The old African secret in the fight against the Covid-19 pandemic

A KimboCare enthusiast in front of a Covid-19 testing center in West Africa

Despite the resurgence of Covid-19 cases across the continent, Africa has experienced some resilience against the virus and its known variants.

Noted health and socio-political experts have been discussing the possible reasoning behind this trend. Does the country’s resilience relate to the younger median age of the population, is it the warmer climate, or is it an age-old secret that has been hidden by Africans for many millennia?

20 Days, 5 Cities, and 13 Covid Tests

For the last month, I have been fortunate enough to travel between Europe and three African countries while visiting stakeholders, on behalf of KimboCare. As you might imagine, the journey between these regions presented different Covid-19 restrictions and processes.

On a quest for better access to quality care, I visited five different cities: Geneva, Abidjan, Yaoundé, Nairobi, and Paris. In only 20 days, I have been tested a total of 13 times, with each region and situation using either method, the PCR test or the quick test, also referred to as the antigen test. My nose is still on fire, so I can say with confidence that the virus is being taken seriously in those countries, for many reasons.

Let me share with you some insights from my travels, as I am sure it will give you faith in what’s happening around during these unprecedented times. Many changes are happening behind the scenes, and I hope to bring them to light and continue our efforts to help through KimboCare.

Patient Healthcare Ownership

At KimboCare.com, we invest our time into putting our feet to the ground to travel the roads and meet real patients internationally. The new-age of technology offered in 2020, has without a doubt, helped us shape a solution to the Covid-19 pandemic. However, there is still something to be said about seeing patients virtually, versus meeting them in-person to discuss their ailments. Nothing is quite as beneficial to understanding a patient’s woes, then engaging in deep conversation about their aches and pains.

Engaging directly with our patients has made us pioneers once again, bringing back strong values in healthcare and its delivery, for everyone. Gone are the days where we absent-mindedly take medication on a presumed threat to our health. Today, more than ever, patients are demanding to be more informed about their health and the choices being made concerning it. They want to know “why, how, and what” is being done in “plain French”, in that order, there is no way around it.

KimboCare’s medical partners in Cameroon adopted strict sanitary measures early on, but we fell short getting our patients caught up. Many locals believed that it wasn’t an issue for them to address and was more a Western concern. With the Governments, NGOs, and Private Sectors all doing their part with a variety of imposed restrictions to fight this pandemic, it has come time for patients to take responsibility also. Each individual needs to take ownership of their health, do their research, and come to an understanding of what’s good for them, and how they can stay healthy.

Patient ownership is a key factor to be accounted for when assessing the Covid-19 Vaccination campaign, and its success across the African Continent. We will continue to elaborate on this in more detail in future articles, as it is a broad topic on its own.

Clinique GT - Labo in Cameroon. KimboCare Quality label

Self-Discipline To Get Through

As I traveled, I continued to wonder why everyone wore masks outdoors, why hand-sanitizing gels and temperature checks were at every entrance, and why at 9 pm, everyone was rushing home to meet the mandated curfew. It was very clear to me that the Kenyan Government was taking this seriously, with stringent disciplinary actions put in order.

In response, many residents began to show ownership of their health, understanding that there is a need to take proactive action personally. I was very impressed with a taxi driver I met in Hurlingham Nairobi, named Victor. He had this to say;

 “You know, my brotha. This Covid stuff has almost shut down our economy. My activity relies a lot on tourism, and the pandemic drastically decreased the number of tourists hence my prospective customers. So, I quickly realized that if I want to raise my family, this pandemic has to stop sooner than later. So, I am following the rules, my brotha”.

After a week in Nairobi, I realized this way of thinking was not an isolated case, but rather a shared pragmatic-based discipline among many.

As I ventured on into more peri-urban areas, the philosophy of patients taking ownership of their health continued to be evident. Upon visiting a very well-known private hospital, I noticed their vaccination campaign against Yellow Fever. The effort is quite well structured, with every Village Chief taking charge to ensure their community is actively participating. I’ve noticed this community approach to be effective in bringing awareness and accountability to residents, teaching them to make their health a priority. This approach has proven not only to be efficient at fighting the current issues at hand but has the potential to have a greater impact.

Digitalization: The New Mantra

1 doctor for every 10,000 residents, with 90% percent of the population paying medical services out of their empty pockets. Those numbers seem familiar, right? You don’t need to be an expert mathematician to understand that not all Westernized measures are adaptable to the African continent.

The Ivorian government understood this challenge early on and created a digital strategy to streamline testing. Their online platform is a one-stop-shop service that’s available to any traveler to and from the Ivory Coast. The platform allows users to register quickly, provides locations of local test centers, and clearly explains the process for retrieving results. Once results are available, the digital platform allows users to share them abroad with the use of a QR Code on their mobile device. This strategy not only saves a lot of administrative work, freeing up medical professionals and resources, but it also is a great tool in collecting relevant data at a national level.

