When the ambulance driver pulled up on the hill, Simbota, too weak to move, was left on a stretcher at the main entrance of the red brick building. The minutes went on, his bare chest expanded and then cratered struggling to breathe through a blue surgical mask. She portably parked in a quiet corner, away from pedestrians and staff members who had gathered near the reception desk.
After more than an hour in the scorching midday heat, Simbota’s family pulls in a small hatchback to the entrance. Four of them struggled to pull him off the stretcher and push into his back. His wife cradles his head and covers his feverish body with a green and black blanket.
A dramatic second wave of Covid-19 in Malawi, fueled by the new variant first discovered in neighboring South Africa, flooded much of its health infrastructure, leaving many families with anxious choices and the danger of deep inequalities exposed in Covid-19. vaccine distribution.
“I did regular rounds at district hospitals. It was a way for us to ensure the quality of care across the country,” says Dr. Tamara Phiri, a specialist treating Covid-19 patients at Queen Elizabeth Central Hospital in Blantyre, the largest hospital in southern Malawi.
But like many of Phiri’s other responsibilities, her district visits ended when Covid-19 struck hard in Blantyre and her admissions to Covid-19 in her home hospital moved close to capacity.
Malawi – and Queen’s hospital – were apparently the worst spared during the first spate of Covid-19 – many, including Phiri attributed to its young and mostly rural population. But not during this wave.
According to official government data, the record for confirmed Covid-19 cases in one day was almost seven times higher at the peak of this second wave compared to the first.
In the first three weeks of January, the number of serious Covid-19 patients in Queen’s Hospital increased from 12 to 107 cases, Doctors Without Borders (MSF) says.
Every day, Phiri passes a white tent set up in the hospital’s courtyard on her way to the Covid 19 ward – this is where they disinfect the bodies of the patients she could not save. “It’s one of the most traumatic things. We see people dying all the time, but not like that. Not at this rate, not so many people who were healthy just a week or two ago. It can get quite cruel , “she says. .
“Your emotions are very vague – you do not know when to be the doctor who lost patients and when to be the family member who lost people – you are sad,” she says. “And then, when do you become a Malawian who worries about the whole country, because literally the country is flourishing?”
Healthcare workers were particularly hard hit. Before the pandemic, the impoverished country in Southern Africa could only manage its health care. Now doctors and nurses are calling sick and several have died from the virus.
Phiri points to the offices of fellow senior doctors who are now ill: “The one sitting next to him, the one after, the one after.”
Of the eight specialists working in the converted Covid-19 ward in her hospital, only three are still likely to have more than 80 Covid-19 positive patients.
Vaccines are now needed
But specialists like Phiri and leading health workers in Malawi and in the rest of the continent are likely to gain access to vaccinations only long after they are available to young, healthy people in the US and Europe.
Malawi’s national vaccination plan is dependent on COVAX, the World Health Organization facilities organized to help poor countries access Covid-19 vaccines. The government promised last week that the first shipment of the AstraZeneca vaccine would arrive by the end of February. But health workers are preparing for a much longer wait, skeptical that they will be delivered anywhere near the schedule due to regulatory red tape, and they are concerned about an announcement Sunday by South African scientists showing that the vaccine ‘provides minimal protection’ against the variant discovered there. .
“It’s cruel, but it’s the reality,” Phiri said. She says it reminds her of the fight against HIV / Aids, where life-saving antiretroviral drugs were available in the United States to fight the virus years before it became available in countries like Malawi – one of the worst affected countries in that Stadium. pandemic.
In the fight against coronavirus, rich countries with only 16 percent of the world population have already reserved about 60 percent of the available vaccine supply, according to ongoing monitoring by Duke University researchers.
According to current schedules, it can take years to get enough vaccines to Malawi to vaccinate the general population and stop waves of infection. MSF says the immediate goal should be to get 40,000 doses, enough to vaccinate all of the country’s overloaded top health workers.
“The vaccine problem is now more of an issue than an issue,” said Marion Pechayre, head of MSF in Malawi, whose team uses every available space outside Queen’s Hospital to build triact tents and consultation areas for potential Covid-19s. patients for this and future waves of the virus.
The medical charity is trying to buy directly from the pharmaceutical companies to donate to medical workers in the foreground. Otherwise, they say, the health care system could collapse. So far, pharmaceutical companies have only negotiated directly with governments.
“If we vaccinate and put medical staff in the front line fast enough, the health care system will not be as badly affected as if we do not. It seems unfair and unreasonable not to do so,” Pechayre said.
Too scared to seek help
The coronavirus has also indirectly affected health in Malawi by deterring people from seeking treatment for other problems. Many are worried that they are not taking care of too many staff, or worse that they will catch Covid-19 during their visit.
After finishing her Covid-19 rounds for the day, Phiri goes to one of the general wards in the hospital to prepare a final-year student for his final internal medicine exam. He examines the only patient in a row of empty beds carefully and reports to Phiri.
The general ward has more than sixty beds and is usually full of malaria cases and patients with chronic problems, but it is now largely empty. People are just too scared to get to the hospital, Phiri says. “It’s a disaster waiting to happen.”
Many will die at home
Away from Queens Hospital to the outskirts of Malawi’s healthcare, smaller district hospitals and clinics have the same pressure, only greater.
In the impeccable Thyolo District Hospital, south of Blantyre, dr. Arnold Jumbe his small isolation section Covid-19 where several patients – including a clinician – recover from the virus.
Vaccination by doctors will build up the hospital’s minimum resources and erase some of the myths about it on social media and in the local press, Jumbe says.
“As health workers, we are ready to take the vaccine. We were even ready to take the vaccine yesterday. Yes, because we need to be safe,” he says.
Vaccinating health workers would be the first step in sharpening a weakening health system – and in particular in restoring Malawi’s confidence in their hospitals. But until then, families do not know where to turn.
After Simbota’s family left Mulanje District Hospital, they rushed to take care of him who they felt they could trust.
The family could not afford the mission hospital in the city. The district clinic in the next town does not treat Covid-19 patients; therefore they refer the family to Mulanje.
On Sunday morning, access to Simbota’s modest brick house was blocked with branches and leaves strewn across the red dirt road. It was a symbol prepared by his neighbors.
A man passed by on a bicycle. “Andrew Simbota passed away last night,” he said.