COVID-19: DOCTORS WITHOUT BORDERS (MSF) OPERATIONAL UPDATE
MSF SOUTHERN AFRICA OPERATIONAL UPDATE
Contact Screening and Coronavirus testing
In Khayelitsha, on Saturday, 04 April after a second positive case of COVID-19 was confirmed our team, in collaboration with the provincial Department of Health, conducted contact and general screening in the community with the addition of conducting outreach testing (swabs for PCR lab based testing).
This is the first time community sample collection for testing has happened in South Africa. 450 individuals were screened, and the team took 21 swabs, all of them negative
Gender based violence (GBV) and Choice of Termination of Pregnancy services
Police Minister Bheki Cele announced that at least 2,230 gender-based violence cases have been reported during the first week of the national lockdown, 30% more than for the same dates in 2019. While the government is due to announce a range of services to be provided to survivors of GBV during the lockdown, our team in Rustenburg is seeing a lower number of sexual violence clients in the Kgomotso Care Centres (dedicated SGBV clinics), indicative of the serious barriers to access posed by the lockdown.
Our Team in Rustenburg met with the Department of Health about the de-prioritisation of Choice of Termination of Pregnancy (CToP) services in several facilities, and CToP services have since resumed.
Our team is aiming to coordinate a call on government to ensure that sexual violence survivors receive an essential package of medical and mental health care during the lockdown.
Shortage of drugs in Western Cape - a big concern
The Department of Health aims to conduct outreach community COVID-19 testing in the whole of Khayelitsha, and MSF will support these activities once briefed.
A shortage of TB medication limits the Department of Health’s plan to minimise facility visits for TB patients, a population considered to be at high risk from coronavirus. One-month medication parcels are currently possible.
The government’s ability to provide longer refills to people living with HIV is likewise limited by shortages of Tenofovir/Emtricitabine/Efavirenz, and while there is more Tenofovir/Lamivudine/Dolutegravir (TLD) available, switching people to this treatment is not happening fast enough.
MSF GLOBAL OPERATIONAL UPDATE
EUROPE
COVID-19 projects:
Italy: MSF is currently supporting three hospitals in the first epicentre of the outbreak, in Lombardia region, with infection control activities and the presence of few doctors inside. Outside the hospitals we are doing outreach activities in order to reach vulnerable people or supporting a program of telemedicine which is assisting people under isolation at home. We have also started activities in one of the five most affected regions, Marche in central Italy, where the number of cases is increasing. We support a network of nursing homes in several cities, to prevent cases to spread in such vulnerable locations, which have no specialized medical staff to manage the patients. Today there are about forty MSF staff involved in the response to coronavirus in Italy.
Spain: This week, teams have started operating in Castilla y Leon (Soria and Segovia), while also advising on the plan for nursing homes in the Madrid region. The teams are also initiating activities in Andalucia and Portugal (technical advise, training and assessing the situation). More hospital extensions are being opened in different cities in Catalonia (also looking for different hotels to alleviate the pressure on hospitals) and activities in nursing homes start taking place.
Belgium: MSF’s intervention for Covid-19 has three components: 1) support and technical and strategic advice to more than 10 hospitals and post-ICU-care centres to increase their admission capacity, 2) mobile teams to nursing homes for the elderly (30 so far in Brussels and now starting in Flanders and Wallonia), including psychological support for the staff and active case-finding to isolate residents with COVID-19, 3) support for vulnerable groups such as homeless people and undocumented migrants, focused on an isolation medical unit in Brussels that can reach up to 150 beds and outreach to assist other centres where vulnerable people are living in collective centres. There are more than 100 full time staff working on these Belgium COVID-19 projects.
France: projects for vulnerable populations, homeless and migrants, in Paris and surrounding area, with mobile clinics and aid in screening. On 24 March, 700 people were evacuated from a camp in Aubervilliers near Paris, where they were living in precarious conditions. They were dispatched on various emergency shelters located in Paris and Ile de France. MSF teams are deployed in some of these shelters to evaluate their health and identify potential COVID 19 cases.
Another team intervenes in screening homeless people on the street for Covid or other medical conditions.
