When the ambulance driver stopped at the top of the slope, Simbota, too weak to move, was left on a stretcher at the main entrance to the red-brick building. The minutes passed, his bare chest expanding and then cratering as he breathed hard through a blue surgical mask. His stretcher parked in a quiet corner, away from the pedestrian and staff traffic that met near the reception.
After more than an hour in the scorching midday heat, Simbota’s family stopped at the entrance in a small hatchback. Four of them struggled to get him off the stretcher and squeeze him in the back. His wife cradled his head, covering his feverish body with a green and black blanket.
A second dramatic wave of Covid-19 in Malawi, fueled by the new variant first discovered in neighboring South Africa, flooded much of its health infrastructure, leaving many families to make agonizing choices and exposed the danger of deep inequalities in Covid- 19 vaccine distribution.
“I used to do regular rounds at district hospitals. It was a way of ensuring quality of care across the country,” says Dr. Tamara Phiri, a specialist in treating Covid-19 patients at Queen Elizabeth Central Hospital in Blantyre, the largest southern Malawi hospital.
But, like many of Phiri’s other responsibilities, his district visits ended when Covid-19 attacked Blantyre hard and Covid-19’s hospitalizations at his home hospital hovered close to capacity.
Malawi – and Queen’s hospital – seemed 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 at the peak of this second wave compared to the first.
In the first three weeks of January, the number of critically ill Covid-19 patients at Queen’s hospital jumped from 12 to 107 cases, says Doctors Without Borders (MSF).
Every day, Phiri passes through a white tent set up in the hospital courtyard en route to Covid-19 wing – it is where they disinfect the bodies of patients she was unable to save. “This is one of the most traumatic things. We see people dying all the time, but not like that. Not at this rate, not so many people who were just fine a week or two ago. .
“Your emotions are very confused – you don’t know when to be the doctor who lost patients and when to be the family member who lost people – you’re in mourning,” she says. “So, when you become a Malawian who cares about the whole country, why is the country literally bleeding?”
Health workers were hit particularly hard. Before the pandemic, the impoverished southern African country could only manage its health care. Now doctors and nurses are calling to say they are sick and several have died of the virus.
Phiri indicates the offices of other veterans who are now sick: “What is sitting next door, what comes next, what comes next”.
In all, of the eight specialists who work in the converted wards of Covid-19 in his hospital, only three are left to care for more than 80 patients positive for Covid-19.
Vaccines needed now
But experts like Phiri and frontline health professionals in Malawi and across the rest of the continent are unlikely to have access to vaccines until long after they become available to young, healthy 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 have access to Covid-19 vaccines. His government promised last week that the first shipment of the AstraZeneca vaccine will arrive by the end of February. But health workers are preparing for a much longer wait, skeptical that it will be delivered anywhere near that schedule because of regulatory bureaucracy, and concerned about an announcement on Sunday by South African scientists showing that the vaccine provides “minimal protection” against the variant discovered there. .
“It is brutal, but it is the reality,” says Phiri. She says it reminds her of the fight against HIV / AIDS, where life-saving antiretroviral drugs were available in the United States to fight the virus years before they became available in countries like Malawi – one of the most affected countries in that pandemic country.
In the fight against coronavirus, rich countries with only 16% of the world population have already reserved about 60% of the available vaccine supply, according to the continuous monitoring of researchers at Duke University.
On current schedules, it may take years to get enough vaccines for Malawi to inoculate the general population and stop the waves of infection. MSF says the immediate goal should be to get 40,000 doses, enough to vaccinate all overworked health workers on the country’s frontline
“The problem with vaccines is now more a matter of time than quantity,” said Marion Pechayre, MSF chief in Malawi, whose team is using all the space available outside Queen’s hospital to build screening tents and consulting areas for possible Covid-19 patients for this and future virus waves.
The medical charity is trying to buy directly from pharmaceutical companies to donate to medical professionals. Otherwise, they say, the health care system may collapse. So far, pharmaceutical companies have only dealt directly with governments.
“If we vaccinate and prioritize frontline medical personnel quickly enough, the health care system will not be affected as much as if we did not. It seems unfair and irrational not to,” says Pechayre.
Too afraid to seek help
Coronavirus has also impacted health in Malawi indirectly by driving people away from seeking treatment for other problems. Many fear not receiving care from an overworked team or, worse, catching Covid-19 during the visit.
After finishing his Covid-19 rounds of the day, Phiri goes to one of the hospital’s general wards to prepare a senior student for his final internal medicine exam. He carefully examines the only patient in a row of empty beds, reporting to Phiri.
The general ward has more than 60 beds and is usually full of malaria cases and patients with chronic problems, but it is now virtually empty. People are very afraid to come to the hospital, says Phiri. “It is a disaster waiting to happen.”
Many will die at home
Away from the Queens hospital and on the outskirts of health care in Malawi, district hospitals and smaller clinics face the same, but increased, pressures.
At the immaculate district hospital in Thyolo, south of Blantyre, Dr. Arnold Jumbe shows his small isolation wing Covid-19, where several patients – including a clinician – are recovering from the virus.
Vaccination of doctors will reinforce the hospital’s minimum resources and dispel some of the myths that circulate on social media and the local press, says Jumbe.
“As health professionals, we are ready to get the vaccine. We were ready yesterday to get the vaccine. Yes, because we need to be safe ”, he says.
Vaccination of health care professionals would be the first step to shore up a failing health system – and, crucially, to restore Malawians’ confidence in their hospitals. But until then, families don’t know who to turn to.
After Simbota’s family left Mulanje district hospital, they ran to find care they could trust.
The family had no money to pay for the mission hospital in the city. The next village district clinic does not treat Covid-19 patients – so they referred the family back to Mulanje.
On Sunday morning, access to Simbota’s modest brick house was blocked with branches and leaves scattered across the red dirt road. It was a symbol, prepared by its neighbors.
A man passed a bicycle. “Andrew Simbota died last night,” he said.