Social distancing may be the recommendation, but social solidarity must be the path forward

HAI, Coronavirus, & Social Solidarity

Over the coming months, this page will be updated with information on the COVID-19 pandemic in the countries where we work. We hope to not only bring attention to the impact of COVID-19 on the people of Mozambique, Timor-Leste, and Côte d’Ivoire, but also to highlight the adaptation and resilience of health workers and resource-limited health systems in the face of this global pandemic.

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Coronavirus is global

There is no better time to be paying close attention to the impact of inequity on the health of communities around the world. HAI is working closely with our Ministry of Health partners to adjust and build health system resilience in response to the COVID-19 pandemic. 

Data updated: august 4, 2020

TIMOR-LESTE

First Confirmed Case[1]: March 21
Confirmed Cases[1]: 24
Reported Deaths[1]: 0

Population[1]: 1.3 million (2020 est)
Pop. below poverty line[2]: 41.8% (2014)
Doctors per 100,000[3]: 72.24 (2018)
Nurse/Midwives per 100,000[3]: 166.8 (2018)
Ventilators: 93*
ICU Beds: 6

MOZAMBIQUE

First Confirmed Case[1]: March 22
Confirmed Cases[1]: 2,029
Reported Deaths[1]15

Population[1]: 31 million (2020 est)
Pop. below poverty line[2]: 46.1% (2015)
Doctors per 100,000[3]: 8.38 (2018)
Nurse/Midwives per 100,000[3]: 68.47 (2018)
Ventilators [NHS]: 150
ICU Beds [NHS]: 409

CÔTE D'IVOIRE

First Confirmed Case[1]: March 11
Confirmed Cases[1]: 16,293
Reported Deaths[1]: 103

Population[1]: 26.2 million (2020 est)
Pop. below poverty line[2]: 46.3% (2015)
Doctors per 100,000[3]: 23.14 (2014)
Nurse/Midwives per 100,000[3]: 60.48 (2018)
Ventilators: Data Not Available
ICU Beds: Data Not Available

COVID-19 NEWS

TIMOR-LESTE
  • On June 26th, the nationwide state of emergency was suspended (see below).  On July 2, the land border between Indonesia and Timor-Leste opened on a once per week basis for two hours, allowing Timorese nationals and foreigners to enter. All new arrivals are immediately placed in government quarantine centres at the border or in Dili.  It is also possible to request permission to quarantine in your own home.
  • President Guterres, with unanimous support of parliament, declared a 30-day state of emergency on March 28th, which was renewed for an additional 30 days on April 27th by a vote of 37-23 in parliament. This included suspension of public transport, closing of the land border with Indonesia, heavy restrictions on incoming travel, restrictions on gatherings of more than 5 people (enforced by police and soldiers) including churches and schools, and requirements on mask use and social distancing in public. The State of Emergency formally ended on June 26th.
  • The Prime Minister appointed former health minister & prime minister Dr. Rui Aráujo as spokesperson for the TL Government’s Integrated Crisis Management Center (ICMC).  Dr Rui is one of four individuals authorized by the PM to speak on behalf of the government’s COVID-19 response.
  • The ICMC posted daily updates on # of suspected, confirmed, and negative cases, as well as # of people currently under mandatory or voluntary quarantine by district.  You can find the most recent data HERE. Since the end of the State of Emergency and with no active COVID-19 cases since mid-May, the ICMC has been formally disbanded.
  • Timor-Leste appointed a new Minister of Health in June 2020. This was the first time there has been a Minister of Health in Timor-Leste since 2018.
  • On April 25th, the Ministry of Health launched a free instant messaging service, via WhatsApp, with information about COVID-19.  The ‘COVID19 Helpline Chatbot’ was developed by Catalpa International, with whom HAI designed and implemented Timor-Leste’s first mHealth program: Liga Inan.
  • On April 28th, a donation of medical supplies and equipment from the Chinese Government arrived in Timor-Leste.  Supplies included 42,000 masks, 40,000 KN95 masks, 4400 protective suits, visors and shoe covers, 5000 medical cloves, 80 thermometers, and 90 portable ventilators. This brought the total number of ventilators available for use in Timor-Leste from 3 to 93.
  • Many organizations, UN agencies, and embassies have continued to donate supplies to PPE.
  • In early May, Timor-Leste began reporting coronavirus test results independently. Previously, the Timorese government relied on verification at an Australian-based lab.  ‘Sentinel surveillance’ for COVID-19, along with scaled up community testing, also expanded outside of the capital city, Dili, in May.
  • No new cases have been reported in Timor-Leste since April 25th and the last positive COVID case was fully recovered by mid-May.
  • The Ministry of Health continues to do COVID testing; however, a positive result has yet to be deteccted.
  • The World Food Program is hosting flights from Kuala Lumpur to Dili once per week, allowing a means for people returning from other parts of the world apart from Australia. Air North continues to fly from Darwin to Dili once per week on a Wednesday.
MOZAMBIQUE
  • On April 1st, President Nyusi announced a state of emergency; however, changes to the original decree and “confusion” over commercial establishment closures and ability to restrict internal migration, led to a 48 hour delay in release of official regulations.
  • The Ministry of Health set four levels of restrictions and the current state of emergency is set at Level 3, which includes restrictions on gatherings of more than 10 people and increased caution on determining work attendance.  Level 4 would include shelter-in-place restrictions and a ban on public activity.  The MOH has a daily bulletin that includes level of restrictions that you can find HERE.
  • A mandatory 14-day quarantine at home has been mandated for anyone who arrived in Mozambique in the past two weeks or has come into direct contact with a person who is confirmed to have Covid-19. People who enter the country give a mobile telephone number as part of their entry form, and the Justice Minister has confirmed that this will be used to locate people, so that local officials can check they are following the quarantine.
  • The Ministry of Health approved a Strategy for Community Response to COVID-19 which includes: 1) COVID-19 risk communication; 2) COVID-19 prevention interventions; 3) COVID-19 Surveillance and contact tracing at community level; and 4) continuity of key essential community health services including maternal and child health, immunization and nutrition services.

