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In Their Own Words: Four of Nigeria’s Health Care Heroes Re-live a Year of COVID-19 Care

Photo Credit: Ayonitemi Digital World for USAID

See how USAID’s health care investments made the difference.

ABOUT THE AUTHOR:

FHI 360 implements the Meeting Targets and Maintaining Epidemic Control (EpiC) project. Designed as a PEPFAR-funded HIV prevention, care and treatment project, EpiC was mobilized by USAID to respond to COVID-19 clinical care needs in 21 countries including Nigeria. Four health care workers shared their story about a year on the frontlines of COVID-19:

  • Job Gogo Otokwala is an anesthetist at University of Port Harcourt Teaching Hospital.
  • Dr. Ibrahim Salim Abdullahi is a case manager and ICU service provider at Abubakar Tafawa Balewa University Teaching Hospital.
  • Awotona Ajoke Adijat is an infection prevention and control nurse at Federal Teaching Hospital Ido Ekiti.
  • Dr. Robert Egot is an anaesthesiologist at the National Hospital in Abuja, Nigeria.

With a large population and the threat that a pandemic poses, meeting demand for health care services remains an overarching challenge facing Nigeria and the health care workers who treat patients with COVID-19. After over a year of the fight against the COVID-19 pandemic, we’re highlighting three health care workers trained through USAID’s Meeting Targets and Maintaining Epidemic Control (EpiC) project. These health care workers share their experiences fighting on the front lines of the COVID-19 pandemic and teach us why investing in their efforts to strengthen service delivery and health systems is more important now than ever before.

Photo Credit: Dr. Job Gogo Otokwala (FHI360) for USAID

DR. JOB GOGO OTOKWALA,

UNIVERSITY OF PORTHARCOURT TEACHING HOSPITAL, RIVERS STATE, NIGERIA

Share your journey to becoming a health worker. What inspired you to do this work?

Most science students in high school normally gravitate to study medicine. My maternal cousin encouraged me to go for medicine instead of my preferred option – engineering – and so I did. The interest in medicine grew after I gained university admission as it offers me the rare privilege to offer health-related assistance to people. My voyage to Intensive Care Medicine came as a result of witnessing several lives lost in our ICU. I was provoked to sub-specialize in critical care after experiencing a critical incident in the OR where a young lady with ruptured appendix had delayed recovery from muscle paralysis during anesthesia and I had to manually ventilate her for over 12 hours alone until the oxygen in the ICU was exhausted and she died. That moment was the turning point in my drive to understand the science behind critical care medicine. I have not looked back since then.

Photo Credit: Dr. Job Gogo Otokwala

How has COVID-19 impacted your work?

COVID-19 came as a thunderbolt with fear and intimidation; it destabilized the psyche of everyone. With fear, no one was willing to do routine work as uncertainties held sway. As an anesthetist, elective cases were interrupted. Emergency cases were fraught with risk of infections. This was compounded by the dearth of personal protective equipment (PPE). The response of the government then was to construct isolation centers to contain the spread of the virus. This was laudable, but minimal efforts were made to integrate critical care into these centers. Data from Europe and China showed that about 5% of patients presented with severe illness. Absence of defined platforms to manage the patients with intractable hypoxemia was a serious cause of concern and heartache from my critical care perspective. Patients with intractable hypoxemia were referred to me with no facilities to support the failed respiratory system. This experience was excruciating and depressing. There were no ventilators, no monitoring devices, oxygen was poorly supplied and not piped, patients were poorly monitored from a lonely distance. It took intense advocacy to compel authorities to consider the critical care needs of patients and provide much needed facilities for respiratory support. It worked.

Photo Credit: Dr. Job Gogo Otokwala for USAID

Is there a meaningful moment in your career that sticks out to you?

I was managing a young man who was infected with COVID-19 and had other comorbidities (diabetes and hypertension). His initial presentation was flu-like symptoms and he was being monitored at home. However, he suddenly developed nausea and vomiting. Initially, I thought it was caused by the erythromycin he had that night; the drug was withdrawn but the nausea and vomiting continued. A cursory assessment of the clinical history prompted his admission to the COVID-19 center and electrolyte results showed grossly elevated serum creatinine level in a patient whose renal status was normal. He was hydrated and reassured to be calm. Repeated follow up for five days without any renal replacement therapy (RRT) helped and he tested PCR negative after day 14 and he was discharged. It was an interesting experience. It would have been difficult to conduct a RRT for this young man with rapidly rising serum creatinine level with a PCR positivity. I also had severely hypoxemic patients that were placed on non-invasive ventilation that improved to the delight of all but, unfortunately, we lost them to pulmonary embolism

Why is investing in health care workers important now?

Training is paramount. Training exposes health care workers to contemporary learning skills and equips them with knowledge. Knowledge, as it is said, is power. A knowledgeable health care worker (HCW) is confident to face challenges presented by the pandemic and keeps one updated with current issues. Training is the most important aspect of the determinants of success in managing COVID-19. Policymakers also rely on a knowledgeable workforce for guidance.

