Friday, 14 August, 2020

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INTERVIEW WITH THE CMAC ON COVID -19


Publisher of Vision Newspapers Online interviewed Dr. Joseph Ugboaja, the Chairman, Medical Advisory Committee(CMAC) of NAUTH, and also Chairman, the Taskforce on Covid-19 NAUTH, on the state of affairs regarding his team’s response to taming coronavirus pandemic, especially, within the NAUTH cluster.

Could you please introduce yourself?

My name is Dr Ugboaja Joseph, an Obstetrician & Gynaecologist by training and currently the Chairman, Medical Advisory Committee of Nnamdi Azikiwe University Teaching Hospital, Nnewi. I am also the Director, Clinical services, Research & Training as well as Chairman, Taskforce on Covid-19 of the hospital. I am the chairman of the Total quality management system Committee, committee on laboratory Quality management system as well as the Revolving committees of the hospital including Drug revolving fund committee, Radiology revolving fund committee as well as the Laboratory Revolving fund committee. I am also on the Board of management of the hospital where I am the Chairman of several board committees including Board Committee on Clinical Services Improvement & Servicom, Board Committee on Public Private Partnership, Board Committee on Capital budget as well as Board Committee on Liaison.
I hold Postgraduate fellowships in Obstetrics & Gynaecology of National Postgraduate Medical College, Nigeria (FMCOG), West Africa College of Surgeons (FWACS) and International College of Surgeons (FICS) and Minimal Access Surgery (FMAS). I joined the Hospital management in 2014 as the deputy CMAC, a position i held for 4 years and was subsequently appointed the CMAC in 2017 for the initial tenure of 2 years which ended in 2019. I was reappointed in 2019 for the final tenure of 2 years as the CMAC of the hospital. My tenure as the CMAC of the hospital brought a lot of innovative changes and improvement in services under the leadership of the CMD, Prof AO Igwegbe. These include the formation of the NAUTH Research Society; the Quality improvement committee; the Clinicopathologic conference series; the NAUTH Cancer Society; Laboratory Quality Management system as well as the introduction of the Annual NAUTH Scientific Conference.
I have attended several workshops, trainings and conferences on Strategic leadership and healthcare management including those organized by the administrative staff College of Nigeria (ASCON) and I am an associate of the Institute of Management Consultants of Nigeria.(IMCON). I believe in transformational leadership and also believe strongly, that leaders should be altruistic, inspiring, motivational, transparent and accountable.

How do you assess the current Corona virus pandemic ravaging the world?


It’s an unfortunate and bizarre public health emergency that took the world unnoticed. The virus is a novel virus and hence, not much was known about its pathogenesis and treatment. Therefore, new insights are gained everyday into its pathogenetic and transmission mechanisms, treatment methods as well as preventive strategies. Initially it was thought to cause deaths due to interstitial pneumonia and so ventilators were thought to be critical to the survival of patients. But emerging evidence shows that the virus causes blood clots in the lungs and other parts of the body, therefore, reduces tissue oxygenation. This is why blood thinning drugs such as low dose aspirin have been added to the treatment plans. In terms of treatment, many protocols have been tried with differing results. But largely hydroxylchloroquine, zinc, azithromycin, doxycycline and recently the antiviral drugs such as Lopinavir, Favipiravir, and remdesivir have been introduced with good effects. Also steroids (dexamethasone) have been found effective in reducing mortality among patients with severe disease by suppressing cytokine storm in those patients.
Worldwide, the Covid-19 Preventive measures have centered on staying at home via lockdowns, maintaining social distancing, the use of the face mask, regular washing of hands under running water as well as the use of hand sanitizers. The Nigeria’s response is coordinated by the PTF, NCDC, and FMOH through regular sensitization of the public on the need to comply with the preventive strategies, aggressive testing and contact tracing, national lockdowns as well as the strengthening of the health system especially, the tertiary health institutions via the provision of PPEs and training. Currently, Nigeria is in the community spread and so the numbers of cases are increasing everyday alongside the deaths. This calls for a more stringent measure to curb the further spread of this deadly virus.

Would you be kind to explain what portfolio you have been assigned in the fight against the Covid-19 pandemic, and what are your parameters of the mandate?