The MSF intervention is also gradually expanding, including in support to hospitals. Last weekend logistical support was started to Reims hospital (inflatable tents to increase beds capacity). Other interventions in hospitals are being looked into.
New intervention in a COVID centre for homeless and migrant populations opening southwest of Paris is also underway.
Switzerland: In Geneva providing log / sanitation support to areas where vulnerable people are living targeting 1300 families in Geneva. Exchange of medical expertise with the University teaching hospital in Geneva (HUG), MSF medic detached to the HUG focusing on case management and management of medical teams. IPC - HP support activities started in Lausanne as well.
Norway: MSF is providing strategic advice and IPC support to a hospital hosting 10-12% of the hospitalized patients in Norway, situated geographically in one of the main clusters in the country.
COVID-19 highlights on preparedness:
Greece: MSF is providing support to the asylum seekers in Lesbos and Samos. At the moment we are promoting health information to the camp residents and we have all procedures in place in order to support referrals of patients presenting symptoms related to COVID-19.
At the same time, we have adapted our facilities and procedures in order to ensure the safety of our patients and our staff, we are increasing the provision of water and sanitation services in the camp and we are scaling up our operations with the recruitment of extra medical, paramedical, support staff and the acquisition of the necessary equipment. We are in discussions with the ministry of health to see how we can coordinate action and offer more support.
Ukraine: We have expanded our health education activities for all our patients and staff, providing them with information on how to prevent transmission of the virus, and we are increasing infection control measures at our project locations and in our offices in Ukraine.
MIDDLE EAST
COVID-19 projects:
Iraq: MSF has started supporting Ibn El Khateeb Hospital, a Ministry of Health (MoH) hospital in Baghdad, identified as one of the main hospitals treating COVID-19 patients in the city. We are providing the facility with technical training on patient triage and infection protection and control.
In Mosul, MSF has equipped a 50-room building (run by the MoH) in Al Salam hospital complex and meant to ensure the isolation of patients. Another hospital, called Al Shifaa, is located in this same complex. Al Shifaa was rebuilt by MSF in 2019 and is now being used as the main COVID-19 referral point for patients in the Ninawa province. MSF will support Al Shifaa by setting up 40 isolation wards and 30 beds for mild and severe case management in its center for post-operative care.
MSF’s existing projects in Ninawa, Diyala, Kirkuk and Baghdad have also been reinforcing their capacity to triage, support infection and prevention control, and refer cases to MoH hospitals; according to the protocol established by health authorities.
Lebanon: In Zahle where MSF runs a paediatric ward in the Elias Hraoui Governmental Hospital (now identified as is a COVID-19 referral hospital), our teams are supporting the hospital staff by managing a triage zone for children in tents set-up outside the premises. Management of suspected cases in the IPD ward and the pediatric intensive care unit. Support to the Elias Hraoui Governmental Hospital by setting up a COVID-19 emergency room outside he premises for triage and screening of adult patients.
In Bar Elias, MSF’s elective surgeries hospital, usually handling elective surgeries and wound-care activities, will be ready to host COVID-19 patients around the clock too. To better prepare for a potential influx of COVID-19 patients, MSF had to suspend the elective surgeries for a temporary period but, yet the wound care activities are still running.
On top of adapting activities in hospitals and hospital services we run, we’ve been in contact with several governmental hospitals (in Hermel and Saida) to support them with different logistic services and medical supplies and increasing their medical capacities through training staff members.
MSF also deployed a medical team to UNRWA’s Siblin training centre (near Saida), which will be turned into an isolation site. Our team trained the staff there on IPC and biosafety.
In Dora, a northern suburb of Beirut, MSF has created a medical helpline in partnership with a local organisation called Anti-Racism Movement, in order to provide medical support and assistance to the migrant communities and especially women domestic workers during the lockdown.
Iran – see latest PR release sent to the movement (24 March), situation on hold for now, meetings with authorities ongoing for clarification, not sure whether we will deploy in the end. More comms to come. https://www.msf.org/msf-surprised-iran-put-stop-our-covid-19-response
COVID-19 highlights on preparedness:
Yemen, support to MoH in Aden as set up isolation facility (for more Yemen see reactive only info).
