The same Africa with a new virus: three key considerations

As Africa prepares for the pandemic-induced challenges that lie ahead, there are several key considerations for our context. We are a proud continent of community-oriented people, in some instances living in densely populated neighbourhoods. We have many passionate doctors working in non-ideal circumstances, and our hospitals are accustomed to working well over capacity. These are all factors that may react differently as the tides of the Covid-19 pandemic change.

The people: the challenge of social distancing

Contemplate this: in Alexandra township in Johannesburg, over 700,000 people are estimated to live in less than five square kilometres. Mbare in Harare has a population density of 800,000, Makoko in Lagos is over 300,000 and Kibera in Nairobi has at least 250,000 people per five square kilometres. Not only are these overcrowded, but the bustling and competitive commute to get to work poses significant risks to potentially expose more people to Covid-19.

Many Africans’ livelihoods are at great risk, with no choice or ability to ‘work from home’. To choose to stay home may mean to fail to provide the evening meal for your family. On the other hand, venturing out into the city to try and fend for your family may be viewed as being irresponsible towards the community at large. These are tough decisions facing many countries in various stages of a lock-down. Social distancing in these circumstances may be viewed as a privilege and an unrealistic dream for the majority.

The doctors: the ‘world’s new crude oil’

The Abuja Declaration of 2001 requires each country to set aside at least 15 percent of its national budget for healthcare. It is still unmet with only 1 country on the African continent meeting this requirement 10 years after it was signed. With developed healthcare systems in northern Italy buckling under pressure from Covid-19, and 150 Italian Doctors reported dead, one can only imagine the impact this will have on front-line health staff across Africa who are without personal protective equipment. Many are already underpaid and infrastructurally frustrated.

In the face of a global pandemic, medical staff have become each nation’s most important resource. As Covid-19 continues to generate panic within the world’s most powerful countries, and as a direct response to the pandemic, the US Department of State’s Bureau of Consular Affairs is currently actively seeking to recruit foreign medical professionals by expediting visa processes. Similarly, according to the UK government’s ‘NHS People Plan’, qualified doctors and nurses with a job offer from the National Health Service will be offered fast-track entry and dedicated support to relocate. These nations are prepared to exploit poorer countries by recruiting their doctors and nurses. As we face this disease burden as a continent, we call upon our governments to be uncompromising against such practices, to unconditionally support our medical personnel during this unprecedented time and use this crisis as a reflection to bolster our frail health systems.

The disease: Covid-19 is not the only battle in hospitals

Most hospitals in Africa have a large disease burden with non-ideal resources to respond. As the virus is spreading and its burden increasing, cancers, heart attacks, gang-related trauma and violence, motor vehicle accidents and other emergencies continue to need urgent attention. Doctors, nursing staff, ward space and numerous other resources are still required for these unending forms of disease.

With unwavering hope, it is entrusted to us to continue to try to take precautions as best as our circumstances allow. We must judge carefully how essential our travels are, being mindful that our decisions, in very practical ways, affect the lives of others, who may not be as young or as healthy.

Having said so, if resilience was the cornerstone needed to combat this disease, there is no better continent to ask this from than our colorful, vibrant and warm Africa.

For more on first world recruitment practices, see University of Cape Town Global Surgery Division’s statement : COVID-19 exposes health worker shortages in the USA and UK, but nationalism and self-interest must not exploit medical workforces from low- and middle-income countries. JJ Fagan et al, S Afr Med J. Published online 8 April 2020. http://www.samj.org.za/index.php/samj/article/view/12905