Fieldset
COVID-19: Finding my focus for the pandemic

As COVID-19 spreads across the globe, a message reaches Kirsti, a US midwife working in Cameroon, that all citizens much return home. In this deeply personal blog, she shares her concerns about leaving, and how the community will prepare for the impact of the pandemic.

I cried when I saw the email last week:

“US citizens should arrange for immediate return to the United States unless they are prepared to remain abroad for an indefinite period of time.”  

But I can’t get home. The borders are closed. No flights coming in, means no flights going out. It is the end of my mission and I am stranded in Cameroon.

Connecting with the chaos

It feels so surreal because nothing in Mamfe is different. The team talks about the possibility and the plan for an outbreak, but day to day things are normal.

I connect with the chaos at home and read the news headlines. I wonder what at of this will look like in a few days or a few weeks. I wonder where I will physically be then. 

I still go to the hospital, I still see pregnant patients, and occasionally help with an emergency case like a motorbike accident or a gunshot wound. I coo at the newborns and remind the mothers, over and over again, not to give their babies water.  

In the day my mind stays busy, but at night my whole world collapses.

I connect with the chaos at home and read the news headlines. I wonder what at of this will look like in a few days or a few weeks. I wonder where I will physically be then. 

Torn

To be honest, I am torn. I want to go home. I want to be with my friends and family. I want to know that they are safe. I want to know that I can get there.

While, at the same time, I recognize that the virus – if or when it arrives in Mamfe – will be catastrophic for this community.

If I am here, I might be able to help the team by alleviating the workload of maternity care. Because for any COVID-19 patients, there will be little we can do besides isolate them. 

Limited resources

We are poorly equipped to manage what is possibly coming our way. While we do have oxygen concentrators, we only have three. Plus, they require electricity. There is a no city power so we need to rely on generators.

Isolation will likely be the medical ward, which is a stone’s throw from maternity. The medical ward has few private rooms, but most patients will be roomed together based on the severity of their illness.

We can test for the virus (although samples need to be sent away) but the symptoms are vague enough that it’s nearly impossible to know who has pulmonary sepsis from COVID 19 versus those that have it from malaria. This means that those who are infected be alongside those that are severely ill with malaria. Of course, we have a system to isolate suspected COVID-19 patients, but immunosuppressed individuals that might otherwise recover from their illness could be unintentionally infected.

Prevention seems challenging.

Social distancing is difficult in a community that always comes together. The people here are a family, they rely on each other for emotional support as well as survival; buying and selling what they need day to day.

Hand washing in the community is even more challenging than before because the water tower is empty.  With no city power for the last three weeks, the water was consumed, and the pump was not able to refill the tank. 

Control and focus

I take deep breaths and try to not let my mind run away with me. Remember to focus what is in my control.

I meditate in the mornings to ground myself. I exercise in the evening to relieve some of the stress. I have recently stopped obsessively checking the news, and have an extra glass of beer or wine most nights.  

I watched the lightning storm and let go of trying to control what I cannot

To regain some sense of control, I do what I know how to do. I organize what I can and plan for how to manage in maternity if and when the outbreak arrives. I prepare the ward, and my national staff in case I suddenly leave.

Yesterday, for the first time, all of this felt a little more manageable. I discussed with the hospital director some plans for managing healthy pregnant patients when there are very sick patients – possibly contagious with the COVID virus – just 30 feet away. I focused on teaching the mothers who are being discharged how to wash their hands, singing the “happy birthday” song twice.  

Then, before I knew it, I was called to the delivery room to help deliver a woman pregnant with twins. Girls.  

I have given up trying to change everything here and do what the people do. I covered the newborns in olive oil to remove the vernix that covers their skin after birth. and dressed them like they are going to the North Pole. I wondered how these little lives will unfold in this new reality. 

I was called back to base just before the rain started to pour and the frogs started to croak.

I watched the lightning storm and let go of trying to control what I cannot.

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Read more: Stories about COVID-19

A ‘devil’s choice’: Balancing childhood immunisation with preparing for COVID-19

“I want to help your country’s hospitals”: How COVID-19 should change our view of aid