Northwest Syria – In northwest Syria, in some of the hospitals and health centres that we support, we are reviewing the triage systems and patient flow to ensure fast detection of potential COVID-19 cases and isolation from the rest of the patients. This measure is taken to put symptomatic people under observation until an ambulance arrives to take them to a dedicated structure for tests and follow-up. We have also set-up Hygiene Committees and reinforced them with additional staff. We have strengthened the infection prevention and control measures in our facilities, equipped our staff with the needed protective equipment, donated protective equipment to the staff and donated additional supply for to these facilities to cope with an increased number of consultations. In some of the camps we intervene in, we have spread awareness messages, adapted the triage system of our Mobile Clinics and have implemented social distancing measures and reviewed our protocols to be able to also continue Non-Food Items (NFI) distributions and healthcare services while diminishing the risk of contamination.
Northeast Syria: Part of the COVID-19 taskforce, we are providing training and preparedness measures in Hassekeh National Hospital and in Al Hol camp, this includes, surveillance, case identification, patient flow and triage training, IPC training, case management training, PPE usage advice (to mitigate overconsumption), Logistical support for preparedness of facilities for receiving patients Our regular activities and support to Raqqa National hospital, to Raqqa outpatient department Clinic, and Kobane maternity hospital continue. In Al Hol camp, we continue running an inpatient nutrition centre, a tent based wound care program for those who could not reach the clinics for care, plus the provision of water and sanitation support in the camp.
Jordan - We have conducted an assessment in Zaatari refugee camp, ready to intervene if the authorities require more support. In Jordan, OCP teams are working to transform the Amman hospital for the possibility of it becoming a Covid-19 treatment centre, dependent on needs within the country and whether the correct authorisations are received. Patients from the reconstructive surgery program have been moved to another location. We have proposed help to the MoH to support them with IPC and material donations. The Irbid mental health project suspended in-person activities, but some patients are now being followed up by phone. MSF is supporting patients under strict curfew by delivering medicines daily to our patients with non-communicable diseases (NCDs) in Irbid and Ramtha.
Gaza - Regular activities have been reduced. We are getting our staff and facilities ready in case our medical capacity is required for the response.
AFRICA
COVID-19 projects:
Burkina Faso: Patient support in Fada health centre, if needed. Training of MoH staff. Surveillance as part of our regular activities and health promotion. We are adapting triage and infection prevention control measures on our projects of Djibo, Kaya and Barsalogho (not yet affected by COVID), and train staff, as concerns are high with the number of displaced people in Northern, Central and Eastern part of the country. The team is also assessing the capacity for patient treatment in Ouagadougou and discussions with the health authorities to support the response are on-going.
Ivory coast: In Abidjan, MSF supported the Ministry of Health at a transit centre to screen and refer people with coronavirus symptoms to the care centre. In Bouake, training activities for health workers and screening at the different entry points to the city are already underway. Water and sanitation activities are also being implemented.
Mali: MSF supports the management of a COVID unit in Bamako, within the grounds of the hospital where it runs its oncology programme. The unit is set up and managed by the MoH and composed of a triage and isolation/observation area and a ward, currently hosting 8 beds but there are plans to move in a new building to increase capacity to up to 100 beds. MSF provides medical, nursing and hygiene control staff (some coming from its regular project in Koutiala) as well as logistical and technical support. Also helping with IPC, training of staff, revision of patient pathways, in 2 other hospitals in Bamako receiving Covid-19 patients. We also reinforce MoH community outreach and contact tracing activities in the communities in Bamako and provide hand washing stations in strategic/most at risk locations (over 30 set up so far).
In the centre and north of the country MSF has started communication and sensitization HP in the supported health structures as well as IPC reinforcement, training of staff. Preventive measures have also been deployed and targeting many different local actors (associations, community leaders…).
