The Coronavirus (COVID19) that has become a global plague is a leading cause of concern for all countries and organizations. The CBC Health Services is no exception. In the following interview, Prof. Tih Pius Muffih, Director of Health Services (DHS) puts into context the response of the CBCHS towards the prevention of COVID19). He spoke with Clementina Njang Yong, Head of CBCHS Communication Unit. Excerpts…
What were the first impressions when the CBC Health Services got news of the existence of COVID 19 in Cameroon?
Prof Tih: The CBC Health Services as a body was worried; the leadership was worried because hearing about another pandemic or another virus is a major cause for worry. We were worried more because the Northwest and the Southwest are already going through lots of problems – the political crisis, which has taken lots of lives and has also displaced many people. Second, we are still fighting with the HIV pandemic which you know very well and it is a major problem for the whole country. To have a third crisis which is the coronavirus normally was not welcome news to anybody and especially not to the CBC that seeks to provide quality care to all who need it as an expression of Christian love. When we first heard of it and the way China was fighting it, it was very worrying because, in the first place, I don’t think Cameroon is prepared to fight it the way I saw that it is being fought in China. So, our first impressions were really bad, we were worried and we’re still worried.
On March 17, 2020, the Prime Ministerial decree announced measures to be implemented as the COVID 19 pandemic response plan in Cameroon. What has been the reaction of the CBC Health Services to this concerning your collaboration with the government to fight this common enemy?
Prof. Tih: The 13 point package that the Prime Minister announced sounded encouraging because the measures that he put forth were measures that if all implemented with fidelity, we will address the pandemic. When those measures were announced on March 17, we intensified the fight that we had, modified, or adjusted the fighting to conform with the 13-point package that the PM put in place. Since then, we have been working very cooperatively with all the delegates in the regions where we are working and with the district medical officers in districts where our services are located to ensure that appropriate measures are put in place to fight the pandemic. We’ve made sure that all that has to be done to conform with the 13 points that the government put in place is done so that, as a collective effort we will be able to prevent the virus from infecting our population.
We have teams in the regions, set by the regional delegate. I am on the regional team and I have assisted him a lot to put in place a strong team at the regional level and down to the districts and so on. We also have a team at the entry point into the Northwest region to ensure that those who come from other regions have their temperatures taken, and are appropriately briefed before passing to enter the region. We hold regular meetings in the delegation intended to brief our staff and population and also brief ourselves on how to fight the virus in our region. I am not only working here in the Northwest, but it is also the same thing I’m doing in the West, the same thing in the Southwest, and the same thing in the Extreme North Adamawa and so on, the Centre region and Littoral. We collaborate with the government in all these regions to see that the fight is from a common front instead of working counterproductively against each other.
It will also interest you to know that at the national level, CDC that is giving us funding to work has been working very closely with the Ministry of Health and together with them, assigned the CBCHS to be responsible for transporting samples from the NW and West region as one line to Yaounde, and from the SW and Littoral as the second line to Yaounde. We placed vehicles in these two lines to transport specimens as they become available. Sometimes, we send two vehicles in a day because before they go we have other samples being collected so the second vehicle takes them. We are collaborating with the government in all that it takes to see that we work for hand in glove to fight the pandemic. So far, that is how we are trying to collaborate, there are many other details, like sharing PPE (Personal Protective Equipment). When we have enough we share with other government facilities and vice versa. So this is what we are doing to work collaboratively with the Ministry of Health.
What has the CBC Health Services put in place as measures to respond to COVID 19?
Prof. Tih: First and foremost, we have a Central Coordinating Committee within the Health Board and that team is headed by Dr. Katayi Edouard, then outside of that central coordinating team we have regional coordinating teams that work right down to the health facilities, and in each health facility we have a team that is working to ensure that all staff members comply with the regulations. We have developed guidelines such that they address all the sectors of our economy; Individuals, families, churches and then professionals like the nurses and doctors, we’ve put in place guidelines for then in the hospitals, in the wards, around the hospital premises and so on. Those guidelines are very comprehensive and not only do we put the guidelines in English and French, but we’ve also translated them into braille. We have some copies here and we’ve also circulated them widely to all our facilities right up to the Extreme North because we have facilities in the Extreme North of the country.
