RuDASA Statement: COVID-19 in a Rural Setting

RuDASA Statement: COVID-19 in a Rural Setting

The Rural Doctors Association of South Africa has issued a statement through which it promotes four lessons for addressing COVID-19 in a rural South African Context:

4 lessons from the #coronavirus #COVID19:
Lesson 1: public health is political
Lesson 2: science matters
Lesson 3: education of the public matters
Lesson 4: we should always be talking about public health

Problems
– Distances from home to health facility, especially when a person in self-quarantine becomes unwell and needs to visit hospital
– Less-regulated employment practices than in urban settings (more potential abuse of employees viz. job security)
– Baseline economic status of most rural communities is poor, and poor municipal services (water, sanitation)
– Import of infections from urban to rural environments:
• university residences being vacated – mass return to home (many students from rural areas)
• International tourism to many rural areas with contact with local staff
• (Month end & Easter) return home by migrant workers
• Poor penetration of public health messages to the most rural communities

Potential solutions
• Local Co-ordination & Innovation
Identify the key stakeholders in your area that need to be involved in the local discussions & plans e.g. Imbizos and DSD SASSA pay points are “mass meetings”, and set up a local co-ordination group
• Community leadership to designate areas for mass quarantine
• Promote COPC model with healthcare workers being available to for community to consult about rural community’s own solutions to public health goals
• Encourage innovation at community and facility level – leadership to give principles/goals, communities come up with their own solutions to be concordant with public health principles e.g. tech savvy youth could run a Whats App Health campaign
• Come up with local policies around unavoidable events e.g. funerals, taxi travel

Public Health Messages
• District/traditional/health facility leadership to lead by example in embracing disruptive nature of recommendations (selfless approach, cancelling non-urgent travel, hygiene)
• Counter poor penetration of public health message, but unclear mechanism:
• District/traditional/health facility leadership to use DoH COVID-19 infographics. DoH KZN has ones in Zulu and DoH has 1 in Xhosa.
• Home visits by CHWs are an opportunity for education, screening and community-based care (which could limit wider movement of people between households) vs. home visits by CHWs are a potential mechanism of spread
• Target high-risk transmission groups e.g. taxis & food industries and adjust health messages for these groups. The Taxi & Tourism industries are developing guidelines.
• Have clear messages on self-isolation within the home e.g. where possible separate room/ crockery/cutlery/facecloth etc
• Reducing face-to-face Contact
• Consider a local WhatsApp health message group for the community
• Have District DoH meetings via Skype/Hangouts/Zoom
• Multi-month prescriptions to be issued to patients with controlled chronic disease

Economics
• Work with the Department of Labour about this.
• Give clear messages about the time span of the illness to local employers. Most people will have short illness like cold or flu and will return to work quickly.
• Job security while ill: Everyone to take measures seriously, so that those who do self-quarantine for good reason are not singled out/punished by employer (safety in numbers).
• As there is poor employment opportunities the labour pool should be enough for employment of temporary staff while permanent staff are on sick leave.
• Have a list of retired health staff in the area that would be willing to return to work if health facilities have a lot of staff on sick leave.