In and around Niono, MSF has instigated awareness raising activities and has installed water points for handwashing at the referral hospital and in the outlying health centres where we have activities. In the area of Tominian on the border with Burkina Faso we have installed a tent for isolation of suspect cases and a handwashing point. And in Bamako we are doing some water and sanitation work in the triage and isolaton zone of the Hôpital du Mali.
Cameroon: The isolation ward for maximum 20 beds in Buea regional hospital has been set up and training for staff done. In Yaounde, we are supporting the health authorities in the Hopital General, where 20 beds have been deployed to receive patients for treatment. We are there implementing a safer patient circuit as well as infection prevention control measures. We are also preparing Djongolo facility for COVID-19 cases, whose capacity is 54 beds for now. We also started the construction of 4 rooms with 20 beds, in order to increase the bed capacity up to 134 beds. We will provide support in case management.
MSF has started its support to Bamenda Regional Hospital – the referral centre for CoVid cases in NW region. Our teams started the IPC training of hospital staff and installed a first pre-screening tent at the entrance. As the isolation room of the hospital is very limited (6 beds), MSF will set up a larger tent this week to reach up to 30-bed capacity. We are not intending to have MSF staff managing saces in this hospital. A dedicated ambulance from our fleet is in charge of all COVID19 (suspect) related movements in the NW region. The ambulance call-center is applying an updated questionnaire to identify suspect cases of COVID, and special procedures are in place regarding staff and vehicle disinfection.
Democratic Republic of Congo: In Masisi General Reference Hospital (North Kivu), a 20-bed isolation ward has been set up.
In Kinshasa, support has started for St Joseph Hospital, one of the six identified by the Ministry of health for COVID19 cases management. Training of medical staff on COVID detection and prevention has started, and team is working on the installation of a 40-bed isolation ward (tent).
Kenya: We have a team of seven staff supporting the Kibera South Health Centre in Kibera, the largest slum settlement in Nairobi, a health facility built and previously run by MSF. The team is boosting infection prevention control, triage, screening and managing referral of suspect cases to a nearby hospital.
MSF has adapted the way we care for people to protect our staff and patients - for example, giving ARVs to patients for three months, so they have to come to health centres less frequently.
Nigeria: Across the seven states where MSF works in Nigeria, we are providing technical support to the Ministry of Health and Nigeria Centre for Disease Control as they set up isolation centres for patients who may present symptoms of COVID-19, as well as undertaking community-based health promotion activities, and setting up hand washing points and isolation areas in local communities and IDP camps. In Ebonyi state, MSF is supporting the Ministry of Health and Nigeria Centre for Disease Control in setting up the state’s first COVID-19 testing centre.
In Sokoto, we are providing IPC trainings to the MoH and supporting set up of a 20-bed isolation and treatment unit. Ongoing community engagement in Anka and Benue in displaced persons’ camps including discussing with the community about what they would like to do with their most vulnerable members, including possibility of setting up shielding options. Ongoing activities installing water points for IDPs.
Liberia: While MSF has been forced to suspend pediatric surgeries for the time being due to staffing shortages caused by travel restrictions and is changing its model of care for mental health in order to reduce the movement of staff and patients, our teams are also working diligently to support the Liberian Ministry of Health’s efforts to prevent and treat COVID-19. MSF provided support to the MOH COVID-19 treatment center, for instance in order to improve patient flow and the quality of care for patients.
MSF is filling the gap in terms of community awareness and prevention of COVID-19 infection and is planning other activities to help prevent transmission among Monrovia's most vulnerable populations.
South Africa: MSF has re-purposed existing project staff from all 4 projects to COVID-19 responses in Gauteng, KwaZulu-Natal and Western Cape provinces. MSF staff are assisting with limiting infection spread by: contact tracing (physical and telephonic); the development and dissemination of health promotion materials; decanting of healthcare facilities through screening/triage points outside facilities and ensuring HIV/TB patients get medicine refills delivered at home. Interventions for vulnerable asylum seekers and elderly homeless are active in Tshwane to mitigate the impact of the national 21 day lockdown, as well as an explo among vulnerable populations in Johannesburg.
COVID-19 highlights on preparedness:
Sudan: MSF teams are in touch with the federal MOH and support the preparedness of a response including infection prevention control measures, setting up treatment center, trainings for MSF and MoH staff, HP and basic logistics.
