Hope and some hesitancy on the frontline as COVID-19 vaccination takes shape in Malawi

The most stressful day for Duncan Banda, a physiotherapist working in a COVID-19 field hospital in Lilongwe, was when the hospital ran out of oxygen cylinders. There were just four physiotherapists to help 59 patients with breathing difficulties.

“We had to reposition patients, do deep breathing techniques and intensive physiotherapy. We lost four patients in four hours that day,” recalls Duncan.

One of the patients who died that day was a fellow health worker- a colleague.  “I helped him, fed him and did the chest physiotherapy until he got better and picked up to 88 per cent oxygen saturation. I left him to attend another patient who was choking in distress. I saved that patient and after 15 minutes when I looked back to where I left my workmate, he was dead. That was the first time I cried in the ward,” he explains.

Duncan heads the physiotherapy department at Bwaila Hospital in Lilongwe. He is also District Palliative Care Coordinator. Ordinarily, his job is to manage orthopedic and neurological conditions, including pediatric issues, cerebral palsy and complications during childbirth.

From the time the first COVID-19 cases were recorded in Lilongwe, Duncan has been part of the response team managing COVID-19 cases, contact tracing and working in treatment centers.

Physiotherapy has been quite critical in managing COVID-19 cases, particularly those with breathing problems. “We only admit those who are unable to breathe independently. For those on machines, physiotherapy helps as we try to wean the patients off. Using chest physiotherapy techniques, we can train patients to breathe properly and return to normal without a machine. We help them breathe and expand their lungs,” explains Duncan.

As COVID-19 admissions increased in Malawi, the pressure on the health system was evident as oxygen supplies started running out. With support from the UK Foreign and Commonwealth Development Office, UNICEF installed an oxygen plant at one of the biggest hospitals in the country, taking some of the pressure off Duncan and other health workers on the frontline.

A pandemic like no other

The impact of COVID-19 goes beyond the health sector. Learning was disrupted for an entire generation of children – 7.7 million school-age children attending pre-primary, primary and secondary education were sent back home for over five months. Only 2.6 primary and secondary school age children could access remote learning from home through an emergency radio programme and online classes.  A study carried out by the Ministry of Gender, Community Development, and Social Welfare (MoGCDSW) in 2020 showed significant increases in teenage pregnancies and child marriage cases in the period of March to July 2020 compared to the same period in the previous year.

More than 33,000 Malawians have been infected with the virus and over 1,000 people have died. Duncan remembers the early days, when people didn’t think COVID-19 was real. Angry mobs attacked health workers as they went about their job, tracing contacts. “So many died even as we worked tirelessly to save people. You assist someone, leave them stable and 30 minutes later they are gone. So, it was frustrating to see all the misinformation and conspiracies among the public and on social media. Some still didn’t believe that COVID-19 was real.”

Timely intervention

For Duncan and many other health workers on the frontline, the arrival of the COVID-19 vaccine in Malawi brings hope that the pandemic could finally end. UNICEF, the largest vaccine buyer in the world, is coordinating and supporting the procurement, international freight, and delivery of COVID-19 vaccines to 95 low- and middle-income countries under the COVAX facility. Malawi received its first batch of 360,000 doses of the COVID-19 vaccine in March. 

Across the country, vaccination teams have been going out to reach health workers and other frontline workers, people over 60 and those with co-morbidities or underlying health risks in some of the remotest areas. The team typically comprises a nurse, a health surveillance assistant (community health worker), a data entry clerk and a clinician in case of side effects such as convulsions on site.

The vaccination exercise has not been completely smooth with vaccine hesitancy reported in some areas- including among health workers. Lucy Kakowe has been leading a team of vaccinators in Dedza district, an hour outside the capital city of Lilongwe. As they delivered the first doses of the vaccine to frontline workers, a few didn’t show up saying they wanted to observe those who get the jab first to see if there would be any side effects.

As of 18 April, 257,754 people had been vaccinated. Of these, just over 39,000 are health workers. In addition to the 360,000 doses, Malawi has received 102,000 doses through the African union and another 50,000 from the Government of India.

UNICEF helps the Government of Malawi to safely store and transport vaccines by improving the cold chain system. UNICEF also supported the government to develop COVID-19 vaccination training materials for health workers and a demand generation plan to improve public acceptance of the COVID-19 vaccine.  

Vaccine hesitancy could derail global efforts to end the COVID-19 pandemic. “It is important to ensure that there are trusted sources of vaccine information that can be accessed by the general public. As more people get the vaccine, we are filled with hope– that the vaccine offers a first step back to normality, that children can continue to learn and access the services they need,” said UNICEF Malawi Representative Rudolf Schwenk.

As vaccination continues, it is important to continue following preventive measures such as wearing masks, washing hands regularly and keeping a distance from others.