Incentives to encourage HCWs at such a difficult time to work and face dangers is very important. Provide requisite facilities and equipment to support their work. An exchange program with advanced programs will also encourage and equip health workers. Encourage collaborative research.

DR. ROBERT EGOT

DEPARTMENT OF ANAESTHESIA, NATIONAL HOSPITAL, ABUJA, NIGERIA

Photo Credit: Prince Agala (FHI 360) for USAID

Share your journey to becoming a health worker. What inspired you to do this work?

Becoming a medical doctor is the fulfilment of a dream that I've nurtured since childhood. So far, I am glad that I can use my heart and hands to help the sick and improve the well-being of others. The passion to save lives is my inspiration. I am a Christian and I also draw inspiration from God Almighty.

How has COVID-19 impacted your work?

The emergence of COVID-19 infection has impacted not just the health systems alone but also how we relate with ourselves daily. At the beginning of the outbreak, we had to restructure our medical consultations and services with more emphasis on hand hygiene and implementation of infection prevention protocols to limit the disease spread and curb the pandemic. In National Hospital Abuja, the first step we took was the establishment of a task force saddled with the responsibility of creating awareness, training staff on preventive measures, and creating holding areas and isolation units. The holding areas provided emergency care services until patients’ COVID-19 status is confirmed, after which they are transferred to the isolation center for treatment.

Photo Credit: Prince Agala (FHI 360) for USAID

Is there a meaningful moment in your career that sticks out to you?

Facing a pandemic and working as a frontline doctor is a landmark experience in my career because it involves standing up to save the sick ones who have been ravaged by a deadly virus that had no cure or vaccine available at the beginning. This entailed passion to put others first even if it involves risking your own life. I reflect that this moment is a defining moment for all doctors.

Our isolation center was earmarked to handle severely ill patients with life-threatening comorbidities. We saw several of them, lost a few, but we had a case where the patient presented with nose-bleed and fever and was COVID-19 positive. To stop the bleed, we had to operate on the patient as all other medical interventions had failed. That was our first surgical case on a COVID-19 patient. Procedure was done under general anesthesia; postoperatively, the patient recovered well and was discharged home after testing COVID-19 negative.

Why is investing in health care workers important now?

The need for investing in the health sector cannot be over-emphasized as the pandemic further revealed the frailty of the Nigerian health sector. Health workers are willing to give their best to save lives, but the motivation and lack of equipment to work have been the greatest setback. Building functional isolation centers, staff training, and intensive care units have proved to be of immense relevance to critical care support. The provision of ventilators and pulse oximeters by a few agencies including USAID and FHI 360 has made a great difference to critical care support for severely ill patients. We're indeed very grateful for the intervention.

Photo Credit: Prince Agala (FHI 360) for USAID

Photo Credit: Ayonitemi Digital World for USAID

AWOTONA AJOKE (NURSE)

FEDERAL TEACHING HOSPITAL, IDO-EKITI, NIGERIA

Share your journey to becoming a health worker. What inspired you to do this work?

My aspiration to become a health worker started during my elementary school days when the village nurse/midwife served as my role model. She was the only nurse at the maternity center then. She went around to all the schools to provide health education to us. She gave health talks in the market. When anyone was sick or a child was convulsing, they were taken to the maternity. The whole community considered her as the “savior.” I aspired to be another version of Mrs. Olanipekun, the community nurse. I developed a strong rapport with her as a child and she provided mentoring to me and other children in the village. She counselled us on the steps that we needed to take to become nurses. This mentoring continued until we lost contact in 2005.

I was inspired by her passion, diligence, and commitment to making a difference in people's lives.

How has COVID-19 impacted your work?

COVID-19 has had no negative impact on my work, rather I see it as an opportunity to make a difference in people's lives. Occasionally, when there are challenges, my team and I go the extra mile to proffer solutions. When there was scarcity of hand sanitizer, I collaborated with the management to get raw materials for us to prepare the hand sanitizers. These raw materials were drums of isopropyl alcohol, hydrogen peroxide, glycerol, and aloe-vera gel. This local preparation of hand sanitizer ensured constant supply of hand sanitizer to every unit, ward, clinic, and office in the hospital throughout the period of the lockdown until things got better.

Is there a meaningful moment in your career that sticks out to you?

Yes! There are many meaningful moments in my career but there are two particular ones that stick to my memory. The first one was during the Lassa outbreak in 2015. A student nurse was confirmed positive and people were scared and ran away from her. But, I followed the required infection prevention and control measures and provided her with life-saving clinical care. She survived and we celebrated her discharge. I felt fulfilled.