Libya: we have delivered trainings on infection control & case management to nurses & doctors in hospitals in Tripoli.
Senegal: In Dakar, we are supporting the health authorities in the Hopital Dalal Jamm, in the northern part of Dakar, where we are giving training as well as a support for WASH activities.
Niger: We are adapting triage and infection prevention control measures on our activities in Magaria, where we run a 450- beds paediatric hospital with particularly vulnerable patients when the seasonal peak for malaria and malnutrition. Isolation capacities are also developed here and on the external axis, where we run preventive decentralised care each year. In Niamey, a 45-bed treatment centre is currently in construction, close to the Hôpital National Lamordé. We are also planning to provide training for health workers on COVID-19 preparedness and started health promotion activities both in Niamey and Magaria.
Tanzania: Our health promotion team in Nduta camp, Tanzania, are working to sensitise and educate the community on hygiene and best health practices, to improve preparedness for a potential threat of COVID-19 within the camp. MSF is the main healthcare provider at Nduta refugee camp in Western Tanzania, which hosts over 73,000 Burundian refugees. Currently MSF teams on the ground are strengthening systems and implementing measures to enhance our capacity for a potential outbreak of COVID-19 in the camp.
Zimbabwe: We are supporting case management of COVID-19 cases who are in isolation in Harare and upgrading facility capacity to 164 beds, while WASH team provides additional support in communities.
Mozambique: In Mozambique, we are implementing infection prevention and control measures and triage for respiratory symptoms in all health facilities where we work, including 16 new hand washing points. We have also adapted our models of care in order to decrease health facility frequentation allowing our patients and staff to comply with physical distancing measures. Our teams are also working with local authorities to improve patient flows by providing logistic and technical support for 2 referral hospitals in Maputo.
Eswatini: We are providing support to the ministry of health by assisting with infection control and triage at health facilities. We are also part of technical advisory groups to the ministry of health and are implementing adjusted models of care for patients living with HIV, TB and non-communicable diseases in order to reduce their risk of infection.
Guinea: In Kouroussa, a 8-bed isolation ward is being put in place at the Hopital Préfectoral de Kouroussa
Sierra Leone: MSF is part of the national emergency preparedness task force and an MSF epidemiologist has started providing support with contact tracing and surveillance. We are active in health promotion and Infection Prevention and Control support to MoH primary healthcare units that we support.
Sudan: In collaboration with WHO and the Sudanese health authorities, MSF provided Trainings of Trainers (ToTs) to key medical staff of 90 public and private hospitals in Khartoum including the two isolation centres for COVID-19 identified by the Government. Subsequently the WHO and the Ministry of Health rolled out ToTs in nine states. The objectives of the trainings were to increase capacity of health facilities in being prepared to respond to potential suspected and confirmed COVID-19 patients, reinforce IPC knowledge and standards and rationalize the circuit of the health facilities depending on the level of exposure.
South Sudan: MSF is assisting the Ministry of Health with the training of healthcare workers in infection prevention and control measures and triage for symptoms consistent with COVID-19. At the same time, the MSF projects around the country are setting up contingency plans for eventual COVID-19 cases in their catchment areas.
CENTRAL & SOUTH EAST ASIA
COVID-19 projects:
Afghanistan: After an assessment in the Afghanistan-Japan Hospital in Kabul, which is the referral hospital for COVID cases, MSF is providing IPC training. MSF intends to look at ways to support case management in Herat. In MSF’s maternity in Khost, in Afghanistan’s southeast, the exceptionally sensitive measure of no longer permitting caretakers into the hospital has been explained to, and accepted by, community leaders.
Pakistan: In Timurgara, the team is doing pre-triage for COVID cases and seeing suspect cases. We are running the isolation ward and put in place the layout, IPC and patient flow of the isolation ward before it opened to patients. We are also referring seriously ill patients to the tertiary care structures and are using the ambulance to collect COVID-positive patients in Lower Dir district to bring them to our isolation ward.