These local committees that I say are in the facilities have to ensure that all the staff members abide by those guidelines that we’ve put in place and the national committee follows through by zoom calls once a week to appraise themselves of how these guidelines are being respected in the facilities. Besides, the facilities also meet weekly to appraise and encourage themselves and also find out how they see the developments in the facilities. Not only do we have the guidelines, but we also have posters. Some of the posters are from WHO, UNICEF and other international organizations. Those posters are placed in conspicuous places for everybody to see and learn how the virus is transmitted from one person to the other and also how you can prevent it. We have also produced hand rubs which are a little lighter to spray on the hand, and we try to teach them how to do the rubbing through demonstrations to make sure that you do good rubbing. The hand gel which is also produced by us is available for people to move with them in their pockets so as often as possible as you touch surfaces you should use it. The reason for this is that the virus is transmitted through substances, body substances like cough, catarrh, and other fluids that come through the human body especially from the mouth and nostrils, and so on. If you don’t get it directly and it drops on surfaces and you touch it as you’re moving around in the ward and anywhere human beings are with that cough, if you touch it and touch your face you can transmit it to your body and infect yourself. And so we want that as people touch surfaces from time to time, they should make sure they drop the gel again and make sure to do some rubbing often.
Now, we’ve placed in strategic places water in buckets, all institutions must have those buckets with water and liquid soap. The reason for this is, even though you put the hand rub or the hand gel, it kills the germs but it doesn’t take away germs. It is advisable to always wash your hands. In the absence of the hand rub or gel, you can always wash your hand thoroughly for 20 to 60 seconds and you will take off any germs that were on your hands or the virus if you happen to pick it. Please remember we’ve been telling our staff that if you have dropped any catarrh or cough sputum on any surface and so on and you were already living with the virus, that virus in the substance that you have dropped can live for as long as 2 to 4 hours if it is on a hard surface, and up to 3 days if it is a plastic surface and therefore do not say that nobody passed here recently, it could have been several hours or days ago, and you will still carry and you will pass it on.
We try to give this information as an organization to all our facilities so that they will keep themselves free from the virus. We have instructed people to maintain the social distance which we are calling it physical distance because we want you to be at least 1 to 2 meters away from each person or if you cannot go further because of low voices, maintain the distance, and don’t come too close. Avoid hugging and all kinds of closeness. The Prime Ministerial package also talks about big groups, people should not meet in groups more than 50. We are trying to maintain that in all our facilities by letting our screeners and doctors know that they don’t have to keep many patients sitting in one place when giving health education and the rest. As patients come, we consult them and they move. We decongest them as fast as we can. Even in places where they pay bills, they do not line up as they used to, the same thing happens where they collect drugs. We decongest them as possible as we can, asking people to stand 1 meter apart. We’ve put in place all this and even beyond to ensure that our staff first, then patients and caregivers are safe.
Right at the entrance of all the facilities, we take temperatures of those that come in, we have water available to wash hands. This is not a virus that we should joke with, we are just at the beginning of it, and it is going to get worse except we do something, except we comply with basic health rules that are being given and if we do not comply it is going to be rough on the whole nation. We’ve heard that when you are exposed to it, during that period of incubation, you are infectious and may likely pass it to other people. As you see people moving around looking well, they could have been exposed to the virus and we will not know so avoid body contacts with people that you meet because you don’t know who has been exposed and that person will also expose you to the virus and may develop the illness even before the first person that was exposed. All our immunities are different, some have a higher immune system than others, and ages too are different. The virus goes a lot with that kind of strata of persons we have. This is something that when we start to talk we rather lament because we are seeing the way it is spreading in the country and since I’m transporting the specimens, the number of specimens that were transported from each of the regions to Yaounde for testing is alarming. The government is doing everything possible to decentralize the testing, we will be testing in Mutengene in our laboratory and possibly we may have one in Bamenda. This will reduce the travel time and turnaround time of the results from when the specimen gets to the lab and back to the health facilities that sent the specimen. I pray that things will go well for the nation.
How are the health workers effectively implementing the guidelines set aside by the government and those of the CBC Health Services?
Prof. Tih: This is not new in terms of universal precaution for health care workers. All health care workers have all been told to be very cautious of substances and cautious of the patients. This ought not to be something new to them. They are getting used to respecting this social distance; we have not been talking about that one in particular but about precautions in working with substances, body substances and all this is not a new thing to any public health worker. What we see is that there is some kind of lukewarm attitude because you still see people go to work with patients without the face mask. If you are talking with somebody face to face in a health facility now, you need to have that face mask and put it on. I have gone to health facilities and some people are respecting, some are still to respect and we are saying that is dangerous because you are exposing yourself to this germ. You’ve seen other countries already saying everybody should carry a mask. Now, we are saying we might not be able to afford the face mask to carry. But there will come a time when you will treat yourself with more money than affording a mask now.
