Leading by example

Innovation: local heroes

Kenyans are used to finding local solutions to everyday challenges and COVID-19 has inspired innovators to find creative ways to cope with the pandemic

Kenyan fashion designer of “Lookslikeavido”, David Avido, 24, poses for a portrait at his studio in Kibera, Nairobi, on March 18, 2020, with a mask he made, that he creates from remnant of cloth he uses, to hand out to people for free so that they can wear it as a preventive measure against the COVID-19 coronavirus. (Photo by Gordwin ODHIAMBO / AFP)

Onyango Okoth was diagnosed with COVID-19 on 14 July after he visited a hospital in Kisumu for what he claims was a routine medical check. The father of four, who works as a fisherman in Lake Victoria in the western part of Kenya, says he had experienced shortness of breath and high fever the previous day, prompting him to look for treatment. “After receiving initial medical assistance, I was advised to go back home as the hospital facilities were packed,” says Okoth. “The doctors said I was to self-isolate for at least 14 days.” But Okoth, 45, did not know where to start; he’d never heard of self-care. “It was a long, tough and draining struggle with my meagre resources, which had to compete for food, medical equipment and sanitary products,” he told Africa in Fact. Faced with this financial pressure, he says he opted to look for alternative and affordable solutions, particularly a special bed that he had been advised to obtain. Okoth’s story mirrors the daily struggle of many Kenyans in the wake of the COVID-19 pandemic.

While more than 30,000 Kenyans had contracted the disease by the first week of September, and there had been 581 deaths, many people had also lost their livelihoods, which has translated to escalated poverty rates. On 1 September, the Kenya Bureau of Statistics said in its Quarterly Labour Force report that unemployment had increased to 10.4% between April and June 2020 compared to the 5.2% recorded in the first quarter of 2020. But even though the crisis has meant sweeping changes to Kenyan society, daily routines and work life, it has also acted as a powerful driver of creative thought and innovation, especially among young people. “As much as we are working around the clock to ensure Kenyans adhere to the COVID-19 protocols and guidelines to contain its spread, we are also challenging young people to come up with innovations in response to the outbreak to stimulate economic and job growth,” says Julius Korir, the Principal Secretary, State Department for Youth.

This, he adds, is being done through training, mentorship, support systems, funding and the creation of an innovation-specific regulatory framework. Acknowledging that innovation is a critical element in providing solutions to ensure better health for all, the World Health Organization (WHO) in the African region held the first in a series of virtual innovation showcases on 21 May that brought together eight innovators and entrepreneurs drawn from Ghana, South Africa, Nigeria, Guinea and Kenya, all of whom had found their own creative solutions to addressing gaps in local responses to COVID-19. Innovations showcased included interactive public transport contact tracing apps, dynamic data analytics systems, rapid diagnostic testing kits, mobile testing booths and low-cost critical care beds.

Among the eight innovators was Gordon Ogutu, 34, from Nairobi’s Githurai slums, who turned to YouTube to learn how critical care beds could be made and improvised locally to fit the demands of the market for people like Onyango Okoth. Ogutu says it was his anger that the Kenyan government was spending billions of shillings to import critical care beds that inspired him to come up with a local solution. Using the know-how he gathered from YouTube, he now makes critical care beds from locally assembled materials. Celebrating the creativity of Ogutu’s work during the event, WHO regional innovation advisor Moredreck Chibi said they aimed at continuing to integrate African innovators into the regional COVID-19 response strategy. Ogutu’s metal critical care beds are designed to provide comfort and safety to both the patient and the caregiver. The design includes a release feature that allows medical teams to flatten the bed at the push of a button or lever and IV poles with hooks to hang fluids and other medication administered via a drip.

Kenyan fashion desiner of “Lookslikeavido” David Avido, 24, creates masks from remnant of cloth he uses, to hand out to people for free so that they can wear it as a preventive measure against the COVID-19 coronavirus, in Kibera, Nairobi, on March 18, 2020. (Photo by Gordwin ODHIAMBO / AFP)

The beds also have removable heads and footboards, which lock safely into place allowing caregivers to tilt the bed and also to adjust the height. “If they (western countries) can do it, then I knew I could also, perhaps even better,” says Ogutu, who graduated from the Kenya Polytechnic in industrial chemistry in 2010. “I gained a lot of knowledge from various online platforms; it was not as complex as I had thought initially.” He told Africa in Fact that the demand for his beds had grown exponentially, with small hospitals as well individuals among his customers. “Impressed by my workmanship, customers have come from as far as 500 km away to order their beds. As a result, I have expanded my workshop labour pool to six, sometimes as many as 15 depending on the orders to be made.” Among his individual customers is Michael Ndwiga, 54, from Embu in central Kenya, who in June had two suspected COVID-19 cases in his family.

