Tuesday, June 2, 2020

Leading the fight against an invisible enemy

Seemingly overnight, coronavirus has put a stop to everything. One farmer has even had to abandon his integrated horticultural project after an unexpected call.

A source with knowledge of how it all unfolded says there was a thorough discussion of the skills set in the country, and one name ticked all the boxes.  And so the decision was made. All that was left was to place the call to the man, and find out if he was available.

The call inviting him for a meeting at Office of the President found Dr Kereng Masupu at his smallholding just outside Mochudi where he is known to be one of the major producers of different crops such as butternut, cabbage, and lablab.

One of the country’s foremost epidemiologists, Masupu politely declines to discuss the intimate details of the meeting at OP, except that he was briefed on the Covid-19 status at the time, and that government was putting together a Covid-19 Task Force. Then came the cut to the chase. He was asked to be the coordinator of the task force. In his wry humour, he recalls the offer being presented as a question whether he still had the energy to do this kind of work. He did not ask to be given time to think about it because all around him he could see that the country was hurtling towards a national health crisis. So no time to play Mr Hard-to-Get.

“I said since it was a call to national duty, I would do it,” he tells me over the phone.

I have asked for a few minutes during his lunch break to fill in a few details to the outline I have put together from talking to people who know him – former colleagues, friends, clients…… they come in all shades – and the conversation goes for much longer than we had planned. Not once do I pick a sense of irritation or edginess.

In the best of times, the interview would have been face to face, possibly over a cup of tea. But these are not the best of times. In fact, we could be in the worst of times. A novel virus is whizzing across the world changing life as we used to know it, decimating populations, bringing national economies to their knees, and spreading fear, anxiety and uncertainty. This is the time of social distancing, and WFH (working from home), and conversations are done electronically.

Masupu’s professional training in veterinary medicine.  He is an alumnus of two universities in the United States, Tuskegee University (Doctor of Veterinary Medicine) and University of California (Master of Preventative Veterinary Medicine).  Having spent his early professional years at the Ministry of Agriculture, his career focus was changed by another pandemic that – in the words of Botswana’s president at the time, Festus Mogae, in one of his most symbolic speeches – threatened the country with extinction, HIV/AIDS.  So when Mogae’s administration established the National AIDS Coordinating Agency (NACA) to address the HIV/AIDS pandemic, it was deemed that Masupu’s epidemiological expertise was needed more in the new battle front.

That was after two years fighting another fast-moving epidemic that, like the current coronavirus, threatened livelihoods, and called for drastic measures. Only that was a livestock disease.

In 1995, Contagious Bovine Pleuroneumonia (CBPP), which affects the lungs of cattle and buffalo, was noticed in one farmer’s kraal in Xhaudumo Valley, on the edge of the Okavango Delta. It quickly spread. Masupu was dispatched to head a national task team to contain the disease.

He draws a parallel between CBPP and Covid-19. For one, just like CBPP, Covid-19 is highly contagious and if not contained through restricted movement of carriers, it can spread very fast and spiral out of control.

“The dynamic of how this virus spreads, and the importance of contact tracing make it very similar to CBPP,” he says.

To illustrate the importance of restricted movement in the current case, he makes the point that when CBPP was first noticed in Xhaudumo, the red zone only extended around the valley. But because some farmers who did not agree with the measures suggested to contain the disease smuggled their cattle out of the red zone, the disease soon spread to Shakawe, and ultimately the entire district.

“Eventually, the entire Ngamiland became a red zone and we had to kill all the cattle in the whole district to contain the disease,” he recalls.

To this day, mention of Masupu’s name among the pastoral farmers in the North West District elicits different emotions.  He has fans and harsh critics. To his fan base, the man is a hero who eradicated a disease that threatened a people’s way of life, while the opposing camp blames him for the disease’s spread throughout the district.

To his credit, perhaps he may point out that since the last outbreak of CBPP 25 years back, there has not been another occurrence.

A former colleague who worked under Masupu at the Department of Animal Health says he is a scientist to his fingertips who pays attention to the minutest detail. He says because the man has a huge capacity for work (an early riser and a late sleeper), he can be a hard task master. But methodical, he is.

The former colleague, who later veered off veterinary science and is now a deputy permanent secretary in one ministry, recalls an incident in 1988 when a young Dr Masupu was a livestock officer in Serowe.  An elderly man was inexplicably bitten by his cat and died at Nyangabgwe Referral Hospital. It was a mystery because the cat had never shown any violent tendencies towards people. The pathologist at Nyangabgwe refused to do a post-mortem on the corpse because he said he was not well-versed in animal diseases. So Masupu asked to remove a brain smear from the man’s head and sent it to the veterinary lab for test. The result showed that the man had died from rabies, which he had contracted from the cat.

“So we vaccinated all the animals in the area for rabies,” the former subordinate says. “That’s how persistent and methodical he can be.”

When he left NACA, then began a period of wanderlust as his services were enlisted by the governments of Zambia (one year), Namibia (three years), Nigeria and South Africa (six months each) to set up HIV/AIDS intervention strategies. He later became the founding Executive Director of Champions for an HIV-Free Generation, a group of former presidents and other influential personalities which was launched in 2008 by President Mogae to mobilise high-level leadership in response to HIV/AIDS in Sub-Saharan Africa.

When he was appointed to the Covid-19 Task Force in mid-March, Botswana had not recorded its first case. What he calls the “baptismal case” came during his first week on the job. We are now sitting at 22 confirmed cases, one death, zero recovery, and 5 023 tests.

At the National Emergency Command Centre in Gaborone, where he turns up at 6am each morning and often only retired for the day at 10pm, he leads a closely-knit team of distinguished professionals who bring different skills – from the security cluster, to medicine, epidemiology, communication, and IT.

The same structure has been replicated in all the districts. At that level, the structure is a District Command Centre. The district structures present situational reports to the National Emergency Command Centre every day.

Having fought to contain both livestock and human diseases, I ask Masupu which is easier to control.

“None is easier,” he answers. “In both instances you deal with human beings. To control a disease you need the buy-in of the people, who in the case of livestock epidemics are the livestock owners and caretakers. And in both instances, your success depends on the degree to which the population abides by the measures that are meant to contain the epidemic.”

Already, there is talk that post Covid-19, certain practices should be reviewed due to their predisposition to spread infections. Masupu agrees. In that bracket he mentions the tendency to shake hands throughout the day, without having to wash the hands frequently. He would also like to see a conversation around being crowded in various buildings and amenities such as public transport.

“But as medical professionals we are not dictators of what society should do,” he adds. “Society will decide its own practices and culture.  After this experience, some will revert to the old ways, while others may want to draw lessons.”

So when will we go back to our normal lives – so that interviews can be conducted face to face once again, and retired epidemiologists can go back to tend their farms?

“It all depends on when we arrive at time that evidence tells us that we have brought the virus under control,” he answers. “The time frame will be dictated by what unfolds, particularly at this phase.”

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