R. D. Congo: this is how a hospital is prepared in front of COVID-19 with the luxury of having drinking water

Monkole Hospital is preparing to deal with the coronavirus pandemic. It is the reference centre of half a million inhabitants. It has 100 beds, six respirators (“in hospitals in the city centre there are three or four,” says Candelas Varela, director of her nursing school), and water

Candelas Varela, director of the ISSI nursing school, linked to the hospital in Monkole (Democratic Republic of the Congo), doubts whether to attribute to logic or desire her opinion that «if the coronavirus has not already reached this area, it will not arrive». Most of the 98 cases of COVID-19 in the country (with eight deceased) are concentrated in La Gombe, the wealthy area of the capital, about 25 kilometres from this medical centre.

«These are cases that came from Europe or the United States (it is people who travel abroad)» or from people around them who got infected. «They are controlling them and their contacts a lot, and it is not spreading» too much. « They are people who do not usually move around these other areas. They are also better nourished, have access to medical care, larger homes, can telecommute...». Although the official data is not entirely reliable (there is only an accredited entity to do the tests), «if there had been contacts, people would be dying in the neighbourhoods, and at the moment there is no news of large pockets of deaths» unexplained, says the director of ISSI.

Yes, some positives are worrisome in the troublesome provinces of Ituri and South Kivu, to the east. These regions are marked by a long conflict that has intensified in recent months, in addition to poverty, the exploitation of their natural resources and an Ebola outbreak that has killed 2,200 people. Fortunately, after the discharge of the last patient, on the 3^rd of March, there have been no new cases and if the trend continues until the 14^th of April, the end of the epidemic will be declared.

Intermittent confinement

This has left the scientist who has managed the crisis, Jean-Jacques Muyembe, available to continue with the same work, now facing the coronavirus. «He did it well and people have confidence in him». The Spanish nurse values the government's performance quite positively: «Ten days after the first confirmed case, the borders closed. I think it was the best measure».

In addition, the capital has been internally isolated from the rest of the country and a sui generis confinement has been decreed: for three weeks, four days of isolation and two without it. «Here, people live to the day –explains Varela–. They can't shut their stall three weeks in a row». At the same time, the number of people in the means of transport has been limited: only 16 people will be allowed to go in a van (the legal maximum, although they usually carry up to 20) and four in a taxi.

The measures are probably not as broad as in Europe. «In the inner neighbourhoods, where the little streets are made of dirt, people will keep going out», says Varela. «The houses are so minimal that it is impossible to stay locked up. I imagine they will put the military and police as to when there are revolts».

Another effort of the Muyembe team is to use all possible means of communication to spread official information and fight against hoaxes, false news and superstitions. Also, in Africa, they run like wildfire and sometimes have fatal consequences. As in the case of a woman from a rural neighbourhood who «last week killed her three children with a purge that was supposed to protect them from the coronavirus».

Six respirators for half a million inhabitants

While the nursing school has closed, the Monkole hospital prepares to deal with the pandemic if it arrives. It is the reference centre for COVID in three areas, with a population of half a million inhabitants. It has 100 beds, six respirators («there are three or four in downtown hospitals»), drinking water (a luxury that should not be taken for granted in the country's medical centres, not even in the capital) and clean fame.

They had their first scare a few days ago, when an Italian volunteer from a nearby orphanage started showing symptoms. After struggling a lot to be tested for the coronavirus, they were initially informed by mistake that he had tested positive. Although he later denied himself, «panic came. We quarantined the 300 children» and to the hospital, says the Spanish nurse. All a dress rehearsal for what can come in the next days or weeks.

If in the end the pandemic strikes her area, Varela fears the lack of supplies. «We have asked for protection material because we are not prepared. We have, but not excessive reserves. Now buying is impossible», so he hopes it will be enough with what has accumulated for Ebola. In any case, it has not yet reached them. They have promoted hygiene measures, and a different circuit has been established to care for these patients. With the information that comes to them, for example, from Spain, «we are also working on making masks with plastics and robes with garbage bags, stocking up on these things and also a lot of bleach».

The consequences of fear

Another concern of the utility is that people stop going to the hospital. «There will be people with COVID symptoms who do not come for fear of stigma or to be quarantined», to them and their entire neighbourhood. «Since there are no means of protection, they leave you up to 48 hours practically alone. In fact, after one of the first patients died, it spread through social networks that more than this disease he had died by abandonment», as he was hypertensive and diabetic and these previous illnesses were not treated while he was isolated.

«We are also preparing ourselves, says Varela, to complicate other diseases, such as malaria», as those who suffer from them do not go to the medical centre. «Seeing what happens in Europe, people are panicking».