Secondly, we would have lost a 45-year-old man with severe COVID-19 illness who was also living with four comorbidities (diabetes mellitus, hypertension, HIV, and pulmonary tuberculosis). I was able to support the clinicians to provide critical care and ventilatory support to this patient. We used the USAID and FHI 360 ventilators. This patient survived.

Photo Credit: Ayonitemi Digital World for USAID

Photo Credit: Ayonitemi Digital World for USAID

Why is investing in health care workers important now?

Investing in health care workers is important now to reduce morbidity and mortality during public health emergencies; promote the health of individual, family, and the society; improve the lifespan of the people in the community; and, prevent complications of illness and diseases.

Investments that are critical to support HCWs during the pandemic are regular supply of consumables and PPE; supply of necessary equipment (e.g., ventilators, oxygen concentrators); and training and re-training of the HCWs. Investing in HCWs during the COVID-19 pandemic motivates them to discharge their duties effectively and efficiently without fear, thereby enhancing productivity.

Photo Credit: Ayonitemi Digital World for USAID

DR. IBRAHIM SALIM ABDULLAHI (DOCTOR)

ABUBAKAR TAFAWA BALEWA UNIVERSITY TEACHING HOSPITAL, BAUCHI, NIGERIA

Photo Credit: Dr. Ibrahim Salim Abdullahi for USAID

Share your journey to becoming a health worker. What inspired you to do this work?

Being a medical doctor was a childhood ambition and dream come true. It is something I have never regretted. Medicine is a very competitive course due to limited number of medical schools and huge financial demands. It’s exclusively reserved for the best candidates and at times the privileged ones. My journey through medical school was full of challenges trying to balance between academic and personal life, but with patience and perseverance the rest is now history. As a doctor, I discovered that I have to work for extended hours, depriving myself of sleep, [suffering] burnout, and anxiety – but it is always a huge sigh of relief when a patient survives a life-threatening ailment. Seeing the patient smile again has kept me on my feet.

How has COVID-19 impacted your work?

The COVID-19 pandemic overwhelmed the healthcare facilities even in the most developed nations. In resource poor settings, where there is gross shortages of manpower and drugs/equipment, the burden was anticipated to be worse. HCWs are forced to manage scarce resources to fight the pandemic. Being a novel disease, we were inundated daily with tons of information and it was very difficult for one to keep pace with the new discoveries. At first, the ultimate fear of contracting the virus was dreadful due to lack of necessary PPE and stigmatization (even among our colleagues) of HCWs manning isolation centers. But, with continuous public health campaigns, training of health care workers on infection prevention and control, case management, and provision of adequate PPE, the fear gradually paced out.

Most COVID-19 patients are kept in isolation wards especially those with moderate to severe disease, which means if at any point their condition deteriorates doctors and nurses are the only people they see in their last hours. At such times, they proffer “god-like” roles on us. Seeing my patients die after I have tried my best put a lot of psychological stress on me. The emotional toll is much worse, as I must stay away from my family to protect them from getting infected. This is compounded by the fear of getting infected. Despite these challenges, I strive hard to keep these negative thoughts away and ensure that they do not distract me from my primary responsibility. However, the good news is [the] recovery rate in Nigeria is high. This gives me the motivation and confidence to work even harder and rid the nation of coronavirus at the earliest time.

Photo Credit: Dr. Ibrahim Salim Abdullahi for USAID

Is there a meaningful moment in your career that sticks out to you?

Being at the frontline carries maximum risk of [being] infected and transmitting the infection to my family. This is one of the most difficult challenges of being a medical doctor at this moment. I had to make a voluntary choice of putting time with my patients ahead of time with my family. This is because of my passion to save lives. I also take the Hippocratic Oath seriously. Together with my colleagues, we work around the clock and go extra miles to attend to patients’ needs. The toughest time is losing a patient in spite of doing everything humanly possible to keep the patient alive with the available resources. The good side is that most patients survive. The smiles on their faces as they leave the isolation ward encourages me to push hard. This great sense of satisfaction derived from recovered patients sustains my spirit.

Why is investing in health care workers important now?

Investment in HCWs can never be overemphasized in the context of achieving a disease-free nation. Empowering the HCWs with requisite knowledge (through training and re-training), provision of much-needed equipment, and continuous supply of drugs and consumables will no doubt help curb the menace of the pandemic. Critical care in this country was hitherto a neglected sub-specialty, but the advent of COVID-19 has underscored the importance of the specialty. Now, critical care is getting a facelift in terms of setting up and equipping intensive care units. If this momentum is sustained and complemented with training of critical care specialist[s] (both doctors and nurses), the nation will witness revolutionary changes in the management of critically ill patients.

Through USAID support, these health care workers showcase how beyond every COVID-19 infection there is a life working to save lives. They represent the dedication health workers have shown over the past year, placing themselves at risk to keep their communities and families safe and to end the COVID-19 pandemic. Their stories are evidence of how important investing in health workers is during the COVID-19 pandemic and beyond.