On 5th August 2023, Ministry of Health with support from World Health Organization deployed the first ever national 12-member Emergency Medical Team (EMT) to Chikwawa District. This team was trained in two sessions held in April and June 2023 as part of preparedness for public health emergencies. A time, cholera cases were on the rise and spreading vastly with increased deaths across the country’s districts.
The deployment was in response to a need. The district is one of the hotspot areas which continued to report cholera cases and deaths despite the overall control of the outbreak in other parts of the country. It is a district prone to natural disasters, droughts, floods and most recently the Cyclone Freddy. Chikwawa borders with Mozambique, and experiences high cross border cases therefore contributing a significant number of cholera hotspots. The aim of the deployment was to improve case management, to help mentor the in-house teams in Chikwawa and offer case area targeted interventions with different strategies, following up each patient in the Cholera Treatment Units (CTU) to where they came from and performing all activities in purpose of controlling the transmission. The CTUs that continuously recorded cases were Chipwaira, Ngabu and St Montfort Health Centers.
Limbani Mapata is a Medical Doctor at Queen Elizabeth Central Hospital in the Emergency Department. He is one of the members of the Emergency Medical Team and was part of the deployment mission to Chikwawa. He shares his experience.
“We went to all three CTU’s. Ngabu, Chipwaira and St Montfort. It was hectic, we had to create rosters. The team was very committed and dedicated and within the 3 weeks of deployment there was no death reported and the length of our stay was remarkedly reduced. Even the communities surrounding the three facilities appreciated the impact we made in reducing the numbers of cholera deaths. The traditional leaders were also supportive and appreciated the impact of our interventions”.
However, concerning and pressing to note was the issue of cross border cases. We saw over 30-45 cases within a very short period. Interventions had to be put in place by the health education and communications team who provided behavioral change messaging. Surveillance and coordination teams worked closely with communities and officials to manage cases, tracking them into Mozambique. The Water and Sanitation, Hygiene (WASH) pillar ensured the distribution of essential WASH resources such as chlorine.
The challenges encountered were, how to reach to hard-to-reach areas which are mostly across the Shire River basin. There were also difficulties in how to properly make one percent stock solution. It took the involvement of chiefs not only those around the 100-meter radius but inclusively bringing everyone and holding meetings ensuring that interventions reached those in need. After this intervention, oral cholera vaccine was given to these very same communities providing a holistic and multi-sectoral intervention which significantly dropped the number of cases and eased the burden on the health system.
Nsanje is another Cholera hotspot district. Chauncy Banda is a Principal Nursing and Midwifery Officer there. She is also a member of the EMT. She says the EMT improved the knowledge of staff in the CTU’s due to the mentorship sessions. It also improved coordination with facility management which facilitated quality patient care through fostered teamwork.
“The different expertise in management of medical emergencies closed a gap which improved the quality-of-care patients received, also documentation and improved use of guidelines. It is one of the success stories in the cholera outbreak as it drastically reduced fatality rate as the intervention came at a time, they had critical patients. The sustainability of such practice will ably offer quality care post the cholera crisis” she adds.
Thomson Makalani is a Nurse Midwife at Chikwawa Hospital. He recollects the memories of the cholera crisis in Chikwawa before the deployment of the EMT.
“The impact of the Cyclone Freddy left road networks cut off hence movement of vehicles was difficult. Some of the health facilities were damaged and there were no designated places for cases to be managed. This escalated the cholera situation for Chikwawa. Patients were being sent back to their homes. Some were dying in their homes. Only those that could afford to travel long distances through impassable roads would make it to the main hospitals. We also had many patients coming in from Mozambique and others presenting with other conditions, hence requiring special care. We were overwhelmed. The same staff that had to deal with cholera cases had to cater for day-to-day management of general cases. The EMT eased this burden. They worked with us 24 hours nonstop while our staff had time to rest. They also transferred skills on how to manage cases with underlying special conditions like diabetes and high blood pressure.
Boniface Grim, Assistant Environmental Officer at Chikwawa District Hospital, highlights the key role played by the Emergency Medical Team. This team, deployed by the Ministry of Health with support from the WHO, worked closely with communities and officials to manage cases, track them into Mozambique through surveillance, provided behavior change messages, and distributed essential WASH resources. He alludes the comprehensive approach had a profound impact on the situation.
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