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“Your first COVID-19 case arrives tonight!”

A doctors hand holds a stethoscope and mask
By Sodzi Sodzi-Tettey

Greater Accre Region
Ghana

The Director’s words rolled with an unyielding certainty, his curious eyes engaging Evelyn in a steady gaze. What an impractical month she had had. At first, she had been frantically preparing with other colleagues to launch the Ga East District Hospital as a regular district hospital on April 1, 2020. By March 19, all that changed with its redesignation first as a quarantine center and later as the national COVID-19 treatment center. As if changing the original mandate of the hospital was not disconcerting enough, here they were, being told to prepare for Ghana’s index [first identified] COVID-19 case, two days after the redesignation and ten days ahead of the scheduled regular start date!

“We were not psychologically prepared,” remembers Evelyn Dowuona, Quality Manager of the facility that once cared for over 80 percent of Ghana’s COVID-19 cases. With little known about the new disease, save its fear-inspiring high mortality among infected health workers in other countries, and associated stigma, the reactions were initially negative. Most health workers were very unhappy. Some requested to go on leave. Others wanted to be transferred.

Management quickly swung into action, bringing a clinical psychologist on board to support staff. Additionally, training was provided in clinical case management, appropriate use of personal protective equipment, and the design of appropriate templates to adequately document activities at the hospital.

“We had to build our own confidence to do our work. I told my team that we are not in normal times. I encouraged the team to quickly make up their minds and to have confidence in the training provided. We did a test run of how to safely wear and remove the suit, and I asked my colleagues to observe and provide feedback to me while I demonstrated.  When they realized that I could do this safely, many felt much better about their own safety. The removal of the PPE is the most serious aspect. You can easily get infected,” explained Evelyn Dowuona. So far, after about five weeks and 178 cases as of April 20, 2020, no health worker at Ga East has been infected. It is a matter of great joy that 75 percent of patients have also been discharged home with no signs and symptoms.

While admitted, patients are treated with medications in addition to ensuring adequate nutritional support and physical exercise. Fruits and salads are often high on the meal plan.  Any associated medical conditions are also attended to. Psychosocial support is not left out, with health workers praying with the patients. Patients are discharged home using some defined criteria: negative test for COVID-19, significant improvement in signs and symptoms, completion of adequate arrangements for self-quarantine as needed, and tying up any loose ends relating to contact tracing [of people exposed to those who are ill]. Interestingly, patients and health workers have created a WhatsApp group where questions that arise after discharge can still be addressed with patients also supporting each other.

Management has been most supportive, doing a great job of involving staff in decision making. Of particular note have been the efforts of Dr. Ebenezer Oduro-Mensah, the Medical Director, Dr. Ali Samba, head of the national case management team, and Dr. Oliver-Commey. “They have done very well to create an environment where we can all speak freely if something is bothering us. I actually don’t remember the last time my director left this facility before 9:00 PM. He always leaves after 9:00 PM. The fear among us has been totally eradicated,” says Evelyn. The dedication of the Ga East team has not gone unnoticed, with individuals like Mrs. Agyin-Asare and corporate entities like the Executive Women’s Network and the Ghana Commercial Bank providing breakfast, lunch, or dinner packs daily for staff for two weeks to a month. The leadership of the Ghana Registered Nurses and Midwives Association has also been fantastic in supporting frontline nurses and midwives. It is also a source of great pride and motivation to staff to see their set up serving as a benchmark for other treatment centers in Ghana.

Evelyn would like Ghanaians to avoid stigmatizing patients: “When some patients get home, their own family members and the communities don’t want to get close to them.”

 

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