We have not reached the lockdown phase, but we only want people to travel if strictly necessary. So we are limiting but not banning travel.”

– Helena Mateus Kida, Minister of Justice, Government of Mozambique

CÔTE D'IVOIRE
  • On March 23rd, President Ouattara imposed a nationwide 9am to 5pm curfew, closed all restaurants, and implemented an “unauthorized travel ban” between the nation’s commercial capital, Abidjan, and the rest of the country.
  • The CI Ministry of Health announced the identification of 5 testing sites, 6 treatment sites, 1 quarantine site, and an official sample analysis lab (all in and around Abidjan). The Ministry is also leading surveillance and contact-tracing activities.
  • Following the airing of a widely denounced French radio program on which two doctors advocated for COVID-19 vaccine testing in Africa, Côte d’Ivoire’s Ministry of Health formally denied any such vaccine trial.  Nevertheless, the program has increased mistrust of general vaccination campaigns and led to demonstrations and attacks on one COVID-19 testing center as well as on routine medical supply deliveries.
A

HAI RESPONSE

TIMOR-LESTE
  • Active member of MOH COVID-19 Response Team on Pillar 2 – Risk Communication and Community Engagement and Pillar 9 – Essential Health Services.
  • Added COVID-19 messages to the Liga Inan mHealth Program which connects pregnant and recent mothers to their government midwives via mobile phones.  The additional messages include best practices on respiratory hygiene, social distancing, pregnancy & postpartum care under COVID-19, and how to contact care providers with questions/concerns using the Liga Hau (call me) function.
  • Follow-up calls with mothers to assess understanding of COVID-19 messaging through the Liga Inan system
  • Logistical support to MOH through the provision of four vehicles with drivers tasked to do community engagement and transport health providers and meals to quarantine centers.
  • Co-creation with MOH of COVID-19 brochure targeted at pregnant women, new mothers, and their families.
  • Printing of promotional COVID-19 materials at request of MOH.
  • Use of HAI-TL facebook page to share information on COVID-19 in Tetum with the community
  • Established HAI-TL workplace contingency plan and adjusting HAI project activities to limit potential exposure among vulnerable populations and follow national guidelines on assembly.
  • Implemented COVID-19 awareness program with Mother Support Groups in three municipalities in Timor-Leste
  • HAI Clinical Team participated in training on COVID-19 PPE, triage and infection control with WHO; COVID-19 practical simulations and skills stations with the Australian NGO Saint John of God Health Care; and COVID-19 antenatal care with the United Nations Population Fund (UNFPA).

