Thursday, July 18, 2024

Crumbling Health System and Covid-19 Nightmares

The Coronavirus Pandemic has placed enormous pressure, strain and public scrutiny on the Botswana health system. The ability of health systems to manage Covid-19 has been tested throughout the world this past year and half. Some governments responded swiftly and decisively to the pandemic. Others were less proactive. Others reactive. The worst were haphazard and negligent.

At the centre of this test are the issues of infrastructure, emergency readiness, focus directed to health security, health coverage and mitigation of the health crisis. What is becoming clear is the simple fact that the response of any health system to a health emergency and catastrophe of this nature and magnitude depends on resource alignments in place to prefigure varied objectives and priorities strengthening nationwide health system.

The fight against Covid-19 is driven by several policy and structural issues; financing and investment in the national health system, investments in universal health coverage, protection of jobs and incomes to promote resilience in economic recovery and equal and equitable access to vaccination.

Like many countries Botswana focused on preventing transmissions and infections, detecting spreading of the virus and the disease, keeping hospitalizations low, and saving lives of those testing positive to the disease. No doubt this elaborate health surveillance saved lives but this winter has turned the course of the disease and the pandemic around, and for the worst. Infections are skyrocketing. Hospitalizations have already hit the roofs. Deaths are now a daily occurrence.

Public discontent is palpable and caseloads are rising, overwhelming hospitals, the national health system itself, and plunging an entire nation into a black nightmare. Other countries have experienced this nightmare; Italy, Spain, Brazil, America and India. We could have learnt a few things from them. But we didn’t. We could have prepared for this tragic hour. But we didn’t.

Why are health interventions like social distancing, washing hands or sanitizing, and wearing masks not stemming this slide towards national death? The major problem is not the health system alone. We have a huge population of Batswana who depend entirely on informal daily wages and even under lockdown conditions this informal economy keeps going and some health protocols are routinely cast aside, not out of petulant misbehaviour, but because of the competing needs of basic survival.

Unemployment, hunger, lack of water, expensive utility bills and rising food prices are driving many Batswana to desperate measures. Life has long become cheap and disposable in this country and personal dignity is now just a currency for the few who are rich and powerful.

Are we saying the rich and powerful are not dying of Covid-19? No, not at all. Only that they have more resources, access to better health facilities and better medical support, a wide choice of social behaviours, more space where they live, opportunities to work from home and better paying jobs to get away from the pressures of household and public crowding, poor sanitation and expensive utilities that force the poor to conform less to health restrictions and self-care preventative measures.

If Botswana is to bring this alarming health storm under control it is important to identify and rectify the situations and circumstances that underpin them.  It’s easy, too easy, to stand at a public forum and blame people living under near impossible conditions of existence and mere survival for spreading the virus and the disease. In fact it is not necessary or useful to blame these people.

What is important is to look at and address structural issues like these. Fund informal businesses. Provide financial exemptions to small businesses. Buy vaccines and deliver them into the hands of Batswana. Engage in proactive screening and strong clinical measures such as home diagnosis and care. Support frontline workers through access to vaccination. Make sure social security grants get to poor households and the destitute on time. Promote risk communication and community mobilization and engagement.

Get to work on time. Make decisions you are expected to make by Batswana about these troubling issues if you are a Government employee, Minister or the President. Batswana are not asking for miracles. They just want people in these positions to do their jobs, to justify their salaries, to save lives, to save this nation and its beautiful country from the misery of death, ruin and arrested development.

To recover, heal and rebuild it is important to accept the terrible situation facing us. We are in the grip of a devastating health emergency. Covid-19 has become a runaway infection tragedy. Social media feeds are full of public agony, obituaries and videos of funerals arising from Covid-19 deaths.

Covid-19 has become the leading cause of death in Botswana in the last two weeks by a big margin. Mortuaries are overflowing with the dead and bereaved families are been forced to collect their dead at short notices. Hospitals are full of gasping patients. The health system, our last line of defence against this calamity, is overwhelmed with frantic demands for ICU admissions, bed in hospitals, medicines, essential tests and drugs and oxygen. Our national vaccination effort is struggling. Vaccine supply is a problem. Vaccine shortages are being reported all over the media. Death and despair have become defining features of our public space and national life.

This should not be happening Botswana. Our population is more than 60% young. The country is huge, almost empty and populations are widely scattered. What exactly is driving this infection surge? Are Batswana letting their guard down? Why? Is there a problem with Government messaging and management of the coronavirus pandemic and Covid-19 disease? Is our health system itself too weak, too fragile, too vulnerable, too broken, to deal with a health emergency crisis of this magnitude? Could we have prevented, delayed or somehow postpone this hour of health terror? Did someone drop the ball in the chain of decision-making?

If we are to win the war against this health disaster we must find answers to these questions urgently and immediately. Government must take drastic measures to bolster the health system to deal with this national crisis. There must be holistic surveillance in the trends of transmission and markers of death, not just focus on social distancing mandates. How much of the increase in mortality is due to alcohol use, drug dependence, or needed health care being delayed or deferred because of competing demands of the pandemic? How many infection risks arise from mental health disorders, including depression, that have been triggered by pandemic anxiety?

What is the contribution of chronic conditions and general national disease burden given the widespread dominance of non-communicable diseases and HIV in the national health calendar? Are Batswana giving up to the burden of daily struggles and public misery? Is fatalism killing this nation?


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