I was happy when I listened to the National TV say we have foreign organizations that have come in to help produce face masks for us in our National Polytechnique in Yaounde. I pray that is done and made available to everybody. I also observed a documentary where around Mokolo in Yaounde, they are producing lots of face masks with cloth, which is commendable. We [CBCHS] are producing in Banso and Mutengene and these face masks will become available. Don’t continue to preserve the face mask that you have because you believe they will not be available, NO! By the time they become available you may not be available to use it and therefore, use it as much as possible. As long as you don’t have many of them, it is good to sterilize it in alcohol. It is not advisable to wear it and sweat in a health facility and continue to wear it with sweat because that becomes damp and it will even attract more bacteria, viruses, and other microbes on it. That is not good. Once it is getting wet you better take it off and either wear a new one or spray it with alcohol and wait for it to get dry and then you can wear it again. I insist when you spray it allow for it to get dry, don’t wear it when it is still wet. We are preparing and as you have asked, they are respecting the regulations. Some of them don’t have the PPE in the rural facilities yet but I thank God there is not much movement in the rural communities but we are trying to make sure that all the PPE is available in all health facilities. It doesn’t make sense to have all the equipment and pack them in the store and be happy that you have them there, use them, if they get finished, ask for more and you will be given; we do not want anybody to get infected because they do not have the PPE to use, we will make them available, so use them.
How prepared are health facility leaders for COVID 19?
Prof. Tih: I cannot say our team is very prepared, but they are preparing, and for the next 1 to 2 weeks even in the most remote health facilities they should have the guidelines because we sent them electronically and also in hard copies. We have also sent them to churches, to school leaders; they are available all over. The distribution of the PPE may not be everywhere yet but we are in the distribution process and I just heard the Regional Delegate say they have some for us, we are happy about that, we will collect and see how to make it available to the people in the community.
We have a permanent health committee that we call the Task Force. The Task Force communicates with the people and if there are needs they also inform us and we send. It is a continuous process until this pandemic is under control. We will be doing it regularly because they may have equipment today and tomorrow it is finished. We are now sending hand rub in 20-liter containers so if the smaller bottles are finished they can refill. Individually, if your hand rub is finished you just need to come back and have it refilled and keep it handy. Do not be too economical so much so that where you are required to use 2 or 3 drops to adequately sanitize your hands, you use just very little, this will not kill the germs. We advise that more than anything else use running water. Although in the periphery we don’t have taps or anything close to one, we advise that you insert your tap heads to a bucket and you stand it on a high surface with soap where people can wash their hands. Whether you have the sanitizer or not use that running water and you are fine.
What measures have been taken to prevent any transmissions among inpatients?
Prof. Tih: We screen! Inpatients come through the outpatient department. Before these patients get into the wards we make sure that they are adequately screened so we know if they are possible COVID19 cases. In the wards, if a patient is not coming in with COVID19, we are continually cautious and very observant. We are trying to admit fewer patients in the wards. We don’t know for how long that will be because the moment more people are sick it will become compelling to admit them as they come. In the meantime, we are making sure that patients are adequately admitted by keeping some distances and making sure that we screen as much as possible. The screening done at the outpatient department is very very important to ensure that we don’t admit patients that have the virus because they will contaminate the rest of the patients in the ward and also the workers working with them.
Also, every patient that is in the ward must carry a face mask because you are either a carrier or you will be infected by the person who is a carrier but as long as you have the face mask on you will prevent getting or sharing it. This is not something that we have all the answers ready to go but we are doing the best we can.
What activities of the institution have either been restructured or suspended as a result of COVID 19 and why?
Prof. Tih: I think we have only suspended big meetings, we have suspended most of the training programs that involve bigger groups of people, and we have rearranged movements in the hospital by making sure that there is only one entrance into the facility because when you have people moving in a way that you can’t control but the main entrance now we have and we have those teams that take temperatures, ensure that people wash their hands and so on. So we are re-orientating the way we do things and we’re making sure that messages are overhead, where you can hear through some speakers that stating that this what you have to do to stop the spread of the virus and so on. We have stepped up the sanitation activities in the health facilities by dusting surfaces, cleaning surfaces, and making sure that there are enough disposals continuously. We know that when you clean surfaces more regularly than usual, you will also be reducing the transmission rate within the facility because many people touch surfaces and so we must make sure that there is a lot of cleaning. We have also looked at the places where people come to register, usually, we have long queues for people registering, now we are trying to discourage long queues in the institution so people do not line up but if they must line up there must be a lot of spacing for the people. This is the same for registration, the same for the pharmacy to collect drugs and the place to pay bills as well. These are some of the things we are doing in the institution. We are trying to limit the number of patient caregivers, usually, we had 3, 4, 5 people by a patient but now you have to have 1 caregiver per patient in the wards and at some point, they have to move out.