COVID-19 Clinical Management
National Institute for Communicable Diseases 0800 029 999
• Hospitals are making their own SOPs while waiting for National & Provincial Guidelines
• A number of guides have been posted on the RuDASA Forum & Facebook page. These are listed in the reference section.
• Share SoPs between facilities
• Have a dedicated COVID-19 Whats App group to get information out to all hospital staff & clinic staff quickly
• Establish a screening area/ward
• Sanitising spray in every department and waiting area
• Get good stock supplies
• Liaise with EMRS regarding confirmed cases in transit
• Train gate security on queuing suspected COVID-19 cases
Mental Health
• SADAG Mental Health Line 011 234 4837
• Suicide Crisis Line 0800 567 567
• Suicide support line manned by trained counsellors 0800 21 22 23 (8am to 8pm) 0800 12 13 14, (8pm to 8am) Or SMS 31393
References
Clincial Management (SA & International)
NICD
• Staff training slides: http://www.nicd.ac.za/wp-content/uploads/2020/03/
Corona_Training_Slides_NDOH_20200229_Version6.pdf
• Clincial Management of Suspected or Confirmed COVID-19 disease http://www.nicd.ac.za/wpcontent/uploads/2020/03/
Clinical_management_of_suspected_or_acute_COVID_V1.1_13.03.20_updated.pdf
• Coronavirus disease 2019 (COVID-19) caused by a Novel Coronavirus (SARS-CoV-2) Guidelines
for case-finding, diagnosis, management and public health response in South Africa http://
www.nicd.ac.za/wp-content/uploads/2020/03/NICD_DoH-COVID-19-
Guidelines-10March2020_final.pdf
• Coronavirus disease 2019 (COVID-19) Quick Reference for Health Workers http://www.nicd.ac.za/
wp-content/uploads/2020/03/COVID-19-Quick-reference-v7-10.03.2020-Final-clean.pdf
• Symptom monitoring tool http://www.nicd.ac.za/wp-content/uploads/2020/02/
COVID_19_Symptom_Monitoring_tool_v6_14.02.2020.pdf
• NICD notification of COVID-19 http://www.nicd.ac.za/covid-19-update-17/: Note for Clinicians: In our efforts to expand and streamline testing for COVID-19, we have decided that doctors do not need to contact the NICD for approval as long as they apply the case definition before testing. The NICD will test the submitted samples as long as the required supporting documents accompany the sample (specimen submission form and PUI form) which is available on the NICD website: http://www.nicd.ac.za/diseases-a-z-index/covid-19/
• NICD Notification App: http://www.nicd.ac.za/nmc-overview/ electronic registration via APP
There is more information on the NICD web so keep checking their updates!
South African HIV Clinicians Society
• SAHIVSoc HCW recommendations COVID-19 & HIV https://sahivsoc.org/Files/
HCW%20recommendations%20COVID-19.pdf
DoH Western Cape
• Infection Prevention & Control for suspected & confirmed COVID-19 https://
www.westerncape.gov.za/department-of-health/files/atoms/files/
IPC%20for%20suspected%20and%20confirmed%20SARSCoV-2%20%28cause%20of%20COVID-19%29.19%20February%202020.pdf
• Correct use of N95 Respirators/Masks for COVID-19 https://www.westerncape.gov.za/departmentof-health/files/atoms/files/Use%20of%20N95%20respirators.19%20February%202020.pdf
Disaster Management
Disaster Management for COVID-19: https://www.gov.za/sites/default/files/pictures/publicserviceguidelines-disaster.pdf
Health Education:
DoH Health Messages Whatsapp 0600 123 456
• Facts about Coronavirus in all official languages https://www.gov.za/sites/default/files/pictures/
facts.pdf
• Prevent spread https://www.gov.za/sites/default/files/gcis_documents/PosterPrevent_COVID-19.pdf
• Stigma and use of masks https://www.gov.za/sites/default/files/gcis_documents/infographicsCOVID-19.pdf
• Myths & medicine https://www.gov.za/sites/default/files/pictures/Mythbuster.pdf
• Travel: https://www.gov.za/sites/default/files/pictures/StayHealthyWhileTravelling.pdf
• Food and shops https://www.gov.za/sites/default/files/pictures/FoodSafetyDuringOutbreaks.pdf
• Sports https://www.gov.za/sites/default/files/gcis_documents/SAFA-covid.pdf
• Schools & child care https://www.gov.za/sites/default/files/gcis_documents/childcare.pdf
• Posters: https://sacoronavirus.co.za/category/tool-kits/
International COVID-19 Mapping
• NICD http://www.nicd.ac.za/diseases-a-z-index/covid-19/daily-updates-of-countries/
RuDASA COVID-19 In a Rural Setting 2020 Page 4 of 5
• https://www.worldometers.info/coronavirus and https://www.worldometers.info/coronavirus/

countries

• https://infographics.channelnewsasia.com/covid-19/map.html
Local Mapping & Statistics
• DoH health information, infographics and links to WHO & Global mapping https://www.gov.za/
NovelCoronavirus
WHO
Guidance on 14 topics: from clinical management to refugee camps
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance
WHO Twitter feed
https://twitter.com/hashtag/COVID19?

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