Fieldset
A day in the MSF COVID response in Homa Bay, Kenya

What is it like to be part of a COVID-19 team in an area where people are already struggling to access treatment and support for HIV, tuberculosis and non-communicable diseases? Dr Sayontonee Ghosh looks back…

Drip. Drip. Drip. The leaking roof of the tent becomes a steady deluge of water as the storm outside becomes the storm inside.

Only yesterday it was thirty degrees with 80% humidity. Now the storm, stronger than anyone predicted, has everyone racing to move the patients into the three other tents that form our COVID-19 treatment unit.

Most of the patients are on oxygen, all are unwell.

Homa Bay

Homa Bay is a sleepy town on Victoria Lake, which is the main source of livelihood for many of the town’s residents.

Peter is wearing a face mask connected to two oxygen concentrators. Like many COVID patients, he has developed a blood clot in his lungs … the worry is that he will need more oxygen

At the point when the Omicron wave hit in December, only 6% of the county were fully vaccinated. MSF was already supporting the hospital here, and I’m part of a new team that has stepped in with COVID support.

Team effort

Under the rain, the COVID activity manager, in full personal protective equipment (PPE), jogs past pushing an oxygen concentrator attached to a patient, who is in a bed being pushed by two nurses.

Meanwhile, the cleaners arm themselves with mops and buckets; the logistics team work frantically to patch the tent; and more nurses hurriedly move vital records and equipment.

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Wet floors in the tent after the storm
Staff worked fast to get everything to dry spot

Ward rounds

By the time all the patients are moved, our clothes are rained through and our shoes are squelching. It’s time for our ward round.

The HIV prevalence rate is 19.6% in Homa Bay County, the highest in Kenya, and we also see relatively high rates of tuberculosis alongside. There’s also an increasing prevalence of conditions such as hypertension, diabetes, heart disease and stroke.

This combination of infectious diseases and unmanaged chronic health problems, alongside low rates of COVID-19 vaccination means that in the COVID unit we see some very unwell patients, whose care is challenging to manage. We have a proportion of patients who have minimal respiratory symptoms, but their positive COVID tests mean they are admitted to our ward for treatment for their other health issues, which would otherwise be delayed while they are infectious.

Peter*

There’s Peter, an older man, admitted with breathlessness.

He is HIV-positive, with blood tests showing good adherence to his medications and lower risk for opportunistic infections.

Peter is wearing a face mask connected to two oxygen concentrators. Like many COVID patients, he has developed a blood clot in his lungs, which alongside a couple of decades of smoking is putting even further stress on his respiratory reserves.

The worry is that he will need more oxygen – which would require a special mask and machine called CPAP (continuous positive airway pressure) or intubation. However, the closest hospital which can offer this treatment is two hours away, and Peter and his family would have to find the money for both the transfer and the hospital bills there.

Despite his condition, Peter is unfailingly polite to everyone throughout his stay on the ward.

[Peter requires a four-week admission with slow weaning off oxygen. One month after going home, he returns for follow-up. Seeing him walk in, smiling, remains one of the highlights of my time in Homa Bay.]

Millicent*

Millicent came to hospital with a headache and has tested positive for both COVID-19 and HIV.

Her blood tests suggest she may have been diagnosed with HIV previously but taken medication for this only intermittently. The virus is not suppressed, so she is at risk for opportunistic infections.  

Her tests are suggestive of cryptococcal meningitis – a serious fungal infection of the brain. She declines the lumbar puncture which would help to rule out other similarly presenting diseases. She is started on treatment for both cryptococcal and bacterial meningitis.

Millicent is a younger woman who runs a small business. As we talk, I think about how we must look to her, alien-like, with our eyes, noses and mouths shielded, and covered in white plastic.

[Millicent does not improve over the proceeding days and has worsening confusion. She has a cardiac arrest, and although the team attempt resuscitation, she sadly dies.]

Mary*

Mary is a very young woman who is admitted to the COVID ward from the out-patients department. She has high blood sugars. Mary explains that she was diagnosed with diabetes several years ago and has been injecting herself with insulin for a year.

Mary does not require oxygen for her COVID, but her blood test tells us that her diabetes is uncontrolled. If it is left so, it will lead to renal failure, eye and nerve damage, plus increased risk of heart attacks and strokes.

After years of managing her condition alone, without regular medical support, Mary does not believe it is possible to achieve control of her disease.

Over the course of the week, we adjust her insulin and explain that it must be kept relatively cool to be effective. Mary and her mum plan to start storing it in a neighbour’s fridge when they get home. We try to encourage them both in their efforts to manage the disease.

[Mary returns to the post-discharge clinic and impresses herself and the staff with her blood sugar numbers, which are much better, though still with some room for improvement. She will be followed up for six months before transferring to ongoing care closer to her village.]

Warm tea

In total we see eighteen patients in the tents. There are another ten critically unwell patients in the Covid-HDU. Most are yet to be vaccinated. Not all have respiratory symptoms, but for all, the COVID diagnosis impacts their care by delaying their access to diagnostics and treatments.

As the rain continues, we doff our PPE, and the nursing activities manager organises for some warm tea. It has been a long day.

Tomorrow, the sun will shine and we will round with sweaty foreheads and fogged up glasses, but, for today, we are done.

[This COVID surge, Kenya’s fifth, lasted approximately five weeks. At the end of January, we were able to take down the tents. At the time of writing, in early April, the vaccination rate in the county is around 12%. The sixth wave is modelled to begin soon.]

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Tent being taken down
COVID-19 tents being taken down

*Names and identifying details have been changed

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Read more: Stories from Homa Bay

Fighting HIV in Kenya: Tales from Homa Bay

Kenya: Disasters and triumphs at the HIV clinic