The CBC Health Services is known for its inclusive attribute. How inclusive are the steps taken to prevent and control COVID 19? How inclusive are the Information, Education, and Communication materials produced for this purpose?
Prof. Tih: I think we are including all the time. We do not give information only to people who can hear or only those that can see. As from day one, the guidelines that were given out we made sure that they were above expectations to meet those who can and cannot see. Right here you will see the guidelines, the same guidelines in English, French, and braille and you see how thick it is. If you had time I will show you the flyer. Of course, the braille is for people who cannot see, and for those that are deaf we are making their copies and the workers from the SEEPD will tell you that they will have copies for them. If I could read braille I will tell you exactly what is on this braille copy. We are quite inclusive, we make sure that we don’t leave anyone behind in this fight. The virus does not discriminate, it will kill anybody and so we make sure everybody has the same access to the information.
Why is inclusion so important in the activities of the CBC Health Services and most especially in this pandemic?
Prof. Tih: The reason we prioritize inclusion is that we have value for all human beings, there is no half person and just because they are people living with disabilities does not make them less. Everyone is equal in the presence of God and every human being deserves to know what the other person knows and so if the information is available it should be shared by every person. You can never say people are free from the virus when some sectors and individuals are being infected by the virus. Therefore, if people living with disabilities have the virus, they can transmit to you. If somebody is blind it does not mean the virus cannot move even to you who is sighted. Therefore, we must be inclusive in preventing it. In effect, we should have everybody in mind when we give out information, we should ask can every person access this information and if they cannot what can we do to make everybody access this information. I believe that the government is giving this information on CRTV should always have somebody to sign so that the people who are not hearing what they are saying will be able to understand using the sign language because the National TV is for everybody. The blind person may not see but he can hear, and those that cannot hear will only see the PM talking without understanding him unless there is somebody to sign and it will help that person to go along with the people. I encourage our media to include people living with disabilities in the giving out of the very important messages that are given to protect individuals and prevent diseases.
People with disabilities can be at higher risk of contracting COVID 19 for many reasons.
There are sometimes physical barriers to using basic hygiene facilities, they need to touch things, they have difficulty in enhancing social distancing, and there are barriers to accessing public health and coronavirus information. What is being done and can be done to curb these barriers and ensure that they are not left out both at the level of your institution and the level of the government and other institutions?
Prof. Tih: Yesterday, I received two persons who are visually impaired and each of them came to my house with somebody leading them. Now, you don’t lead a blind person by going a distance and he is following you, you lead a blind person by actually holding his hand, how can you call this social distancing? Social distancing to me is physical distancing which means the person should have a physical space of about a meter. You cannot do that to a person and say you are leading the person. If that is the case that person is more vulnerable than you are. If you don’t do this and the person has to enter the house, he’ll have to touch the wall and feel the door to know how to enter. He’ll have to touch the whole door to know where the lever is to know where to enter. They are more vulnerable to touch surfaces and as I mentioned, normally the virus is in substances and substances are heavy, they don’t fly and if they drop on surfaces and a person living with this disability happens to touch all around he can infect himself. This is to say let’s not leave them out when giving these messages. Again, if somebody living with blindness entered here he’ll have to touch several places before feeling where the chair is and that is vulnerability, I will still agree with you that we have to concentrate even more in giving messages to people living with various disabilities so they can protect themselves and protect all of us.
What advice do you have for the general public and PwDs to prevent COVID 19? How should they treat social groupings, schools, churches, traveling, sporting activities, and other public places like dining halls, restaurants, and ceremonies?
Prof. Tih: Again, the PM’s circular addresses some of these and we leave in a social environment where we have ‘Njangis’, ‘Tontine’, all kinds of family meetings, and come together for marriage, ‘Bornhouse’, ie childbirth ceremonies, funerals and all of these. This is the time to say no to all of these, no exceptions! Just say no. If you know of any gathering you need to attend just say no you won’t have the time to go to such places. We can use either Whatsapp to communicate with as many people as we can, we can also use a money transfer to send this meeting money, we can also send condolence messages to families. Normally, a few members of the family will go to assist and bury a loved one – that is the only one that is inevitable. Even in such a place like this wear a face mask, keep the social distance and ensure that we do not sit in crowded houses where we are unable to even raise an elbow because we are packed together. This is not the time to socialize the way we used to.
