Dr Fikreab Kebede is Public Health and Community Development Consultant And Immediate past President of the Ethiopian Public health Association (EPHA)
He has been working for more than 30 years on different posts in the medical sector mostly being the Director of the Integrated Public Health Program for twenty years. He was a Regional Health Head in governmental quarters for ten years and also Consultant and head of different Health programs in different None Governmental Organizations (NGOs).
Currently, he is a Consultant for Diseases that need Priorities at the Ministry of Health. He also served as the President of the Ethiopian Public Health Association over the past four years and until February of the previous year. Dr. Fikreab is Herald’s guest on this publication and will share his long time experiences with the medical service he has been delivering with the tips he would give for the current combat against COVID-19 pandemic.
Herald: You have been serving in the medical sector for three decades and surely there are several ups and downs you may have passed through. Would you tell us about your journey as a health professional and the most significant events that have made a difference on your medical career?
Fikreab: It was in 1984 the first time I was graduated and assigned to a job in Mekele Town of Tigray. That was the time of draught and famine that has particularly affected the northern part of our country. I was directly assigned in a temporary settlement camp in Mekele. There were people who left their homes entering the camp. Almost ten thousand displaced people were in the camp because of food shortage.
During the time, there had not been adequate access for healthcare facilities such as medicines and medical equipment. Nearly fifty people had been dying in that settlement camp. That was of course because of food scarcity. But since I had been responsible to do the reporting, the situation was devastating for me because I felt that I hadn’t done much.
Herald: What were the constraints that challenged your operations during that time?
Fikreab: It was hard to reach out the people in need unless they come to the camp by themselves or the voluntary health care workers find them. So, if I relate that situation with the current CVID-19 pandemic, it was the same frustrating reality. Like I said earlier even if we were professionally able to support the people, the lack of medical equipment and medicines was our major problem.
The other problem was that we were only five medical workers in the camp. Every day there used to come nearly hundred patients. I was the only Doctor who had been handling the diagnosis jobs most of the time while I let the other handle the minor cases. Therefore, it was very difficult to treat hundred people in a day with the two tents and two stretchers available by that time. Thus, it was my first challenge at the beginning of my medical career and has made a difference in my medical career in a certain way.
But due to the relentless effort of health care workers in public mobilization, we have been able to reach the needy and deliver food as well as health care services and the rate of death would decline from fifty to forty and lesser.
Meanwhile, the scale may be different between the fight against the current COVID-19 pandemic and the one in my past experience. But what could make it similar is that reaching the people to the extent that the developed countries are achieving so far in terms of medical access. The government is doing its best to mobilize all concerned actors from different sectors to provide quarantine access and create awareness for the public about the situation. Health institutions are also engaged in preparatory jobs for what’s to come.
But the most difficult issue is that the current pandemic has new and much more complicated behaviors that our health care workers to deal with, than the situation we had faced during the time I have been talking about. Even though there were communicative diseases that time, they were not much aggressive as COVID-19 and we had been able to control the infections easily.
Herald: Thus, what do you think the challenges for health care workers who are on the front line to combat COVID-19?
Fikreab: Well, it is a new experience for everyone and the complicated and aggressive nature of the COVID-19, would cause psychological impact not only in terms of providing efficient medical service for the patients but also concerning the thought of vulnerability and transmitting the virus to other patients, families or friends. That is a big challenge for health care workers.
Herald: Were there other situations that you could mention as an exemplary success that present medical professionals would take as a lesson from your past experiences?
Fikreab: It was in 1985 and I was still working in Mekele. Neraly fifty people were coming to our health center everyday suffering from Diarrheal diseases (Tekmatt), which was the case that we have to deal within that time. Therefore, we had do our research and find out the source of the disease. As we continued our medical treatment for the people who are affected, we identified an underground waterhole that the villagers used to fetch a drinking water. So, as soon as we found out that was the source of the disease, we would treat the water and cleaned it up. That way, we had been able to contain the disease in less than a week.
There was also an epidemic cholera incident in different parts of Tigray about the same year. The outbreak of the epidemic started in the camp where I was working. What we have done was isolating the people who were contaminated and assigned two nurses for treatment. The nurses would be instructed for the necessary measures and I would be working on severe cases. No one was allowed in the quarantine for visit but only I and the two nurses.
Herald: Why not deploy more health care workers?
Fikreab: Because they would easily be contaminated for the fact that there was scarcity of water, soap and other sanitary inputs.
Herald: How do you describe the commitment of the two nurses who have been working on that case?
Fikreab: That is the crucial point for a health care worker of being in the presence of such critical situations. During that time, one of the two nurses was completely dedicated to his duty while the other was a little bit reluctant. The latter did not like working on the same environment and would be on and off in the way which demonstrates he wanted to work in a different place and post. So, it had become difficult for a follow up. Finally, the dedicated nurse proposed that he would handle allthe job by himself and said “I do not want him to disturb my concentration on the job”.
Being on the same position and such situations as a health care worker, it is difficult to discharge responsibilities if partners go on separate ways. So, sometimes it is better to take full responsibility, carry extra burden and handle the job by one’s self if there is no commitment from the other side. As a result we had to reassign the reluctant nurse to another place. There were about forty five patients in our camp but with the full commitment from that dedicated nurse we were able to have all of them recovered. Another important point is that we were able to pull it off because we have taken immediate action.
The same goes to our present situation concerning COVID-19 and that is what the government is exerting effort on controlling the source. For instance, the first source that cases are being found is people who are coming from overseas and our brothers and sisters who have travel stories. These people are being kept in quarantine.
The second measure is treating the people who are infected by the virus. The other factor is that the public has to accept the advices or directives and apply them with commitment. If the people understand the situation, they would know what to do to protect themselves.
Our communities have been suffering from infectious diseases for a long time, which made them come up with the saying “precaution before suffering from illness”. Our health policy also focuses on prevention. Thus, everyone has to be careful not only for sake of their own selves but also for everyone else around them. It is with the overall contribution and cooperation of all citizens that our prevention focused health policy would be achieved.
Herald: Despite the COVID-19, hospitals and other health centers have other emergency situations. What would you say on how the health care workers and hospitals would handle such situations based on you long medical experience?
Fikreab: First of all every citizen has the right to health care access. Everyone who comes to hospitals and health institutions has to get the service no matter what. The only question is how. There could be an individual with diabetes in need of emergency treatment and there is the COVID-19 patient. So, ones’ life cannot be more important than the other.
So both emergency and medical treatment for both patients is mandatory. But we have to avoid the risk during the process. Currently the pandemic level is not that high [compared Europe, Latin America, Asia and the USA] and the government is handling checkups in selected institutions. Therefore, other health institution [private and government] will continue their routine health care services.
The referral chain of the health service is still intact, which should continue. On the other hand common vaccinations for infants must continue and people living with HIV/ AIDS should not stop their medications for COVID-19 would reduce their immunity if they stop.
The Ethiopian herald June 7,2020
BY HENOK TIBEBU
