Rwandan health worker tells about COVID-19 anxiety, stigma

By James Tasamba

KIGALI, Rwanda (AA) - The COVID-19 pandemic has presented a combination of anxiety, stigma, and fear of the unknown to different individuals worldwide. In Rwanda, one person who had to quickly figure out how to go through these challenges was Jean Pierre Muhirwa, one of the Rwandan community health workers.

As a community health worker, his work normally focused on sensitizing people about risk factors of non-communicable diseases among others in his village.

But after the COVID-19 outbreak, he was tasked to mobilize the public to observe measures to prevent the spread of the COVID-19 pandemic such as regular hand washing, wearing facemasks, and physical distancing.

Speaking to Anadolu Agency, Muhirwa, a resident of the Kicukiro district in the Rwandan capital Kigali, said he first got information from officials that he was to work with local leaders to mobilize people to prevent the spread of COVID-19 in mid-March.

It was after the Rwandan Ministry of Health had reported the first case of COVID-19 in the east African country.

The father of five thought this was not a huge task since he had done similar sensitization work before.

- Fear factor with COVID-19 responsibilities

However, fear and anxiety gripped Muhirwa when at the height of the pandemic the Health Ministry adopted home-based care for people diagnosed with the virus.

By October, about 900 COVID-19 patients had been treated through home-based care in Rwanda.

Speaking to journalists in that month, Health Minister Daniel Ngamije described the home-based care approach as effective, and the government looked to it to cut costs of fighting the pandemic.

Through home-based care, expenditures such as accommodation and food costs at quarantine sites are avoided, which are costs incurred on average for a period of 21 days per patient.

To ensure effective home-based care, the Health Ministry laid out clear guidelines for community health workers and health personnel at different health centers who had been trained to regularly follow up those patients.

Rwanda has more than 60,000 community health workers across villages, and they have undertaken similar responsibilities over the years.

Each village has four health workers who have divided their responsibilities: some are in charge of pregnant mothers and child health, others conduct awareness on non-communicable diseases, while one was charged with COVID-19 responsibilities.

Muhirwa, 42, was tasked to monitor closely all COVID-19 patients in his area of operation and give daily reports to the Health Ministry.

This involved visiting the patients on a daily basis, checking for alarming signs.

“It was a terrifying experience following up COVID-19 patients unlike initially when we were informing people on the disease prevention measures,” he said.

“I had to follow up on patients daily to ensure the patient was in isolation and educate their other household members about isolation, telling them to avoid interaction with the patient, among other things,” he said.

His area of operation, the Gatenga area, was at the height of the pandemic, a hot spot in Kigali.

- Difficult job

Muhirwa said he followed up at least five cases in his area.

“We had acquired basic training on COVID-19 symptoms and taking temperatures. But taking care of COVID-19 patients is not an easy task as we were at risk of contamination," he said.

"Though we kept the social distance and observed other health guidelines, I could not be sure enough about my safety.”

The patients eligible for home-based care include those who are asymptomatic, must be below 65 years old -- without other long-lasting health complications -- and must have their own bedroom at home.

The patient must also be able to self-quarantine at home with the Health Ministry set to track his or her movements to avoid leaving home.

“Our tasks include follow up of patients being treated from home and communicate with health center managers who can determine whether the patient’s situation could be getting worse so that they are referred to the coronavirus treatment center. But I personally received no such case and all the patients were cured from their homes," said Muhirwa.

- Related stigma

Besides the fear, Muhirwa said he endured stigma from family members and neighbors.

“I faced stigma from the start when I started going out to sensitize people on health guidelines to prevent the spread of COVID-19. But the stigma worsened when I started following up patients under home-based care as everyone was scared of meeting me,” he said.

“Whenever I arrived home, my wife and children were asking me to first remove clothes and bathe before I could interact with them. Much as that looked normal, it was a kind of stigma. The neighbors were also afraid of coming close to me thinking I could be infected with the virus,” he said.

He, however, said as a community health worker who had volunteered in other activities he was still motivated by the fact that he knew the safeguards.

Recovery of all patients he followed up helped him overcome the stigma, he added.

“I have no problem now and the stigma has ended, my family has no problem with me, we interact normally,” he said.

- Commendable job

To Dr. Menelas Nkeshimana, the head of COVID-19 case management and coordinator of the response activities in western Rwanda, the role of community health workers in COVID-19 fight is commendable.

“Their work is highly commendable. COVID-19 responsibility was an addition to their responsibilities, they do it with dedication and results have been commendable,” Nkeshimana told Anadolu Agency.

“One who was given COVID-19 responsibilities underwent training to build their capacity and confidence. If they found a patient with mild and severe symptoms they referred them.”

Rwanda late Tuesday reported 85 new confirmed cases of coronavirus bringing the total accumulated figure to 6,832 with 6,036 recoveries and 57 related deaths.