My experience and success story as a Kenyan FELTP resident
I am pleased to share my experience and success story as a Kenyan FELTP resident .Having to sit in a field epidemiology class for close to two months in 2019, struggling to get a good grasp, understanding and master concepts on outbreak investigation , public health surveillance, laboratory methods in epidemiology and principles of epidemiology as FELTP resident seemed a bit hard and was looking for an opportunity to apply or see the concept being done practically . little did I know that COVID 19 was in the pot cooking and was only a matter of time to get served. In December 2019 health care workers saw an increase in respiratory infections of unknown cause in china and as usual nothing much was done. In 31st December 2019 Wuhan Municipal Health Commission, China, reported a cluster of cases of pneumonia in Wuhan, Hubei Province. A novel coronavirus was eventually identified. This was new and since this was in China miles and miles away from us, I was not bothered as there was no evidence of human to human transmission. little did I know that we are living in a global village and this was a disease of international concern. The World Health Organization declared the outbreak a Public Health Emergency of International Concern on 30 January and I was still cat walking and not bothered after all I didn’t even have a passport. At this time cases were increasing; deaths being recorded and especially among health care workers and this caught my attention and started following the updates from china and little reading about the disease. As of February 2020, more than 30 thousand cases of COVID-19 had been reported in more than 30 countries and territories, resulting in more than ten thousands deaths, in 7th march WHO declared it a pandemic and things started to move first.
I was deployed at the (JKIA) Jomo Kenyatta international airport for surveillance from 8th February- 5th march 2020, I was involved in screening of passengers on arrival regardless of where they were coming from. This basically was temperature taking to take note of any signs of fever as this was a key symptom for the disease. any passenger with a fever reading above 37.2 degres was a suspect case and would be isolated and detailed history was taken to find out history of travel and other COVID 19 symptoms or contacts with a confirmed case. After the passenger had a little time of rest temperature taking would be repeated and if the readings were below 37.2 degrees, they would be released but if the fever was relenting the pot health authorities would be informed for further management and referral to Kenyatta national hospital. During this period, I was the surveillance officer at Terminal IA which is a high-risk desk as it dealt with arrivals from Ebola and Coronavirus infected countries which called for a lot of precaution on infection prevention and data management. Out of the 7 suspected cases identified during this time non was confirmed for COVID-19
On 12th march the first COVID -19 case was reported in Kenya and having learnt from the other countries that were reporting cases the ministry of health was fast at initiating prevention and control measures , I landed in the national rapid and response team from 23rd march 2020 where I responded to alerts as team lead with surveillance/Epidemiologist capacity in a team of two others. The alerts were flagged out by the call centre team, at first we were responding to cases all over the country but mainly in Nairobi county and we would go as a team consisting 3 persons 1 serving as an epidemiologist or surveillance officer, another one as a clinician and a laboratory officer, after taking history if the person met the suspected case definition ( having fever, cough and difficulty in breathing and having travelled from a country reporting cases the previous two weeks prior to symptoms onset) oral pharyngeal and nasal pharyngeal swabs would be taken and sent to the national influenza centre for testing . I responded to 17 alerts and 4 were confirmed for COVID -19. As at March 30th, 2020 the number of suspected cases who had been tested was 1,005 out of which 50 (males=32, females=18) were confirmed to have COVID-19 in Kenya. They were distributed as follows: Nairobi, (37) Kilifi (6), Mombasa (4), Kajiado (1), Kwale (1) and Kitui (1).
From 31st march -16th march I participated in an outbreak investigation in Kilifi county as a FELTP resident cohort 16 as the disease was being reported in other counties. We went to support in setting up an incident command system supporting in rapid response, contact tracing and assessment of the counties preparedness in with dealing with the COVID 19 disease. We managed to put together the list, conducted on job training in contact tracing, filling of the case investigation forms and reporting with the updated national tools, responded to alerts from the county call centre and by the time we were leaving the county there was no additional case the number was still at 6.
From May 2020 I participated in targeted mass testing in Eastleigh area, Kawangware, Dandora and Embakasi. This involves taking oral pharyngeal and nasal pharyngeal swabs, packaging and transporting of samples to the lab for testing. I also took the role of filling the case investigation forms and the data management part.
From 27th may -3rd June I participated in community event-based surveillance in Siaya county which included training of community health managers and the community health volunteers on use of event-based surveillance for early warning and response. Emphasizes was put in reporting of signals which would indicate events that precedes disease out breaks and in regard to COVID -19 three signals were added which would enable community detection and reporting of coronavirus cases.
Some of the challenges encountered include:
- Insufficient personal protective equipment’s - During the very first days in the point of entry we were supposed to use a surgical mask for a week, this was a challenge as we didn’t know how to store it when going home We were working with our home clothes and we feared transmitting infections to our family members. I had to buy masks for myself to avoid re use
- Lack of supplies - Disinfectants and sanitizers were erratic which called for one to dig into the pockets to purchase.