He says he purchased the locally made critical care beds from Ogutu after the government announced the plan for patients to be looked after at home due to congestion in hospitals. “Apart from being affordable, they are of good quality, and (quite) similar to those that are imported from abroad,” he said. Ogutu hopes to benefit from President Uhuru Kenyatta’s call on 15 July, which instructed the government to procure 500 hospital beds from local innovators. “The locally made critical care beds are a vital aid to public hospitals that are reeling under the pressure of COVID-19-related admissions,” President Kenyatta said then. The opportunities arising from the pandemic for young innovators have extended beyond critical care beds to locally made surgical masks, which were initially imported, at a relatively higher cost, from the United States, Europe and Asia.

David Avido, 24, a designer and proprietor of the LooksLikeAvido, a Kibrabased fashion firm that focuses on African fabrics, says he took matters into his own hands to produce masks for the people of the Kibra slums after he realised the gravity of the coronavirus. Unlike other businesses driven by return on investment, he told Africa in Fact that he makes and distributes the masks for free. Since March, Avido said, he had distributed more than 20,000 of the items. For his philanthropy, Avido has received a special commendation from President Kenyatta, listed in the 2020 Presidential Citations Order for Outstanding Professionals in Kenya’s response to the coronavirus pandemic. Also among the 68 on the list for the Presidential Order of Service – Uzalendo Award was nine-year-old Stephen Wamukota from Mukwa in Bungoma, western Kenya, who came up with a wooden hand-washing machine to help check the spread of coronavirus.

Wamukota, who came up with the idea after learning on television about ways to prevent catching the virus, says the machine allows users to tip a bucket of water using a foot pedal to avoid touching surfaces, thus reducing the chance of infections. In a bid to enhance innovation, Deputy President William Ruto, in a 24 July tweet, said the government would step up the mentoring and resourcing of micro-, small- and medium-sized businesses and startups “with an appreciation that they are the arteries of our development”. He noted that, due to the biting effects of the COVID-19 pandemic on the economy, the government would support and forge partnerships with creative entrepreneurs and businesses, big and small, to support their sustainable growth. Young people across Africa, he said, were exposed to environments that encouraged innovation.

“No doubt in the near future, given proper attention and the right environment, Africa will be the centre of global innovations and inventions, where even vaccines for stubborn pandemics like COVID-19 can be found,” he said.

Mark Kapchanga is a senior economics writer for the Standard newspaper in Kenya and a columnist for the Global Times, an English-language newspaper in China. He is pursuing a PhD in investigative business journalism at the University of Nairobi.

COVID-19 means faith, hope and a plan

Nigeria: the long haul

The West African country’s frontline healthcare workers have gained a wealth of experience with Lassa fever and other pandemics, so it’s about getting on with the job

A health worker works on a sample during a community COVID-19 coronavirus testing campaign in Abuja on April 15, 2020. – The Nigerian government commence search and sample collections of eligible cases as they struggle to contain the COVID-19 coronavirus pandemic as cases rise in Nigeria amidst lockdown. (Photo by Kola SULAIMON / AFP)

Widely referred to as Dr Biddie among his peers and other healthcare workers, Ayodele Bidemi knows the emergency department of Nigeria’s first teaching hospital, the University College Hospital Ibadan, inside out. He has spent nearly two decades in the tertiary health facility as a student, house officer and clinical resident, but COVID-19 has been nothing like anything else he and his colleagues at the unit have had to deal with – both in terms of stress and the risk to their own health. During the early days of the pandemic, when community spread was not yet underway, there was very little information on the pandemic, and the hysteria around the disease meant that more people visited emergency rooms like the one where Bidemi works.

“Patients would say, ‘I have a cough or fever, I may have COVID-19’. Having a cough or fever doesn’t mean someone has COVID-19, as it may be a symptom of stress, but patients are not like that,” Bidemi said. “Because of the hysteria created around COVID-19, when people started coughing, they came to the hospital.” And as the outbreak shifted from individual imported cases to community spread, the unit had to evolve new means of keeping its workers safe, while also meeting the emergency healthcare needs of the city. “The Accident and Emergency Unit was barricaded at some point to limit the movement of people. We had only one entry and one exit point. Back then, if a patient was brought to the casualty section and had Covid-like symptoms, they would not be handled or admitted, but would be sent to the dedicated COVID-19 isolation centre in another part of the city,” Bidemi told Africa in Fact.

