary part of our daily lives.'

On the healthcare systems, he said 'the recommendations for calling the Doctor when one shows symptoms assumes that the healthcare system is fairly robust and resilient. Lagos, with a population of 22million and the most advanced level of preparedness in Nigeria has approximately 2000 beds ready for a Covid19 surge. If the current and commendable efforts of NCDC succeed in limiting community contagion and only 1% of Lagos needs serious medical attention, we will still be looking at 1bed to 100 patients. This means only the rich or connected will get beds while the remaining 99% will be abandoned to their fate and asked to  manage in their homes or left outside in corridors. 

Faulting the lock down/stay at home policy, Ndem noted that while the measure is very effective, however, it 'assumes that the economy is robust and there are safety nets and strategic reserves of food or cash that can be released to the vulnerable citizens. That is certainly not the case in Nigeria and our circumstance is exacerbated by the fact that the majority of our urban poor live on daily paid wages, hawking, street trading, and other petty and informal means of livelihood. Lock down/Stay at home order of even 1 week spells doom for such persons and resistance, breakdown of law and order will occur very quickly as people are forced to choose between death by starvation or death by Covid19. This has already started taking place in some localities.  Government may feel it has no choice other than to impose curfews and deploy soldiers with far reaching consequences'.
Given the glaring cracks in the recommended protocols proposed by WHO who Ndem observed can work in other countries and may work with the elite class in Nigeria, but are not tenable in our country; and given the highly contagious nature of the virus which is likely to infect the generality of the Nigerian populace owing to characteristic poverty levels and abysmal healthcare services which will frustrate the stringent contact tracing, isolation and follow up that can slow or stop contagion until a vaccine is available, he went ahead to adduce the following context-dependent recommendations:

'Oral tradition in parts of Cross River state recall how during the Smallpox epidemic people built temporary shelters on the outskirts of the village, for the sick. They were brought food ,in disposable containers (banana leaves) ,which were kept a distance from the shelter and a bell or rattle was shaken to alert them. If after 2 days the food was untouched it was assumed that the occupant had died but no one went to the shelter to check until the next planting season. Fire was set to the farm lands and the quarantine shelter ,after which the bones were gathered and a special burial arranged. That way Smallpox did not ravage us as much as it did in some other places. 

'Our people in the rural areas need to be reminded of such practices and every village should build its quarantine shelter now ,while the people are enlightened on what symptoms to look out for and all public gatherings put on hold for now.
Rural health workers can then be mobilised to the isolation shelters in any village that reports a suspected case.

'For the Urban dwellers, we need to shift our focus away from the death toll and work to increase the already  high survival and recovery rates for Covid 19.

We should focus our strategy on the facts that:
1. There is no pharmaceutical cure or vaccine for now
2. 80% will survive with minor symptoms
3. The most vulnerable are the elderly and those with medical conditions
4. Current treatment revolves around supporting the sick until their immune system overcomes the virus
5. The biggest threat is collapse of the economy and a breakdown of law and order. 

'In practical terms adaptation of the current protocols would include the following:

'A. Isolate and self-quarantine the Elderly: These are the most vulnerable and every household and compound should quarantine the elderly. Same could apply to anyone with a cough or fever in the house or compound.

'B. Masks/Go back to work: The economy cannot be allowed to collapse. Many more will die from a collapsed economy than from Covid 19  and people must be allowed to go to work.  However, the use of face masks must be mandatory once outside your room  and the masks should be distributed free of charge by government.

'It helps to slow the spread of the virus even among the 80% who will be asymptomatic.  The "No Mask-No Movement " policy championed by  Cross River state should therefore be encouraged and enacted nationwide. 
'C. Public Enlightenment: 99% of those who catch the virus will be forced to get better at home. Apart from handwashing,social distancing etc emphasis should also be given to educating the public on how to care for the sick at home...OTC drugs, proper feeding,hygiene,isolation and other homecare protocols. Radio , Social media and accredited health workers should aggressively disseminate the right and approved  information on home care for the sick. 

'D. Nutrition Support: Government and the private sector should provide food support for the masses.  Repackaged 2kg bags of  Rice ,beans, indomie,garri, semolina should be distributed in a more humane and decent manner. Better still, a colleague  has suggested 2 cooked meals a day. The State government could contract with various community organised groups, Landlords etc This generates economic activity,enhances security  and lifts the communal spirit  as they come together to distribute food twice a day, while observing the required protocols.

'E. Non pharma-prophylaxis: Any way and means of physically and chemically  minimising contagion should be encouraged. The education of our people in languages and images they can relate to shall be a part of it. Physical barriers must be put up to force physical distancing of people in public areas. The ban on all public gatherings  must be enforced for now. 

'F. Preparations for a surge:
In the event that all the precautions and steps taken so far do not work,then Government has a duty to make adequate preparations for a surge of deaths. The citizens must not be further traumatised  by the experiences and images of what has happened in Ecuador. Supplies of  formaldehyde ,body bags, coffins and new cemeteries must be planned for. 

'G. Weather: The rainy season has started and weather is suspected to play a role in the propagation of this disease. We must be wary of the usual cold and coughs that come with the season and lower the immunity of our citizens so as not to experience an elongated disease curve in Nigeria. The thinking that it may be better to catch Covid 19 when the weather is your ally may be worthy of another look. 

'In addition, the planting season is here and ALL farmers should be encouraged to go out and specially supported by Government. If this is not done then we may suffer a double blow from the virus now and starvation in 6 months or less.'

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