Colleagues report from health projects in Northern Iraq, Cambodia and Kyrgyzstan
As the pandemic spreads across countries in the Middle East, Central and South-East Asia, German-supported health projects refocus their activities to help partners rise to this unprecedented challenge. Contributions range from health worker trainings to setting up digital case reporting systems and devising social media campaigns.
At this time of year, the population of Northern Iraq’s autonomous Kurdish region usually celebrates Newroz, a festival of spring and new beginnings. People come together for joint meals, fireworks, dancing, singing, and poetry recitations. They cut spring flowers, show off their new clothes and spend the day with their families in the countryside.
Not this year.
Enabling Kurdish health workers to curb the spread of the virus
The population has been asked to stay at home to slow the spread of the novel coronavirus. Schools, universities, restaurants and shopping malls are closed and the local government and health services are gearing up for their COVID-19 response. In Dohuk Governorate, the health component of the German-supported CONNEX project supports these efforts. Commissioned by the German Federal Ministry for Economic Cooperation and Development (BMZ) and implemented by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), this project was originally set up in 2016 to help the Governorate expand its water, education and health systems to meet the needs of over 370,000 internally displaced people and 83,000 Syrians who fled here from ISIS’ terror regime.
Most of the internally displaced and Syrian refugees still live in Dohuk’s large camps and more refugees from Syria continue to arrive every day. ‘Comprehensive risk communication and prevention measures to slow down the spread of the virus are highly relevant for everyone – the Kurdish and the camp populations, as well as the health workers who serve them,’ says Dr Gunnar Strote, head of the CONNEX health component. This is why the project entered into cooperation with the Italian non-governmental organisation AISPO, which specialises in strengthening health services in regions affected by conflicts. AISPO has already trained 239 Kurdish doctors and nurses in COVID-19 prevention and management. Whether these measures will suffice to prevent hospitals being overwhelmed by COVID-19 cases remains to be seen. ‘Practising social distancing in a refugee camp is a challenge,’ says Strote. He is glad that the AISPO experts know what daily life in the region looks like and what it will take to muster a comprehensive COVID-19 response. He points out: ‘They tackle this task with a professional serenity that I find admirable.’
Strengthening Cambodia’s testing capacities
‘When I visited the Institut Pasteur here in Phnom Penh in late January, the novel coronavirus was something affecting a faraway region of China,’ says Dr Bernd Appelt, head of the Cambodian-German Social Health Protection Project, implemented by GIZ on behalf of BMZ. ‘Hardly anyone in Cambodia talked about it, except for Dr Laurence Baril, the Institute’s director’ who, according to Appelt, foresaw what soon turned into a pandemic of unprecedented proportions. She invited his project to support the institute’s laboratory testing and research capacities as a crucial element of Cambodia’s epidemic preparedness. As soon as BMZ made additional funds for partner countries’ COVID-19 responses available, Appelt and his project started supporting the Pasteur Institute. As Cambodia’s national reference laboratory, it is now testing individuals with COVID-19 symptoms and contributing to research supporting the development of tests, treatments and vaccines.
Fighting fake news with facts in Cambodia’s social media
There is another area for which the project has offered its support: ‘In Cambodia, many people use Facebook to inform themselves and to share all kinds of news with their social networks,’ says Appelt. Kelvin Hui, an experienced IT expert in Appelt’s team, joined up with the national WHO office to develop a social media information campaign for Cambodia’s Ministry of Health. ‘There is a lot of faulty information and hysteria being spread on social media,’ says Hui. He believes that this could be changed if popular local social media influencers spread correct messages about COVID-19 prevention. They could also inform people where to turn with COVID-19-related questions and concerns. Together with WHO and staff from the ministry, the project has started to identify partners and to develop messages that take account of the population’s fears and susceptibility to rumors.
Working 24/7 in hospitals and labs in southern Kyrgyzstan
‘All health workers are now working at their limits,’ says Dr Sardarbek Karimov, head of the patient-centered care component of the project Promotion of Perinatal Health in Kyrgyzstan which GIZ implements on behalf of BMZ. ‘It is hard, but such difficulties unite people. The doctors who work on the frontlines trust in our support. Now the whole focus is on COVID-19.’
Some of the first Kyrgyz cases were detected in Osh, the country’s most densely populated area and one in which multiple generations typically live together under one roof. The project has helped coordinate the Osh region’s response, from the development of guidelines and the setting up of mobile COVID-19 response teams to the provision of protective masks, gloves and gowns for hospital staff.
‘In the laboratory in Osh, 15 virologists have more or less locked themselves in to run tests for the virus 24/7,’ explains Valerie Broch Alvarez, head of the perinatal health project. ‘We sent food for them and for the hospital staff,’ she says, because many of those working in regional hospital and laboratory no longer stay with their families in order to minimise the risk of infecting them. ‘There is a huge responsibility on our partners’ shoulders now,’ says Karimov, ‘and they are looking for our – the international partners’ – support’. The project initiated close coordination between development partners and local non-governmental organisations, and this has worked very well.
Supporting a digital case reporting system for Kyrgyzstan
‘When the outbreak started, there was no uniform way in which health facilities could digitally report new COVID-19 cases,’ explains Dr Jyldyz Turgunbaeva, head of the project’s quality management component. Together with IT experts of the Kyrgyzy eHealth centre and the National Mandatory Health Insurance Fund, the project therefore developed such a reporting system, and this has rapidly been adopted by health facilities nationwide. For the time being the National Mandatory Health Insurance Fund provides the necessary server space for the COVID-19 case database. In parallel, the project supports the development of an independent digital health management and information system to which this database will eventually be transferred.
Protecting pregnant women before, during and after deliveries
As trusted advisors on neonatal and maternal health, the project has also helped to adapt WHO’s guidelines for protecting pregnant women, mothers and newborns against infection with the novel coronavirus before, during and after their deliveries. All pregnant women are now screened for COVID-19 symptoms and possible contacts with COVID-19 cases before they enter health facilities. The aim is to separate potentially exposed or infected patients from those who have not been in touch with the virus.
Things have definitely begun to move
The advisors in all three countries are fully aware of the seriousness of the situation, and of the fact that the hardest part is yet to come. They are impressed by the discipline of those working in their partners’ health systems and by the population’s readiness to comply with the rules concerning hygiene and social distancing. ‘During the terror regime of the Khmer Rouge, becoming socially invisible was the best survival strategy for people in Cambodia,’ says Appelt. ‘In times of crisis, Cambodians still respond with withdrawal and social distancing – which, in times of coronavirus, actually helps.’ According to Karimov, ‘this crisis brings out into the open how we can improve our healthcare system and our work with other sectors. In both areas things have definitely begun to move.’
Anna von Roenne, April 2020