This approach was to prevent exposing other patients and health workers to the disease while also attempting to ensure that emergency care for accident victims and others was not disrupted. The paucity of PPE has been a well-reported global phenomenon that also challenged health institutions in Nigeria. “Initially, we reserved the available masks for those who came into contact with patients, because we were not sure when we would get our next supply; KN95 masks became very expensive and hard to come by,” said Nurse Abimbola Oluseun, an emergency room (ER) nursing officer at Jericho Chest Clinic, a secondary health facility in the south-west region of Nigeria that was one of the first places where patients suspected of having COVID-19 were referred to and admitted.

With no certainty when the next batch of PPEs would arrive at hospitals, clinics and individual health workers had to find other means of protecting themselves, leading to a wide array of face masks and ingenious deployment of new waste bags for PPE purposes. Bidemi said they took solace in the fact that even in countries where shortages were not as acute as in Nigeria, health workers were still testing positive for the disease. “It became obvious that health workers contracting the virus in spite of wearing PPEs likely got infected in the process of taking the PPEs off,” he said. “So we became very conscious of that essential step, irrespective of how many or how few PPEs we had.” Moreover, considering ERs cannot be quickly expanded, to achieve some form of social distancing, call duty rosters for various cadres of health workers were revised.

“Instead of the usual three shifts daily roster, it was reduced to two (8am to 6pm and 6pm to 8am),” Bidemi said. When the pandemic began, hospitals had to decongest wards, and patients who were not severely ill were quickly discharged, while those reporting to the ER for mild cases were given prescriptions and sent back home. Patients who could be managed at home were asked to go home. Despite these efforts, however, the ER workers were still at risk of exposure, especially by patients hiding their COVID-19 status. This was the case in several health facilities across Nigeria, including the University of Benin Teaching Hospital (UBTH) in Edo State, where 25 health workers were exposed to COVID-19 in early April after three patients who were rushed to the ER hid their travel history. By 27 August, Nigeria had recorded 53,317 cases of COVID-19, with 40,726 people discharged and 1,011 deaths.

Although lockdown measures have eased since they were imposed in March, the federal government announced on 6 August that the second phase of the eased lockdown would be extended by four weeks. As the numbers rise, doctors and other health workers at the frontline remain at risk. In June, the BBC reported that Nigeria’s National Association of Resident Doctors (NARD) had raised concerns about the number of infections and deaths among health workers, saying that 10 doctors had died. In Bidemi’s ER, four out of the group of six doctors had tested positive but had recovered and gone back to work. Although PPE supplies are still not as satisfactorily ubiquitous as desired, the fear of contracting the virus has subsided among health workers since it became apparent that those with comorbidities were at highest risk, and most of the health workers that tested positive for COVID-19 had recovered.

With lockdowns easing and movement increasing, the World Health Organization (WHO) Regional Office for Africa has said it expects the number of cases to continue to rise. But with a comparatively lower case fatality ratio (CFR) than several other continents, moving on seems possible as long as local health systems are not overwhelmed and health workers at the frontline are not overstretched. Bidemi noted that the government had made a number of promises to healthcare personnel regarding life insurance, but for now, all they had was a COVID-19 hazard allowance and hope that COVID-19’s CFR remains low. “We were here during the Ebola outbreak. It was contained. There is still a Lassa fever outbreak underway that nobody is talking about. Our consolation is that COVID-19 is yet another disease that we have to be very careful about and protect ourselves against,” Bidemi said.

“A part of me feels like even if I have COVID-19, I will be fine. If you look at the disease, there is no cure. What we currently have is supportive management. And people are getting better, including my colleagues across the country that tested positive,” Bidemi said. “At the ER, we are doing our best to strengthen our immune systems. So I will say that we are still lucky, and we just have to do our best for those who will need critical care. This is the reason we continue to work and save as many lives as we can,” he said.

Paul Adepoju is a Nigeria-based freelance journalist, scientist, academic, and author. He covers science, health, tech and development in Africa for leading local and international media outlets. He’s also the founder of healthnews.ng. He is completing a doctorate in cell biology and genetics and holds several reporting awards.