Bangladesh - Regular activities in the Rohingya refugee camp in Cox’s Bazaar are ongoing. In OPDs, we’ve put in place a specific waiting area for patients who show symptoms of COVID-19. In MSF hospitals, dedicated ward and isolation rooms have been put in place for eventual cases.
Hong Kong (OCB), MSF has conducted more than 20 face-to-face health promotion sessions with vulnerable groups since February. In addition, the team has also conducted 4 workshops on “coping with stress and anxiety" to the same target groups to address their mental health needs. However, with the new restrictive measures on public gathering imposed by the government, the team has shifted their activities from face-to-face community engagements to online sessions. As the outbreak has lasted for months now, we are putting more efforts on mental health to address the stresses caused by prolonged exposure to uncertainty.
COVID-19 highlights on preparedness:
Uzbekistan: MSF is maintaining key TB and HIV programmes while engaging in interagency cooperation for COVID-19 response. We are supporting the translation of health education documents and drafting of infection control guidelines. MSF is posting health education messages through social media channels and supporting health education to TB patients in Karakalpakstan. We are offering to support the WHO and Ministry of Health in Karakalpakstan to increase infection control education and implementation to reduce transmission.
Kyrgyzstan: In Kyrgyzstan, we are working closely with the Ministry of Health, and offering our support for Covid preparedness planning, with a specific focus on our areas of operation in Kadamjay Rayon and Batken Oblast. Today, we provided the Ministry of Health with personal protective gears including N-95 masks and gloves, thermometers, chlorine tablets and alcohol pads.
Malaysia We are ready to increase support to the national MoH and district authorities for contact tracing and testing. We have also issued a call to the Malaysian government to repeal a circular, obliging public health facilities to report irregular migrants, including refugees and asylum seekers.
In Penang, we are providing COVID-19 health education in different languages, including Rohingya and Burmese, and translations in hospitals. We’ve had to suspend mobile clinics, but patients reach us through our phone hotline. We have donated food supplements to 100 vulnerable families.
Indonesia: In Indonesia, the current project team has started COVID-19 health promotion for the communities it is serving in Banten province, West Java. Leaflets on preventive measures were distributed in key locations such as schools, restaurants, mosques and other public areas. Trainings and sessions via webinar on infection prevention and control measures, guidelines on the use of PPE were conducted with volunteer medical workers from Indonesian Doctors Association as well as to members of Indonesian Hospitals Association. MSF will also be conducting COVID-19 infection prevention and control training and resource sharing at the Labuan and Carita community health centres in Banten province. This training will be extended to other affected/worst affected health centres in Banten.
Cambodia - All regular project activities on hepatitis C are on hold, both in Phnom Penh and Battambang. The team contributes to the development of national guidelines for IPC and clinical care of COVID-19 –cases. Once validated, we’ll roll out trainings in eight hospitals around the country which have been defined as referral hospitals.
Philippines – Regular activities have been put on hold, both in Manila and Marawi. Assessments for Covid activities are ongoing.
PNG – Regular TB activities are on hold. Teams have started providing trainings on IPC, screening and triage in 22 provinces across the country.
AMERICAS
COVID-19 projects:
Brazil: Activities in São Paulo started last week with screening of homeless population and other vulnerable groups for suspect COVID-19 cases; also health promotion, mostly in sites in the city´s central region where they gather to receive meals. Infection rates seem very high. Teams have also been visiting shelters and provided health and IPC basic education to health professionals.
COVID-19 highlights on preparedness:
El Salvador – Adaptation of current intervention to the COVID response in full coordination with the
MoH, increase of ambulance services coverage & capacity in order to deal with the non COVID cases & adaptation of mobile clinics services in neighbourhoods & potential switch to home -based care services. Also assessment status of deported people from USA & Mexico continue confined in hotels to identify needs regarding IPC/Isolation/diagnosis/treatment and define a possible response.
Haiti: Admissions have been stopped at our burn hospital in Drouillard.
Mexico: MSF increased medical activities in Matamoros due to the lack of comprehensive care inside the camp, where around 2,000 asylum seekers live. We are providing physical and mental health services, and health promotion activities in a precarious environment.