Managing Covid a year on: stigma, skills and solidarity

Last week we caught up with Dr Edilu Robert in Uganda after he obtained the certificate of completion from PCI’s COVID-19 e-learning course. A year after the first Ugandan presidential address on COVID-19, Robert shared feedback on the training module, as well as discussing the broader impact of the pandemic on the community where he lives and works – in particular around stigma and morale.

Robert was the first certified ‘NCD champion’ from our multi-country project with UNHCR. He’s now both studying and volunteering in a hospital in a town in up-country Gulu District in northern Uganda and has obtained the certificate of completion from PCI’s COVID-19 e-learning course: a series of online training modules for clinicians working in resource-poor settings, which covers a range of topics from screening and triage, clinic operations, health workforce planning through to continuity of essential services including mental health.

Impact of COVID-19 on the community and on healthcare

“My country started lockdown restrictions in March last year. Since then, there have been over 40,000 official cases with 334 deaths. But as a primary care provider, we can’t be confident that these are the only cases or rule out silent community transmission given challenges such as contact tracing, surveillance mechanisms, stock-outs of testing kits or even effectiveness of quarantine systems (both self and institutional) for the contacts and cases under home based management or even motivation allowances for the frontline health workers.

Vaccination commenced across the country earlier this month to some key groups such as health workers and the security. We don’t know when it will reach the broader community but there are concerns around acceptability since the masses have limited information concerning safety and side effects on current vaccines.

The scars of the lock-down restrictions are still fresh in the population; many were rendered jobless, and died of other conditions such as malaria, non-communicable diseases, and many others; it definitely stretched primary health care due to additional responsibilities. When people in my district heard there was a COVID-19 patients at the facility they stopped seeking care, even though it is the only facility in the whole district.

Also though Ministry of Health provided trainings on COVID-19 at various levels of care, this did not reach all the primary care providers whom at the peak of the pandemic with community transmission had to join the frontline by default or became cases. This was particularly detrimental yet primary care givers form the largest workforce and pivot of health service delivery in the country. That is why I found the PCI COVID-19 online training so useful, and as always helped me in patient care at the Covid treatment unit.

Support for mental health

I definitely found the mental health section one of the most important and necessary. As primary care practitioners we have faced huge challenges around both morale and stigma.

Healthcare workers are overwhelmed and that poses a lot of psycho-social challenges, for example a colleague of mine got Covid and she faced a lot of stigma and so did some members of the case management team. She considered leaving her job. However with skills from the PCI COVID-19 module on mental health I was able support her and other colleagues. These skills are particularly useful when someone is nearing the end of their life, to help the rest of the family cope both with the news and the safe and dignified burial practices different from the usual burial ceremonies in our communities.

Overall, having the knowledge, skills and confidence I gained from all the training helped build morale too and I became a useful clinician at the CTU.


Accessibility of the learning?

I have shared the modules with other primary care clinicians but the impacts of COVID-19 have meant we are all very over-burdened and have little time for extra courses – even very relevant ones such as this. It was quite a few months after I received the module myself before I found time to complete it all.

And I had some challenges with internet accessibility, similar to that faced by many colleagues in resource limited settings; so being able to download modules and use them offline is really important.

In solidarity with all health workers

Overall I would say it was really important and useful to have training targeted specifically at primary care workers like us in resource-limited settings. We have challenges local to our settings however to be able to serve the community best we just need the knowledge and the skills. To all the other frontline care workers we cherish your efforts and stand in solidarity with you all.”