When the driver of the ambulance 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 by, with her bare chest unfolding and then cratering as she struggled to breathe through a blue surgical mask. His bunk was parked in a quiet corner, away from pedestrian traffic and staff members gathered near the front desk.
After more than an hour in the midday heat, Simbota’s family approached the entrance with a small hatchback. Four of them struggled to get him off the stretcher and squeeze him in the back. His wife shook her head, covering her feverish body with a green and black blanket.
A dramatic second wave of Covid-19 in Malawi, driven by the new variant first discovered in neighboring South Africa, has flooded much of its health infrastructure, leaving many families to make agonizing decisions and exposing the danger of deep inequalities in Covid-19. vaccine distribution.
“I used to do regular rounds at district hospitals. It was a way to ensure quality care across the country,” says Dr. Tamara Phiri, a covid-19 patient specialist at Queen Elizabeth Central Hospital in Blantyre. United States. largest hospital in southern Malawi.
But, like many of Phiri’s other responsibilities, his visits to the district ended when Covid-19 seriously attacked Blantyre and Covid-19 admissions from his home hospital hovered around capacity.
Malawi – and the Queen’s Hospital – appeared to have been spared the worst during the first wave of Covid-19, a fact that many, including Phiri attributed to its young and mostly rural population. But not during this wave.
According to official government data, the record of confirmed cases of Covid-19 in a single day was almost seven times higher than the maximum of this second wave compared to the first.
In the first three weeks of January, the number of severe Covid-19 patients at Queen’s Hospital increased from 12 to 107 cases, according to Doctors Without Borders (MSF).
Every day, Phiri passes a white tent located in the hospital courtyard on the way to the Covid-19 ward, where they disinfect the bodies of patients she could not save. “That’s one of the most traumatic things. We see people die all the time, but not like that. Not at this rate, not so many people who were fine just a week or two ago. It can get pretty brutal,” he said. he says. .
“Your emotions are very blurry (you don’t know when you want to be the doctor who has lost patients and when to be the family member who has lost people) you are devastated,” he says. “And then, when you become a Malawian who is worried about the whole country, why is the country literally bleeding?”
Health workers have been especially affected. Before the pandemic, the impoverished country of southern Africa could only manage its health care. Now doctors and nurses are crying sick and several have died from the virus.
Phiri points to the offices of fellow doctors who are now ill: “The one next to you, the one behind, the one behind.”
All in all, of the eight specialists working in the converted wards of their Covid-19 hospital, only three remain to care for more than 80 Covid-19 positive patients.
Vaccines are needed now
But specialists like Phiri and front-line health workers in Malawi and the rest of the continent are likely to only get access to vaccines long after they have been made available to healthy, young people in the US and Europe.
Malawi’s national vaccination plan depends on COVAX, the facility supported by the World Health Organization organized to help poor countries access Covid-19 vaccines. His government promised last week that the first shipment of the AstraZeneca vaccine would arrive in late February. But health workers are preparing for a much longer wait, skeptical that it will be delivered anywhere near this time due to regulatory bureaucracy, and worried about a Sunday announcement by South African scientists that shows the vaccine provides “minimal protection” against the variant discovered there.
“It’s brutal, but it’s the reality,” Phiri says. He says he remembers the fight against HIV / AIDS, where there were life-saving antiretroviral drugs in the United States to fight the virus years before they were available in countries like Malawi, one of the countries most affected by the 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 continued monitoring by Duke University researchers.
Under current schedules, 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 front-line health workers in the country
“The problem with vaccines right now is more a matter of time than quantity,” says Marion Pechayre, head of MSF in Malawi, whose team uses all the space available outside Queen’s Hospital to build selection stores and consulting areas for potential Covid-19 patients for this and future waves of the virus.
The medical charity is trying to buy directly from pharmaceutical companies to give to top-notch 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 quickly enough, the health care system will not be as affected as it is otherwise. It seems unfair and unreasonable not to do so,” Pechayre says.
Too much to seek help
The coronavirus has also indirectly affected health in Malawi as it scares people to seek treatment for other problems. Many worry that they will not receive attention from overworked staff or, worse, that they will catch Covid-19 during their visit.
After finishing her Covid-19 rounds of the day, Phiri heads to one of the hospital’s general wards, to prepare a senior for her final internal medicine exam. He carefully examines the only patient in a row of empty cribs, informing Phiri again.
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, Phiri says. “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 District Hospital south of Blantyre, Dr. Arnold Jumbe shows off his small Covid-19 isolation room where several patients, including a clinician, are recovering from the virus.
Vaccine doctors will bolster the hospital’s minimum resources and dispel some of the myths about it circulating on social media and the local press, Jumbe says.
“As health workers, we are ready to get the vaccine. We were willing until yesterday to get the vaccine. Yes, because we have to be safe,” he says.
Vaccinating health workers would be the first step in underpinning a deficient health system and, fundamentally, in restoring the confidence of Malawians in their hospitals. But until then, families do not know where to turn.
After Simbota’s family left the hospital in Mulanje district, they hurried to seek his attention that he believed he could trust.
The family could not afford the mission hospital in the city. The following village district clinic does not treat Covid-19 patients, so they referred the family to Mulanje.
On Sunday morning, the approach to Simbota’s modest brick house was blocked with branches and leaves scattered along the red dirt road. It was a symbol, prepared by its neighbors.
He passed a man on a bicycle. “Andrew Simbota died last night,” he said.