Surgeries take back seat as Coronavirus rages

In March last year when COVID-19 was first detected in Kenya, the country’s 47 governors rushed to set up isolation centres in their respective counties.
The centres were to be equipped to deal with the rising numbers of patients who had contracted the disease.

Several months later, hospitals were jammed with COVID-19 patients, forcing governors to redeploy healthcare workers to concentrate on battling the pandemic.

This move led to stalling of some critical medical procedures and services such as surgery, leaving those in need in pain after Intensive Care Units (ICU) were dedicated to deal with serious COVID-19 patients.

For healthcare workers in most public hospitals, it was a delicate balancing act, as they dealt with the pandemic while trying not to ignore other critical medical procedures that patients needed.

At the Coast General Teaching and Referral Hospital (CGTRH) – the largest hospital in the Coast region, which serves Kwale, Kilifi, Taita Taveta, Tana River, Lamu and Mombasa counties – surgeons were forced to come up with alternative plans to help prevent their patients from succumbing to their ailments.

“I had to take care of my patients. Because there were no surgeries; it meant taking care of their medical condition through medicines just to keep them going,” said Dr Peter Sore, a cardiac and thoracic surgeon who heads the heart clinic at CGTRH.

Dr Sore said surgeons at the hospital were forced to come up with initiatives to manage patients suffering from chronic illnesses.
The specialist had planned to operate his critically ill patients only to shelve their surgeries due to COVID-19 and instead focused on relieving their pain.

“It was sad watching our helpless patients die; we could not do anything since theatres had been turned into COVID-19 facilities,” On March 22 this year, the doctor was heartbroken when the much awaited resumption of open heart surgery at CGTRH was cancelled.

“Everything was set for resumption of the open heart surgery. We were collaborating with our specialist colleagues from Kenyatta National Hospital who were to travel to Mombasa for the operations, but could not after President Uhuru Kenyatta announced lockdown in five counties with high infection rates including Nairobi. That was a major setback,” said Dr Sore.

At his clinic in the facility, he used to attend to 25 patients but nowadays only 10 patients turn up. “Surgeries are crucial for patients’ survival,” said Dr Sore.

CGTRH has six main operational theatres. However, shortage of ICU staff has been another major challenge.

“Some of the staff who were manning the ICU for surgical patients were redeployed to take care of those battling the virus. It was sad that surgeries could not be performed because

ICUs were converted to COVID-19 facilities to take care of those battling the virus,” added the senior doctor.

The specialist is among doctors who have been conducting surgeries on COVID-19 patients with surgical issues.

Dr Sore said he was distressed when some of his patients succumbed at home due to the pandemic.

“My patients were afraid of the hospital, saying they could contract COVID-19, but their conditions, which needed surgeries, worsened day by day. I knew things were really bad when one of my patients who needed an endoscopy succumbed because we could not do the crucial surgery to save his life,” said the medic with over 30 years’ experience.

To ascertain the extent of COVID-19 impact on healthcare, Dr Sore advised the government to conduct research to show how the disease has affected Kenyans.

“COVID-19 has affected surgery practice, slowing down our work and leaving our patients in agony. We have new procedures; before conducting any surgery, you have to do a COVID-19 test,” he said.

Dr Hemed Twahir, an official of the Mombasa County COVID-19 Response Committee, said the pandemic has brought to the fore critical health issues that should be addressed.

“The most important lesson I have learnt is why we must enhance and strengthen primary healthcare. A lot of what is happening could have been handled better and a lot of positives that have been witnessed is because we have managed to strengthen primary healthcare,” said Dr Twahir.

The medical director at the Aga Khan Hospital in Mombasa lauded the government for incorporating community health workers who have enhanced contact tracing and hygiene in communities.

“The basic primary healthcare unit is very crucial. In the future, we should learn that treating a problem is more expensive than prevention. I have learnt that you cannot deal with a pandemic on your own,” Dr Twahir added.

The pediatrician said the world managed to control Spanish flu in 1918 better than it has done with coronavirus.

“Because there wasn’t as much traveling as currently. If we put ourselves together globally, we can come up with appropriate good outcomes. Within a year of coronavirus vaccine, we have had malaria vaccine coming up, that is a very big lesson,” he said.

Due to the pandemic, Dr Twahir said most hospitals have now strengthened their health systems, especially for critical healthcare.

“For a long time a lot of health institutions all over the country were lacking critical care, essential things like oxygen and ICU. But COVID-19 has taught us that we need to be prepared in taking care of critical care patients, counties have now gotten ready,” said the pediatrician.

Mombasa Governor Hassan Joho resolved to improve accessibility to quality and dignified affordable healthcare with heavy investment in medical infrastructure, equipment and human capital.

“We are strengthening the local healthcare systems, enhancing training and capacity building of our medical staff while also increasing awareness of respiratory complications in the community,” he said.