Dying to give birth

Maternal mortality

Postpartum haemorrhage and obstetric fistula are two avoidable conditions that continue to kill and maim women in sub-Saharan Africa every year

Nigerien women suffering from obstetric fistula wait for a chance to be examined and eventually get surgery on July 16, 2008 at the Maradi hospital, southern Niger, as doctors from Turkish help association Deniz Feneri and Doctors Worldwide visit Niger to help some of the 200,000 fistula illness effected women in the country. Obstetric fistula, or vaginal fistula, is a severe medical condition in which a fistula (hole) develops between either the rectum and vagina or between the bladder and vagina after severe or failed childbirth, when adequate medical care is not available. The World Health Organization estimates that approximately 2 million women in Africa, Asia and the Arab region are living with the condition, and some 50,000 to 100,000 new cases develop each year. AFP PHOTO / MUSTAFA OZER (Photo by MUSTAFA OZER / AFP)

Atim (not her real name), from Nigeria’s southern state of Akwa Ibom, was barely a teenager when she was married off to a much older man. She would have preferred to have had a child when she was older, but that was completely out of her control and she found herself pregnant in the first year of her marriage. Her delivery was prolonged and difficult, which was further complicated by the fact that her hearing and speech are impaired. After attempting to cope with the distressing after effects of the difficult birth and with little understanding of what was causing them, Atim ended up at the Family Life and VVF (Vesicovaginal fistula) Hospital Mbribit Itam, in Akwa Ibom’s capital, Uyo. She had developed obstetric fistula. International NGO, the Fistula Foundation, describes an obstetric fistula as occurring when: “a mother has a prolonged, obstructed labour, but doesn’t have access to emergency medical care, such as a C-section.

She often labours in excruciating pain for days. Tragically, her baby usually dies.” For the women who survive this trauma, most of them from impoverished communities and often married young, the physical damage is extensive. Says the Fistula Foundation, “the mother’s contractions continually push the baby’s head against her pelvis. Soft tissues caught between the baby’s head and her pelvic bone become compressed, restricting the normal flow of blood”. The damage leaves holes – fistulae – between the woman’s vagina, bladder and rectum, causing lifelong chronic incontinence unless surgically repaired. Fortunately for Atim, she was saved by the intervention and experience of Dr Sunday Lengmang, who was on a routine visit to the hospital from Jos, in northern Nigeria. Lengmang, a renowned fistula care expert, carried out a two-stage surgery that relieved her of incontinence. Atim is one of the lucky ones; she is not only able to live a normal life thanks to Dr Lengmang, she also avoided becoming a statistic, among the more than 600,000 maternal deaths that occurred in Nigeria between 2005 and 2015, according to a 2019 World Health Organization (WHO) report.

Although there have been reductions in global maternal mortality rates, with a 38% drop per 100,000 live births between 2000 and 2017, the WHO worries that it is still unacceptably high, with “about 295,000 women (dying) during and following pregnancy and childbirth in 2017”. Most of these deaths (94%) occur in poorly-resourced countries, and most of them were avoidable. According to the WHO, sub-Saharan Africa and southern Asia accounted for approximately 86% of the estimated global maternal deaths in 2017. Two-thirds (196, 000) of these deaths were in sub-Saharan Africa alone, with Nigeria accounting for “nearly 20% of all global maternal deaths”, with “no less than 900,000 maternal near-miss cases occurring in the country”. Postpartum haemorrhage (PPH) is the leading cause of maternal deaths and accounts for about 35% of them. Annually, about 14 million women around the world suffer from PPH, with 99% of the deaths occurring in low- and middle-income countries like Nigeria, as opposed to just 1% in high-income countries.

Patients wait in a ward prio to undergo obstetric fistula repair surgery at the Mulago Hospital in Kampala on October 31, 2014. Millions of women in developing countries suffer from the obstetric fistula, a hole in the vagina or rectum caused by prolonged labour without treatment which means they leak urine uncontrollably, and also endure the social stigma arising as a result of it. More than about 200,000 Uganda women live with fistula, but there are 1,900 new cases annually — this is just above the 1,850 women who were treated surgically in 2013, according to a report by the United Nations Population Fund, which funds the majority of repairs through the Campaign to End Fistula. AFP PHOTO/ Isaac Kasamani (Photo by Isaac KASAMANI / AFP)