Already church services are being conducted through the media and in some churches, you see Christians have been divided into different rooms. Whatever the case, it is not acceptable to group people in one location, under one roof or one space and in very close proximity. We may be taking it lightly for now but they’ll come a time when we will lament if we had known we would have respected what was being said. To me, there should be no visitation no inter-family gathering, no going to neighbor’s houses, don’t allow children to visit other houses, you too should not visit other houses, just stay home. If you have to work go straight to the office and back home, stay at home, and not try to visit. Marriages can be done by letting the couple go sign the marriage certificates with the Mayor. The celebration can be delayed even till when the family increases with children, you do not have to do this now. If you invited me I will not come not because I don’t want to attend your wedding, but I think this is not the time to attend weddings. I can assure you even for my staff I won’t attend their weddings now and they should not be sensitive that I don’t love them. Rather, they should understand that this is not the time to group people for any occasion at all.
Let me address this to all health care workers. Do not use your uniforms and hug your kids when they try to embrace you on your way home when you get back from work take off the uniforms before any physical contact, steep it in some hot water with disinfectants, and keep your shoes outside before entering the house. When you have cleaned yourself and changed to house cloths you can socialize in your own house. Immediately coming back from work and socializing with your family is not a wise thing to do, we need to avoid all of that at this point. I’ve gone beyond your question but I think I need to go beyond to give some of this information as I remember and it becomes available.
Prevention, as we do does not mean that we may not have somebody that will eventually get sick. Even with all the good preventions and so on somebody may still get sick. If you finally get the virus through whatever way it might have come, which normally will come from some kind of physical contact where somebody coughs or sneezes directly to your face or you happen to touch a surface that was contaminated and touch your face, just accept it and do self-isolation. Treatments are available and let health personnel follow you up or you should be followed up in a hospital up to the point where it will be okay and then you can reunite with your family. Don’t continue to allow your immediate family to take care of you without proper PPE. The person taking care of you must have proper self-protection because you may end up getting well and the other person who has taken the disease from you may die. It doesn’t automatically mean that when you have the virus you are going to die, many people survive it, the survival rate ranges from about 2% to 8.5% depending on your age, the older you are the higher the fatality rate. You may die of it quicker is you are of higher age, from 70 and above, but the younger people will get it and will be treated and be fine and even some of the old people survive this.
Again, it should not carry any stigma, getting this virus is not about feeling stigmatized that you are a carrier of the coronavirus, you can’t say you have it because you were very careless after all, there are still people who are very careful but still die. Doctors and nurses are coming down with it because they were trying to do good by helping somebody, so anybody can get the virus. Part of what we have done as preparation is stocking either oxygen concentrators or the real liquid oxygen in the tanks so that we can administer it because the survival rate of the patient depends so much on oxygen, and that cannot be given in the house. Therefore, when you have it make it a point to ensure health personnel takes care of you in the health facility so that if it becomes necessary to administer oxygen to you it is available instantly. If you are just in the house, having difficulty in breathing and not knowing what do, you may die when you ought not to die from the disease.
As a faith-based institution, what message of hope do you have for the general public?
Prof. Tih: This virus is here with us, we are not still waiting for it to come, many people are getting infected and it may be you and tomorrow another person. First of all, as Christians that we are, have a compassionate attitude towards those that are already infected. Have a prayerful mind that more and more people do not become infected and as we pray we should act. Do something that will help in the preventions, share a message with somebody that will help in the prevention of this virus, don’t be an agent of transmission but be an agent of stopping or breaking the chain of the transmission of this virus. We should also encourage people to give their contacts if they become positive, be honest and tell everybody I was in touch with this or that person so that those people are tested in time and if positive they will be helped before the condition deteriorates.
We are not a faith-based organization by chance but because God wants us to be there to be the light and source of comfort to those that are hurting. We will continue to say let’s give quality care to all without discriminating, with no stigma, we shouldn’t discriminate as to who we give ourselves and pray especially. If my people who are called by my name will humble themselves and pray and seek my face, I will hear from heaven and heal their land. So let’s do all this prayerfully that this virus will be short-lived in Cameroon because we already have our share of the problems through Boko Haram, HIV&AIDS, the Anglophone crisis and so coronavirus should not come and finish the remnants of Cameroonians. I believe we will survive if we all work hard to prevent it. Thank You.