Kampala, 29 Nov 2021 – The second wave of COVID-19 hit Uganda hard. Authorities announced a total lockdown in June; infections rose. Government statistics at the time showed that for every 100 people tested, nearly 20 were found to be infected.
At the International Organization for Migration's (IOM's) Migration Health Assessment Centre in the capital Kampala, where the organization runs a COVID-19 testing centre, a staff member in a white coat puts on a blue apron, protective goggles, face mask, and a surgical cap while she waits for her next client.
Tabitha Nalumansi, a clinical nurse, felt the impact of COVID-19 first-hand on her friends, neighbours, and family. She saw some die and felt scared whenever she said goodbye to a relative or friend.
“My husband didn’t let my children come next to me; this was sad but necessary,” she says. “They were not comfortable with me joining the front lines. But when they saw photos of my protective gear, it gave them hope."
Nalumansi is one of the millions of frontline workers battling the COVID-19 pandemic. She understands the risks but opts to focus on the task of saving lives.
“You look at people, they need your help, and you are the answer,” says the mother of a boy and two girls. “I look at this as war; we are soldiers.”
She joined IOM in 2018, screening migrants and refugees at the onset of the tenth Ebola virus outbreak in neighbouring Democratic Republic of the Congo, then switched over to IOM’s First Line of Defence (FLoD) project, which offers COVID-19-related health-care services – mostly to United Nations staff, their families, and others referred by the UN – to ensure the organization’s key life-saving activities continue. The project, implemented in 18 countries, was designed to limit the need for medical evacuations.
Nalumansi’s life story starts in Mukono, about 20 kilometres east of Kampala. The seventh-born among 14 children was mostly raised by her dad and grandmother. “They didn’t have a lot of money. But what they had was love,” she says.
Her grandmother, a nurse, inspired her career. “My grandmother was a professional nurse, and I admired their white uniforms. She always told me to be a nurse. I promised myself never to disappoint her.”
That resolve, coupled with incessant reminders by her father to “work hard”, shaped the work ethic of a nurse who, for four years, worked night shifts at hospital ICUs, while juggling college and family responsibilities.
“Even when you were sick, my father left for you something to do. We were not allowed to be free. I think that prepared me for the world.”
When IOM asked her to join the COVID-19 front lines, testing, monitoring contacts and counselling patients, Nalumansi was frightened. It took persuasion from colleagues to get her to stop worrying about the mental pressure and anguish health workers face in a pandemic.
“We have a duty of care, but I always asked myself if I really held the duty to self-care.”
Arriving at work early in the morning, she would first ensure there were enough testing and treatment kits, which she would give to clients throughout the day. On lighter afternoons and weekends, she would make follow-up calls to COVID-19 contacts.
“These were abnormal times. I don’t think anyone of us sat down for a full hour to have lunch. I would excuse myself for 10 minutes, have a yellow banana and tea, then return to the tents," Nalumansi says.
“The long hours don’t matter as long as you are taking care of your health. It is rewarding to see it paid off.”
In early July, the virus struck closer to Nalumansi’s home. She was attending to a brother-in-law in the ICU, when the phone rang; her aunt had lost the battle with COVID-19. Watching the news another evening, she learned of the death of her former supervisor, a senior pediatric surgeon. Days later, it was her patient, a UN colleague, who had died as he sought advanced medical care in Nairobi.
“I felt like everyone I knew was sick,” she says, as tears welled up. She sighs heavily, dropping her head.
Statistics from the government show that Uganda lost 37 health workers to COVID-19 between June and August. The figures could be higher.
Nalumansi recalls the horror when she visited a hospital and people were dying in their cars waiting for oxygen, unable to find a bed. She was engulfed by fear.
“Now, at that time I stopped living; I was ready to die.”
At the IOM clinic, Nalumansi and other medical personnel outdid themselves registering patients, collecting samples, conducting tests, communicating results, dispensing drugs, counselling, making follow-up calls to patients and their contacts, and providing home-based care.
In June 2021, the IOM migration health centre – which already was providing COVID-19 vaccinations for migrants and refugees – started to offer the service to UN staff and their families, including through mobile teams sent to remote areas of the country for increased coverage.
“We sometimes served 120 people per day and your safety would be determined by how careful you were.”
Overall, since July 2020, the IOM FLoD team in Uganda has served some 1,850 people with at least one health service.
The IOM health team’s phones rang constantly. They made countless calls to COVID-19-positive patients and contacts in a day. Even late at night, calls came from patients and emergency cases.
“Nursing is really a calling,” Nalumansi says. “You also have those who shout at you: ‘Don’t call me again! Why am I not recovering?! You are the problem!’
“It is sad, but we call them again because we understand their frustration.”
What kept the IOM health team going, she says, were the humble and appreciative patients, and the fact that there were more recoveries than deaths. Uganda has registered more than 128,000 COVID-19 cases, and over 3,250 deaths.
“I always told people not to panic; testing positive doesn’t mean it’s the end of life.”
Although client numbers for the IOM First Line of Defence unit have reduced significantly, Nalumansi’s 13 years in practice tell her the war is not over.
“It is like a snake hiding in your drawer; at any time, it could be coming out to bite,” she says.
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