The late Humihani Yahaya, from Kogi State in Nigeria’s middle belt region, called her husband on 17 March, 2020 to let him know that she had successfully given birth to a baby girl. Shortly after that, he received a call telling him his wife had begun to bleed uncontrollably. Rather than taking her to the dysfunctional primary healthcare centre a few blocks from her home, her family struggled to get a vehicle to take her to a more functioning hospital, where she died on arrival. In Bwari, a satellite town in Nigeria’s federal capital territory, Nkechi Okonya, 32, the breadwinner of her family, who supported her husband and two children by petty trading, gave birth to premature triplets on 20 April 2018. But after delivering the first baby at the Bwari Primary Healthcare Centre, her labour stalled. “For hours, they kept telling her to push, thinking the baby left inside her was just one, but nothing came out so they referred her to Bwari General hospital,” her cousin, Chinwendu Ekwunife, told journalists.

After delivering the first baby at 9am, it was only at 5pm that day that she was wheeled into theatre. “She delivered the remaining two children, but was bleeding heavily,” Ekwunife said. “She took four pints of blood in less than 15 minutes.” Okonya died shortly afterwards. For many impoverished women like Atim, who do survive an obstructed labour, the price they pay is a life of constant incontinence, shame, social segregation and health problems. In 2018, the WHO estimated that more than two million young women were living with untreated obstetric fistula in Asia and sub-Saharan Africa. This is a situation that experts like Dr Henry Uro-Chukwu attribute to malfunctioning health systems. Uro- Chukwu is the Director: Training, Research and Mobilisation at the National Obstetric Fistula Centre (NOFIC), in Abakaliki, Ebonyi State, in Nigeria’s south-east region. He told Africa in Fact that the underlying cause is “the state of the health system; fistula is a reflection of a bad health system”.

In addressing the condition in Ebonyi, support first came from the United States Agency for International Development’s (USAID) Fistula Work Project, followed by the federal government’s interest in making the facility the first national VVF centre in Nigeria. The centre now receives patients on a regular basis from 17 states across Nigeria as well as some from neighbouring countries like Cameroon. Referring to a study conducted in Ebonyi State, Uro-Chukwu says there is another factor to be considered: poorly performed caesarean sections. The situation is similar in Kenya. Galgallo Golicha, project officer of the Safe Motherhood Project, Amref Health Africa in Kenya, told Africa in Fact that some of the new cases of obstetric fistula presenting for treatment at hospitals are the result of “the doctors accidentally puncturing the bladder and/or uterus” during caesarean sections or other pelvic surgeries. It is also impossible to ignore the cultural influences that raise the risk of fistula and PPH, adding to maternal mortality across sub-Saharan Africa.

These include a form of female genital mutilation, commonly called yankan gishiri in northern Nigeria, and which is also practised in Niger, early marriage and childbearing, and birthing in churches and homes. Other traditional practices that put women at risk include: the belief that surgical delivery by C-section and birthing in hospital are signs of the woman’s weakness; the culture of delivering the first child in the mother’s house; the belief that the husband has the sole right of consent for his wife to undergo any surgical procedure; and a preference or insistence that female personnel attend the birth. Ogochukwu Mbamalu, a senior medical officer at NOFIC, says that while fistula is rarely fatal in itself, the longterm consequences are devastating for patients. She points out that cultural practices, ostracisation and the stigma attached to fistula lead patients to suffer depression, and in some cases they become suicidal. She advocates that more attention be paid to helping patients with their mental health as part of their recovery process.

Salamatou Traore, founder of the DIMOL (Dignity) non-governmental organisation, speaks about obstetric fistula at the NGO’s health centre in Niamey on February 19, 2016. – Niger is in a fight against fistula — a medical condition that affects girls married too young. (Photo by ISSOUF SANOGO / AFP)

Meanwhile in Kenya, Golicha identifies the lack of fistula surgeons as the biggest obstacle to remedying the situation. Although Kenya is “navigating this by organising fistula repair camps at least twice a year in each region,” he says this is a very expensive approach, and unsustainable. African governments, and Nigeria in particular, have signed into various international conventions, but these all seem to be nine-day wonders. The governments appear to be doing little regarding implementation, said Lengmang, who strongly advocates that gender equality policies, universal education and universal health coverage are issues that could help in fighting and preventing these health challenges for women, thus assisting in reducing the maternal mortality rate.

Vanessa Offiong is a journalist in Nigeria, with experience in investigative, science and development journalism. Vanessa is Executive Director of The Black Banana Media & Development Initiative and a Health Systems Global fellow. She has won awards and has been published by the British Medical Journal’s Global Health Blog.
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