For people living in Mathare, one of the largest slums in Nairobi, Kenya, the disruption to local health services caused by a curfew and other preventative measures implemented as a part of the country’s COVID-19 response may prove more dangerous to the 500,000 people living there than the outbreak itself. Shortages of personal protective equipment (PPE) for health care workers are exacerbating the problem.
As of May 14, there were 758 confirmed cases of COVID-19 and 42 deaths in Kenya, and although this number is relatively low, Doctors Without Borders/Médecins Sans Frontières (MSF) teams working in Mathare have already witnessed the impacts of the outbreak response on people’s access to health care.
“Many private health facilities closed because of the risk of contamination and the lack of PPE,” says Dr. Hajir Elyas, MSF project coordinator in Mathare. “At least one public health center has been closed and its staff quarantined after some of them tested positive [for COVID-19]. Some hospitals are refusing to admit patients with respiratory issues even when coronavirus has been ruled out. As a consequence, many [people with] tuberculosis, asthma, and pneumonia end up in COVID-19 isolation facilities, resulting in delayed care and increased exposure to [the virus].”
As in many other MSF projects, our teams in Mathare have adapted and expanded programs to fill gaps and continue providing emergency medical services and medical and psychological care for victims of sexual and gender-based violence (SGBV) amid the pandemic. But our supplies of PPE are limited, and if a reliable source is not found soon MSF may have no choice but to suspend lifesaving activities. Doing so in the middle of an outbreak will be catastrophic.
Consequences of a curfew
In April, MSF teams received 551 ambulance calls and 2,300 people at the emergency room—more than any other month this year. The number of obstetric patients calling MSF’s ambulance at night more than doubled from 98 in March to 209 in April, due to a curfew implemented as part of the pandemic response, a lack of transportation options, and some health facilities not accepting patients.
“The challenge for pregnant women is that no taxis or public service vehicles are operating after curfew, not even the boda boda (motorcycle taxis) that people use in informal settlements,” said George Wambugu, MSF’s medical activities manager. “This leaves mothers exposed to obstetric complications. We’ve had mothers deliver in our ambulances or in the trauma room. We recently had a mother deliver a pre-term baby in need of resuscitation in our ambulance. Luckily, the baby survived, and both recovered well.”
