Hi I’m Dr. Devarajan, I’m an obstetrician in Toronto and I also spend a lot of time working in developing countries.
There are many challenges with addressing COVID-19 in a low resource setting.
First of all physical distancing and hand hygiene may not be possible for many people in these countries. Even something as simple as providing hand hygiene stations, with soap and water at the entry to clinics and hospitals can help.
Ensuring a clean water supply in a community can sometimes save more lives than anything else.
When we’re working in a setting where the population isn’t very literate or doesn’t have access to the Internet then we have to be creative about the dissemination of public health information. We might want to do radio ads. Another effective way is to hire local people who can act as health promoters, so they can go into the community and educate the public about for example:
- The symptoms of COVID-19
- When to seek help
- The importance of hand hygiene
- Wearing masks and so on
And they can do this in the local language in a culturally sensitive way.
Many people who live in a low resource setting may also not be able to stay at home because the money that they make in a day is what they use to feed the family that night; there are just no savings. So setting up a food program may ease the burden on families that are economically strained by not being able to work during a pandemic, and it makes it easier for them to observe social distancing measures if they’re not worried about where their next meal is coming from.
Another strategy in an infectious situation is to have tent hospitals where the people who are most contagious can be kept separate from the people in the main wards or clinics. Alternatively tent shelters can be used by essential workers to avoid bringing an infection into their own home, or to shelter people who are most vulnerable and keep them away from people who are at a higher risk of carrying the infection.
Another consideration in a limited resource setting is deciding how to triage patients. So if drugs or other medical equipment are limited then it’s helpful to agree as a team upon the clinical criteria for who to treat so that you make the most of what you have.
This also takes the stress of decision-making off of the individual healthcare provider and allows uniform decision-making no matter which team is working that day.
The burden of COVID-19 is disproportionately affecting those of a lower socioeconomic status even in wealthy countries and these inequalities are just magnified in a low-income setting. However, if we are systematic and logical and we tailor our approach to the local context we can help flatten the curve and minimise spread.