Here in South Sudan, despite all the preventive measures taken by the government to lock in the population and shut out the virus, expectations are bleak.
Many people here are malnourished and / or living with other conditions such as HIV and tuberculosis. That will make them more vulnerable if exposed to the virus. And, although the country is fortunately not densely populated, people do tend to live close together. That can mean in camps, but even outside of camp settings, in rural areas whole families tend to live together in traditional earthern structures where ventilation is extremely limited.
The luxury of handwashing
Despite the ban on social gatherings, there are still crowds in markets, soccer fields, funerals and churches here. People with symptoms like fever and cough are not likely to stay at home as these are also symptoms of malaria, which is endemic here and which isn't contagious.
Much worse is the fact that many people have hardly any drinking water at their disposal, let alone water to wash their hands several times a day
And, to make matters worse, washing hands, the most important protective measure, that should be available to every person, is not an obvious luxury for the people here.
Infection prevention training
It took dust, sweat, more dust and flat tires to help train all of our health workers and educators. Their job will be to spread the how and what of preventive measures in the local communities here.
Their enthusiastic participation is promising and makes being on the training team really rewarding. At the same time, the concerns and questions they come up with make me sad.
Large parts of the population have no soap available, so the health workers and educators suggested giving instructions on how to wash your hands with water and ashes. Not ideal, but certainly a pragmatic and realistic alternative.
One jerry can
Much worse is the fact that many people have hardly any drinking water at their disposal, let alone water to wash their hands several times a day.
They have to walk for hours, queuing with jerry cans, often in the blazing sun without shade. When it is finally their turn, the water pressure is often so low that it takes hours to fill a jerry can. Imagine yourself as a ten-year-old, with the burden of a filled jerry can on your head or shoulders, on the miles of dusty and shadowless road home, to your thirsty family.
There won't be a lot of water left after everyone has had a drink, your mother has finished washing, has started cooking and you have washed yourself. Which of those should you sacrifice in order to be able to wash your hands?
We are preparing ourselves mentally and practically for the storm that is now inevitably coming
How must it sound when I ask health professionals to explain to people that regular hand-washing will protect them from coronavirus and other infectious diseases?
Just a few days after the training sessions with the team, several people in South Sudan test positive for COVID-19. We are preparing ourselves mentally and practically for the storm that is now inevitably coming.
We do not know on what scale this outbreak will take place, or whether the plans we are making will make sense once the first potentially infected individuals reach our clinics.
We do not know for how long we will receive new supplies and for how long we will be allowed to fly in new staff members or transfer patients to hospitals in different parts of the country.
We only know that this is what we signed up for.
After all, MSF provides emergency medical care. Maybe this is not the emergency we expected. Perhaps it is not what we came to South Sudan for, and it is not the crisis we were prepared for.
But, now we're here, and we need to make the most of it together.