I am the Chairman, NAUTH TASKFORCE ON COVID-19 and our main mandate is to lead the response to the Corona virus pandemic in the hospital and environs. Being the only federal tertiary hospital in the state, NAUTH has an important role to play in the fight against corona virus in Anambra State. These roles range from public and community awareness creation on the pandemic, especially the preventive measures, the effective identification, isolation, testing and treatment of cases of COVID-19; collaboration with national and state agencies to curb the spread, to carrying out research on aspects of the COVID-19 pandemic.
To deliver on these mandates the hospital management under the leadership of the Chief Medical Director, Prof AO Igwegbe constituted a Taskforce on COVID-19 of which I am the chairman. The taskforce has 6 teams/committees. These are the Rapid Response Team, Case Management Team, Sensitization Team, Surveillance Team, Logistics and Supplies Team, and Team on collaboration and liaison.
The Rapid Response Team is responsible for quick response in all alerts on possible cases of covid-19 that presented to any of our service point. They are trained on how to triage, move the patient to the isolation center, collect samples for investigation and commence management of the patient. This team includes doctors, medical laboratory scientists, nurses, hygienists, and others. The Case Management team is led by the Infectious Disease Specialists. The others in the team include the respiratory physicians, the pediatricians, the anaesthetists, nurses, hygienists, and others. This team is in charge of managing all the admitted cases in the Isolation Unit both suspected and confirmed.
The Sensitization Team/Committee led by the public health physicians and nurses has the mandate of sensitizing the hospital community and the general public on issues pertaining to covid-19 infection. This committee has embarked on aggressive public sensitization on the dangers of COVID-19 and the need to adhere to the laid-down preventive strategies. They have effectively engaged the media houses in and around Nnewi to facilitate this.
The surveillance committee is charged with monitoring the hospital environment to ensure that both staff and patients comply with preventive strategies especially, the use of face mask, hand hygiene, and observance of social distancing. I’m sure you know that you can’t come into the Hospital without a face mask. They monitor the attitude of our members of staff and prescribe punitive measures for defaulters and reward for exceptionally compliant ones.
The logistics and supplies team ensures that the PPEs and other materials needed in the fight against covid-19 are available within the hospital through a proper forecasting, procurement, and inventory system. The team periodically reviews our stock of PPEs and guides the management in the procurement in terms of quantity and quality.
Finally, the committee on collaborations which is currently chaired by me is charged with the responsibility of attracting assistance to the hospital from public spirited individuals and corporate organizations. This committee has attracted several donations to the hospital. But by far the greatest donation to the hospital is that of a world class COVID-19 Isolation and Treatment center being constructed by Anambra Progressives, convened by His Excellency, Sen (Dr ) Ifeanyi Ubah. The building is almost 90% completed and will be handed over in about 2 weeks’ time. We remain grateful to the Anambra Progressives for this massive and timely gesture.
However, the greatest asset to us in the fight against this pandemic is the presence of an Isolation & Treatment Center with the full complement of trained members of staff that are willing and available to attend to these cases of suspected and covid-19 patients. Though it is very small with only 3 wards, the staff is always on ground 24 hours a day to respond to alerts of COVID-19 and do the needful. The Isolation Unit is under the leadership of our very hard working and passionate DCMAC, Dr Ezejiofor O. Since he took over the leadership, the unit has got a very big leverage and direction and is more organized now. The management remains appreciative and indebted to them. Management is also highly appreciative of the efforts of all staff members working at the Isolation & Treatment center, and indeed, all our frontline staffs, especially those working at the Accident and Emergency unit.

It is inferred that because the country lacks testing kits capacity, that many people may already survived coronavirus infection and many may have already died from the Covid-19 pandemic without visiting the hospital because of mistrust of many people regarding the pandemic protocol, is there a mechanism for your team to make projections as to the real status of both scenarios?


As I said earlier, in all cases of pandemic or epidemic, testing and subsequent isolation and treatment are key components of the response. The trend in the results of test when appropriately and adequately done gives the true picture in terms of the success or otherwise of the containment efforts. In Nigeria, testing is coordinated nationally by the NCDC through the public health laboratories and augmented by the efforts of the State Governments through the office of the state epidemiologists. Some institutions such as NAUTH also participate in the testing. The challenges with testing in a pandemic is enormous because of the number of people affected and the required logistic which usually include sample collection, transportation, laboratory analysis, and documentation. These processes require immense investment in equipment and personnel. Therefore, with the weak healthcare system in most African countries, it is not surprising that testing will pose a lot of challenges to them. In Nigeria, I feel the NCDC has done very well in the area of contact tracing and testing. Some state governments have also done very well but others need to test more.
In terms of people dying without having been tested, yes it can happen and it is a multifactorial problem occasioned by lack or limited capacity to test on a large scale, fear of stigmatization, ignorance, lack of trust in the health care system among others. Therefore, a lot needs to be done in the area of creating public awareness on the early symptoms of the disease, case reporting and contact tracing and campaigning against stigmatization. The media has a great role to play in this aspect.

There was much fanfare about having an NCDC Covid-19 approved laboratory in Nnewi to be used for the next cluster and beyond, what has become of the approved laboratory?


