Dear PAPSA Members,
Greetings from the Secretariat.
These are interesting times around the world and we need courage and dedication to maintain our focus at this time. Since the outbreak of the Coronavirus disease in late 2019 in Wuhan province in China, we know it is only a matter of time before it becomes a present reality in Africa.
As of this morning, Africa has 572 cases and 12 deaths. While this is the smallest compared to other continents, it is believed that it may get worse with time. As we know, our specialty is particularly endangered in our continent with PS:pt ratio as low as 1: 1-2million. Some countries have 1 or 2 Paediatric Surgeons and therefore critical to keep the “War Generals” in this battle.
Essentially, lessons learnt from Italy where over 2,600 physicians (not only surgeons) have been infected with 9 deaths is that the singular most important cause of that high infection rate is lack of (and probably inappropriate use of) PPE. In Africa, with lean resources, this will pose a challenge but we advise strongly that those in the frontline must insist on minimum standards of PPE to offer service. It is the only way to keep the lean personnel from getting leaner and able to attend to others.
With respect to surgical operations during the pandemic, several surgical associations including ACS &BAPS have come up with guidelines. Some of the principles are outlined here for local adaptation:
1. Need to tone down (outright cancellation) elective cases – to free beds and personnel for possible covid 19 cases.
2. Urgent (e.g. oncology) and emergent cases (e.g. congenital neonatal intestinal obstruction) must go on.
3. In countries where the covid 19 virus transmission is no longer from external visitors to the country but due to community transmission, use of social distancing is encouraged and as such, limits to number of visitors allowed on the wards and use of mobile technology and social media to communicate with stable post op patients should be employed. Drugs can be prescribed and bought in pharmacy without visiting hospitals. In addition, screening techniques such as use of infrared thermometers to pick patients with fevers and isolate them and conduct tests to rule out covid 19 may also be helpful.
Further, in South Africa for example, certain specialised clinics have been cancelled to reduce patient visits to the hospital. We may borrow from this too.
These measures are by no means exhaustive, but may provide guidance to have bespoke local guidelines.
From the PAPSA exco, the message is: pls stay safe, protect yourself so you can take care of others.