MOZAMBIQUE
 

  • Active member of MOH COVID-19 Task Force on Coordination & Planning.
  • Supporting the elaboration of a workforce contingency plan for Mozambique’s provincial health systems in Sofala and Manica Provinces.
  • Participation in provincial-level planning and coordination meetings with the Manica and Sofala Provincial health authorities.
  • Established HAI-MZ workplace contingency plan and adjusting HAI project activities to limit potential exposure among vulnerable populations and follow National guidelines on assembly.
  • Transport support to Sofala Provincial Health System to conduct contact tracing at the district-level.

CÔTE D'IVOIRE
  • Rolling out updated guidance on HIV testing, care and treatment under COVID-19, including extending ART prescriptions from 30 to a minimum of 90 days so people living with HIV (PLHIV) can remain adherent to stay-home recommendations and life-extending medical regimens.
  • Identifying, and establishing supply chains to stock, reference centers within 30 minutes from the homes of PLHIV to minimize travel and exposure for this immuno-comprimised population.
  • Coaching health care workers on enhanced use of PPE and best-practices for patient care during COVID-19 pandemic.
  • Providing education and coaching to community counselors on COVID-19, updated care guidelines, and best-practices for patient follow-up, including coaching on PPE use.
  • Established HAI-CI workplace contingency plan and adjusting HAI project activities to limit potential exposure among vulnerable populations and follow National guidelines on assembly.

Coronavirus is PERSONAL

No matter who you are, or where you live, your life and community have already been disrupted by COVID-19.  Unfortunately, we also know that the most vulnerable among us are often hit hardest. See how individuals, communities, and institutions are responding, below.

Seeking Safe Motherhood in Seattle

Culturally congruent, decolonized, community-led responses to COVID-19 are critically important and potentially life-saving.

In Seattle, Somali team members of the Mama Amaan Project are delivering care on the frontlines of the Somali community in South Seattle as essential workers, while also serving as community-based researchers.

Safe & Prepared

Timor-Leste’s National Institute of Health (INS) isn’t letting the country’s 7-week streak without a new COVID-19 case stop it from keeping Timorese health workers safe and prepared.  The article seen here, published in the Timor Post, highlights a COVID-19 training conducted jointly by INS and HAI in Timor-Leste’s Manatutu municipality in June.

For photos and additional info on the content of the training,
click the button below

Two Months Later

During a state of emergency, a lot can change quickly. Best laid plans can get upended, delayed, or canceled.

João Luís Manuel, MPH, Director of the Beira Operations Research Center in Mozambique discusses how the center has adjusted plans in the last two months, and the added capacity that would have been available in Sofala Province, had COVID hit Mozambique two months later than it did.

A Very Real Hypothetical

Nearly half a million people living with HIV in Côte d’Ivoire are facing a very real, and difficult decision: How to stay adherent to life-extending ART, while avoiding coronavirus exposure and co-infection?

Dr. Yacouba Doumbia, Senior Technical Advisor in HAI’s Côte d’Ivoire office, talks through the problems facing this at-risk population and steps that HAI and our partners are taking to prevent a “one or the other” solution.

“Generally in the context of emergencies, there has been a lot of effort to attend to biological aspects [of health] to the detriment of psychosocial aspects. This is reinforced by the great stigma from the community in general and from the people who should make decisions in order to have support for greater mental health intervention.”

– DR. VASCO CUMBE, Director of Psychiatry, Beira Central Hospital
Mental Health Coordinator, health directorate of Sofala PRovince, mozambique

Pregnant & (NOT) Alone

In Timor-Leste, HAI is working with the MOH to create informational materials for pregnant and breastfeeding women with answers to questions like: Should I breastfeed if I’m having symptoms of COVID-19?  Can I transmit coronavirus to my unborn child?  Should I still attend my prenatal care visit?

COVID-19 Social Engagement & Community Mobilization in Timor-Leste
“I love that the main public health message for prevention of COVID-19 is ‘wash your hands’ – this is such a manageable behaviour. Washing your hands prevents so many other illnesses as well, and with diarrhoea such a problem in Timor-Leste, especially for children, if the handwashing behaviour can stick, we may see a drop in preventable illnesses such as these.”

-Xylia Ingham, Timor-Leste Country Director, HAI

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