As the global COVID-19 pandemic spreads, there are increasing numbers of cases in low- and middle-income country settings, including in many African countries. The Childhood Acute Illness and Nutrition Network (CHAIN), led by Global WACh Co-Director Dr. Judd Walson, received funding from the Bill & Melinda Gates Foundation to monitor the spread of COVID-19 at sites in Kenya in order to increase understanding of its effects on vulnerable children and adults, healthcare workers, and researchers. This project is a collaboration with the Kenya Medical Research Institute (KEMRI), the KEMRI/Wellcome Trust Research Programme Clinical Information Network (CIN), the University of Oxford and the University of Washington. Click here to learn more about the project in the Department of Global Health News.
The fight against the novel virus has caused major changes in many people’s way of life—some predictable, others still hard to imagine. We asked our CHAIN colleagues in Kenya to share their perspectives on how COVID-19 is affecting their communities and how this new project can benefit vulnerable populations.
Dr. Benson Singa, MBChB, MPH is a Clinical Research Scientist at the Kenya Medical Research Institute (KEMRI) and an Affiliate Assistant Professor in UW Global Health.
Paul Ndung’u is the Study Field Administrator based at KEMRI and supports research activities for CHAIN.
How has work-life changed in Kenya since the start of the pandemic?
DR. SINGA: Working in Kenya has not been business as usual. Instituted measures, such as social distancing with the work from home policy and restriction of movements across certain counties, has ensured that virtual meetings are the only way to go. In some instances, this has improved communication and the ability to stay in touch as people embrace technologies to meet virtually. Many employers have adapted to the working from home policy but struggle to maintain quality services for their customers. Some have re-arranged the workplace to conform to the social distancing and other requirements to ensure a safe environment for their workers. Even healthcare institutions were unprepared to meet all requirements although most have quickly adapted to most of the guidelines. The challenges in setting up the working environment appropriately has been training staff virtually or in very small numbers to conform to social distancing requirements.
PAUL: Work-life in Kenya have changed significantly. Everyone was asked to work from home, which is new, as most of us are used to working from the office. This has resulted to other challenges, such as lacking reliable internet connectivity at home and a few staff not having access to a home laptop. Some work requires staff to be physically in the office to work, such as a clinician who must see the patients at the clinic. Work is interrelated and depends on one another; thus, staff output has decreased, and everything seems to be at a standstill.
What is your role in the response to COVID-19 within the new project?
DR. SINGA: As a local site Principal Investigator, my role is to ensure successful implementation of COVID-19 surveillance activity at the sites. This involves coordination with the County and Ministry of Health facilities and engaging in discussions on the surveillance tools and processes, identifying gaps in the implementation, and ensuring quality and complete data capture for action. Demonstrating successful implementation of the surveillance activity right from the start will help a smoother introduction of a research component to the surveillance later. While the surveillance is a Ministry of Health activity, it has become clear there are gaps in resources both human [data clerks and clinicians] and equipment [personal protective equipment, anthropometry, pulse oximeters], making it difficult to get complete data. It is, therefore, my responsibility to ensure our sites and facilities have workable solutions to mitigate these challenges.
PAUL: As the Field Administrator for this project, my roles include managing logistic for research activities, human resources, finances, and procurement and inventory of equipment.
It appears that COVID-19 is the biggest risk to adults with co-morbidities, but how do you envision women, adolescents, and children to benefit from this research?
DR. SINGA: Our research will contribute data on women, adolescents and children who currently have limited data available on COVID-19 infections. This will be valuable in describing disease history and outcomes in these groups while looking at prevalent co-morbidies in children, such as malnutrition and sickle cell disease, and in adolescent and women in addition to the other known factors, like HIV and pregnancy. The data will also document resource availability and the management of patients with other diseases presented to the health facilities during the COVID-19 pandemic.
PAUL: Considering that women, adolescents and children are the most vulnerable groups, this research will come up with ways that would ensure that they are protected, have access to information about COVID, and have the access to medical care.
What is the general mood in your community and workplace now?
DR. SINGA: After the initial period of fear and general feelings of uncertainty, most people welcomed the measures taken by the government towards containing the pandemic. However, some of the measures such as curfews, lockdowns and restriction of movement is slowly becoming tiresome to most individuals. The most affected are those outside the health sector and without the ability to work from home or those whose work usually involves close proximity with others. Our education sector has been hard hit due to not having a developed eEducation system. Most of the schools are in rural areas with limited access to internet services. There is a creeping feeling of fatigue, especially in following the COVID-19 prevention guidelines. Complacency can make an upsurge in COVID-19 infections in the coming weeks a possibility. While there is still a flurry of ongoing activities, especially in preparation for upcoming research projects, uncertainties remain on when things will return to normal. There is now competition for small windows of time to virtually meet with collaborative partners where multi-site projects exist, making it a challenge for partners to plan for and attend every crucial meeting. A thirst to learn more about emerging evidence on prevention, control and management of COVID-19 and numerous competing research webinars to watch does not make it any easier to find time for new meetings and personal time in the home environment.
PAUL: There is a lot of tension and uncertainty at the moment. With the COVID positive cases increasing daily, people are worried. At the community level, there has been an outcry due to the ongoing government restrictions on movement, which have affected people’s livelihood. People are not able to go about their normal daily activities, which has affected their financial strength as well the ability to support their families. All the learning institutions have been closed, which have resulted in parents having to stay with their children at home. At the workplace, staff output has reduced significantly. There is fear among staff if they will continue earning their monthly salary and for how long. However, some staff are able to continue working from home and some even going to the office once in a while.
Have you seen any positives coming out of the current challenges?
DR. SINGA: While the focus has mostly been about the negative effects of the pandemic, there is need to reflect on the positives since this started. Personally, it has given me more time to spend with my 2 ½ year old twins who I have discovered can be a handful when you spend all day, every day for several weeks in a row. I have newfound respect for our house help and have given them a raise. From the work front, we have been struggling to set up virtual meetings to help with scientific meetings for a long time, but this has been made possible in a short time due to the social distancing and work from home directives. Given the need for others to join scientific meetings virtually, this will offer long-term benefits to ensure inclusiveness with efficient use of personal time for those out of campus. Additionally, this time has really given our institute a chance to conduct a Strengths, Weaknesses, Opportunities, and Threats [SWOT] analysis, making it possible to strategize appropriately. Some possible plans include expanding the production unit at the institute to increase its capacity thus increasing income generation from its products, and planning for increased funding for production of lab reagents and transport media. Increased opportunities for collaborative research with possibilities for venturing into locally produced test kits, and vaccines among others seem to be something within our grasp.
I believe that the COVID-19 pandemic is an eye opener to our government on what kind of investments need to be put in place to improve capacities for responses to such pandemics in the future and for healthcare systems in general. Such investments should ensure retention and expansion of skilled personnel in the health sector, increased investment in research, incentivizing local production of medical equipment and supplies, and investing in medical centers of excellence for specialized treatments across the country. All in all, this pandemic has shown that it does not matter who or what you are, humans need to work as a team and depend on each other to roll back this pandemic. We should learn that to make progress, we must all pull together and be our brother’s keepers in this fight against COVID-19!
PAUL: Yes, there are several positives. Support groups are donating money and food for the most affected groups affected by the pandemic, such as the elderly and less fortunate in society. People are more appreciative of each other’s support. Due to the distance, people have realized teamwork is very important and no man is an island. The pandemic has made people realize that we are all equal irrespective of social status.