Overall, the user experience with this particular platform was good. Despite some initial technical errors around payment options, residents who used the services felt their health was being taken seriously.

It has become clear throughout my travels that digitalization is a common trend in tackling urgent healthcare needs in many regions. However, it seems there is still work to be done to bridge the gaps in healthcare for Africans. For this continent to have a sustainable, relevant strategy they need to understand the commonalities between in-person care, and digitalization- optimizing resource allocation and the power of an educated community.

Still, wondering what the age-old secret is that Africans have inherited from their ancestors? Certainly, you will find it is an innovative combination of educating residents on the ownership of their health, along with a disciplined, technology-driven mindset.

Geneva

Abidjan Yaoundé Nairobi

Paris

Population size

<500K >5000K >3000K >5000K >2000K

Covid 19 related death cases - country wide

>9K <0.2K <0.6K <0.2K

> 85K

Mandatory Wearing Mask in the street

Not mandatory, but wearing a mask? Yes, but not widely followed Yes, but not widely followed Yes, widely followed

Yes, widely followed

Systematic testing at airport arrivals

No No Yes Yes

No

Curfew in place No No No Yes (10 pm)

Yes (6 pm)

Insights of key measures as of February 28th, 2021


Challenges of preventive health adoption in Africa

Access to health care in developing countries remains an issue of concern. In the aftermath of independence, several African countries, following a socialist logic, decided to promote free access to public services, particularly health services. However, the economic recession in the 1970s and 1980s led international institutions and governments to review their system of free health care provision. It is in this context that the 1987 Bamako initiative was born, aimed at liberalizing the African health system by giving patients full responsibility for covering their health costs. For the poorest households, this measure contributed to further accentuating their financial poverty. As a result of this initiative, between 5 and 30 percent of people still did not have access to healthcare in West Africa. How can this situation be explained? 

As far back as I can remember, I didn't like hospitals when I was younger. I remember one time I had a toothache and I had to go to a dentist. In the meantime, I had to pay the cable bill so I could watch a show I loved back then. I decided to ask my father for the cable money first. The next day, as my pain continued to grow, I asked my dad for money to go to the hospital. He was offended that I had chosen my hobby over my health, especially since it would be a few more days before he could have some money again.

This little anecdote highlights two elements: the prioritization of needs and the financial vulnerability of families. How do these two factors influence the choice of individuals to use health services?

Precarious financial situation

One of the first challenges of preventive health remains the financial situation of populations. In 2015, the rate of extreme poverty in sub-Saharan Africa, i.e. the proportion of people living on less than $1 a day, was ~40%, according to the United Nations. Indeed, this precarious financial situation plays a determining role in the access to health care for the populations of the region. The scarce financial resources held by these households must be used to cover critical consumption expenses such as health, but also food, housing, clothing, transportation, drinking water, electricity, and many others. It is therefore essential for households to prioritize their needs and expenditures according to the urgency of the situation, leading to a range of responses to health problems.

Neglect of early symptoms

Then, neglecting the first symptoms also represents a hindrance to preventive health. Indeed, the frequent choice to ignore the first symptoms, in case of illness, is very common in most African countries. The disease is considered as a temporary pain that will fade with time, rest, or even oblivion (Inshallah!). This situation can last several days or even months without adequate treatment. "What doesn't kill us makes us stronger," some would say.

Less controlled medication or medicine

When the pain finally begins to be persistent and burning, many people still choose to put as little money as possible into it, ignoring a medical visit with trained specialists and turning to self-medication. As a result, most households resort to drugs sold on the street. This solution allows them to relieve their pain, is less expensive, and is easily accessible to everyone. However, the quality and storage conditions of these drugs are not always controlled and they are marketed without formal information on dosage or side effects. As a result, the medication prescribed can have a serious impact on the patient's general health by aggravating rather than curing their pain.

Finally, the use of traditional medicine is also a barrier to access to health services. Nearly 80% of African households use traditional medicine, especially in rural areas. This can be explained by the scarcity of hospitals or trained medical personnel and the precarious financial situation of the people concerned. So what is traditional medicine? In general, it is a session animated by rites and prayers, at the end of which the traditional doctor, often called "marabout" or "charlatan", prescribes decoctions to the patient. Here too, the lack of dosage and rigorous quality control can become obstacles to the patient's full recovery.

In the end, it is clear that access to health care depends on the financial situation of the population. The use of health services only takes place when the situation becomes serious or even critical. This is explained by the fact that populations are very poorly educated about the consequences of continued neglect of a failing health condition or live in very limited financial conditions. The poorest households are forced to prioritize their needs, sometimes relegating health to the background. It is therefore important to sensitize communities on the need to have regular consultations with an authorized doctor, in order to avoid serious cases of illness, which will, in turn, generate even more expenses for these vulnerable households. This is why KimboCare is now on the journey to offer these populations a solution adapted to their needs and financial situation.