We were elated when the news of accreditation of Acunalysis laboratory for covid-19 testing by NCDC came to us as that will save us a whole lot of spending on logistics of transporting samples to Irrhua, Edo State, reduce the waiting time for the result, and allow earlier and quicker clinical decision making in suspected cases of covid-19. However, more than one month after, they are yet to commence testing. I don’t have the details of what the issues are, but we are earnestly looking forward to when they will commence covid-19 testing following NCDC accreditation. There is no doubt that having a testing center closer to us will ease most of the logistic difficulties we encounter in moving samples to Irrhua.

The story that testing for coronavirus is at least over three hours away from Nnewi has caused the people to accuse your team of engaging in the ‘the usual Nigeria factor’ by promoting falsehood. What Is the real situation here?


Well like I said earlier, there is yet no testing center in Anambra State and we still take samples to ISTH Irrhua for analysis. You must know, just like the CMD explained, other institutions and states go to Irrhua for testing. So that usually will cause some delays. Mind you that making a pronouncement on a sample in cases like this has profound implications to the patient, the community, and the nation at large. For instance, if a sample is positive and is mistakenly pronounced as positive, your guess is as good as mine as in what the implications will be. So the people working at the public laboratory are specially trained to carry out these tests in very meticulous and tightly controlled processes with little or no provision for mistakes. Sometimes, they need to repeat some of these tests to ensure validity, authenticity, and accuracy. So as you can see, necessarily, it will take some time before these results are gotten. We don’t indulge in falsehoods in the release of patients’ results. That would be unthinkable, criminal, unethical and against everything we stand for both as individuals and as an institution. The results we released are duly signed by the laboratory managers as announced by the State epidemiology office and the NCDC.

There has been an overwhelmingly positive test situation among the health care practitioners in the country, many people within the health care sector and outside the industry have accused the responsible parties of exposing them to danger by not providing them with the necessary personal protection equipment (PPE), what is the task force and the hospital doing to ensure the safety of these staff?


Thank you for this very important question. The safety of the frontline staff in any case of epidemic or pandemic is of utmost priority because they are the ones who will salvage and rescue the situation just like you have in a war situation, the number, strength and ability of men and women at the battle fields is a key determinant to success. That is why at the inauguration of the NAUTH Taskforce of COVID-19, the Chief Medical Director and the Board emphasized that the safety of members of our staff is a topmost priority. The Taskforce and hospital Board and management place a high priority on staff welfare and safety and has 3 approaches to it viz the provision of PPEs in adequate numbers and quality and other necessary materials and equipment such as hand sanitizers, water supply, etc. Establishing clear COVID-19 preventive guidelines and policies, including the triage and treatment algorithms and the constitution of a surveillance team to ensure that members of staff, patients and visitors to the hospital comply with these directives and punish offenders.
Specifically in terms of the PPEs, the Chief Medical Director, Prof Igwegbe AO supported by the Board has been outstanding in ensuring that these are made available to our staff freely. These include the surgical mask, the N-95 masks, the PPE gowns, hand gloves, face shields, etc. A lot of spending goes into the provision of these materials and in the face of rising cost of materials and dwindling revenue accruable to the hospital on account of reduced activities, it becomes a huge challenge to hospital administrators in the country to keep up with this responsibility. A lot of kudos will be given to the Board and management of the hospital for meeting up with this onerous responsibility. Additionally, we have established an incentive for all the staff working at the isolation unit of the hospital. A lot of thanks will also go to public spirited individuals and corporate organizations who have donated materials to assist us and ensure our staff members are well protected. Particular mention must be made of a 50-bedded world-class Isolation and Treatment Center being constructed by the Anambra Progressives convened by Distinguished Sen (Dr) Ifeanyi Ubah. This gesture is not only appropriate but also very timely as our 3-bedded Isolation unit has being overwhelmed and we expect increasing number of cases in the coming weeks because of the ongoing community spread. We are still soliciting for more assistance in the area of provision of PPEs from individuals and corporate organizations.


Finally, what is your advice to the Public?


My advice to the public is to adhere more strictly to the laid down covid-19 preventive guidelines which include staying at home, wearing face masks, maintain social distance as well as practicing hand hygiene. Those of them who have symptoms such as fever or cough should present to the hospital early for testing and management. If they present earlier, chances of survival are highest. The people who are mostly at risk are people above the age of 60 years with some form of co morbidities like diabetes mellitus etc. this class of people should be extremely careful with respect exposure to risk of contracting the disease.
For the government, I feel they are trying but a lot more needs to be done in terms of creating awareness, enforcing lockdowns where and when appropriate, strengthening the health system by provision of PPEs and training of the health force as well as motivating the healthcare workers by paying reasonable hazard allowance and maintain life insurance for them. I believe that if all of us work together, we should be able to defeat this pandemic.
I want to thank all the media outfits who have been partnering with us in this fight against the spread of covid-19. We need to work more closely in order to surmount the twin challenges of ignorance about, and noncompliance to COVID-19 preventive strategies prevalent in our society.

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