When the ambulance driver reached the top of the hill, Simbota, too weak to move, was left on a stretcher at the main entrance of the red brick building. The minutes went on, with her bare chest stretching and then cratering as she struggled to breathe through a blue surgical mask. His stretcher parked in a quiet corner away from pedestrian traffic and staff gathered at the front desk.
After more than an hour in the scorching heat of lunch, Simbota’s family arrived at the entrance in a small hatchback. Four of them tried to pull him off the stretcher and pull him back. His wife tied his head, covering her feverish body with a green and black blanket.
A second dramatic wave of Covid-19 in Malawi, fueled by the new variant first discovered in the vicinity of South Africa, has flooded much of its health infrastructure, leaving many families to make agonizing choices and exposed the danger of some deep inequalities in Covid-19. vaccine distribution.
“We used to do regular tours of district hospitals. It was a way for us to ensure quality care across the country,” says Dr. Tamara Phiri, a specialist in treating patients with Covid-19 at Queen Elizabeth Central Hospital in Blantyre. large hospital in southern Malawi.
But, like many of Phiri’s other responsibilities, his district visits ended when Covid-19 hit Blantyre seriously, and his home hospital’s Covid-19 hospitalizations soared close to capacity.
Malawi – and the Queen’s Hospital – seemed to be spared the worst during the first wave of Covid-19 – a fact many, including Phiri attributed to its young and mostly rural population. But not during this wave.
According to official government data, the number of confirmed cases of Covid-19 in a single day was almost seven times higher right at the peak of this second wave compared to the first.
In the first three weeks of January, the number of severe patients with Covid-19 at Queen’s Hospital increased from 12 to 107 cases, says Doctors Without Borders (MSF).
Every day, Phiri goes through a white tent, located in the hospital courtyard, on her way to the Covid-19 ward – where she disinfects the bodies of patients she could not save. “This is one of the most traumatic things. We see people dying all the time, but not like that. Not at this rate, not so many people who felt good just a week or two ago. It can get pretty brutal.” she says. .
“Your emotions are very dim – you don’t know when to be the doctor who lost patients and when to be a family member who lost people – you’re in pain,” she says. “And then, when you become a Malawian who is worried about the whole country, because the country is literally bleeding?”
Healthcare workers have been particularly affected. Before the pandemic, the poor country of South Africa could only manage its healthcare. Now, doctors and nurses are appealing to the sick and many have died from the virus.
Phiri points to the offices of his senior medical colleagues who are now ill: “The one sitting next to him, the one after that, the one after that.”
In conclusion, of the eight specialists working in the converted Covid-19 wards of her hospital, only three are left to care for more than 80 Covid-19 positive patients.
Vaccines are needed now
But specialists such as Phiri and health workers in Malawi and the rest of the continent are likely to gain access to vaccines only long after they are available to healthy and young people in the US and Europe.
Malawi’s national vaccination plan depends on COVAX, the institution supported by the World Health Organization organized to help poor countries access Covid-19 vaccines. His government promised last week that the first batch of the AstraZeneca vaccine would arrive by the end of February. But health workers are preparing for a much longer wait, skeptical that they will be delivered anywhere near that program because of regulatory bureaucracy, and worried about a Sunday announcement by South African scientists that the vaccine offers “a minimum protection ”against the variant discovered there.
“It’s brutal, but it’s the reality,” says Phiri. She says it reminds her of the fight against HIV / AIDS, where life-saving antiretroviral drugs were available in the United States to fight the virus years before they became available in countries like Malawi – one of the worst affected countries in the country. pandemic.
In the fight against coronavirus, rich countries with only 16% of the world’s population have already reserved about 60% of the available vaccine supply, according to ongoing monitoring by Duke University researchers.
Under current programs, it could take years to get enough vaccines in Malawi to inoculate the general population and stop the waves of infection. MSF says immediate goal should be to get 40,000 doses, enough to vaccinate all overworked front-line health workers
“The vaccine problem now is more a matter of time than a matter of quantity,” said Marion Pechayre, head of MSF in Malawi, whose team uses every space available outside Queen’s Hospital to build sorting tents and counseling areas for possible patients with Covid-19 for these future waves of the virus.
The medical charity is trying to buy directly from pharmaceutical companies to donate to front-line medical workers. Otherwise, they say, the health care system could collapse. So far, pharmaceutical companies have only negotiated directly with governments.
“If we vaccinate and prioritize front-line medical staff fast enough, the health care system will not be as severely affected as it is not. It seems unfair and unreasonable not to,” says Pechayre.
Too scared to seek help
Coronavirus has also had an impact on health in Malawi, indirectly, by frightening people to seek treatment for other problems. Many fear that they will not receive care from overworked staff or, worse, that they will catch Covid-19 during their visit.
After completing her Covid-19 rounds for the day, Phiri heads to one of the hospital’s general wards to prepare a final student for her final internal medicine exam. He carefully examines the only patient in a row of empty cribs, reporting back to Phiri.
The general ward has more than sixty beds and is usually full of cases of malaria and patients with chronic problems, but is now largely empty. People are too scared to come to the hospital, says Phiri. “It’s a disaster waiting to happen.”
Many will die at home
Far from Queens Hospital and on the outskirts of Malawi’s healthcare, smaller district hospitals and clinics face the same pressures, only increased.
At the immaculate Thyolo Hospital in the south of Blantyre, Dr. Arnold Jumbe shows off his small Covid-19 isolation hospital, where several patients – including a clinician – are recovering from the virus.
Vaccinators will support the hospital’s minimal resources and dispel some of the myths circulating on social media and in the local press, says Jumbe.
“As health workers, we are ready to get the vaccine. We were ready to get the vaccine just yesterday. Yes, because we have to be safe,” he says.
Vaccinating health workers would be the first step in supporting a flawed health system – and, crucially, restoring Malawian confidence in their hospitals. But until then, families do not know where to turn.
After Simbota’s family left Mulanje District Hospital, they hurried to find care they felt they could trust.
The family could not afford the mission hospital in the city. The district clinic in the next village does not treat patients with Covid-19 – so they sent the family back to Mulanje.
On Sunday morning, the approach to Simbota’s modest brick house was blocked with branches and leaves scattered on the red dirt road. It was a symbol, prepared by his neighbors.
A man was riding a bicycle. “Andrew Simbota died last night,” he said.