3 August 2020
The Tropical Health and Education Trust (THET) was founded 32 years ago with successful partnerships developed between 31 LMICs and 130 different health service organisations in the UK, largely funded through UK AID. THET now has in-country directors in 10 low and lower-middle income countries and during the COVID-19 pandemic, these Health Partnerships have demonstrated yet again the mutual benefit of partnership activity. We have found new ways to support one another, to share knowledge and resources.
The UK certainly has a different capacity to cope, with PPE, handwashing facilities and ventilators all readily available. Living conditions allow for social distancing and we have a health service for all that is well trained and sufficiently staffed. Indeed, I have personally felt guilt when listening to the weekly THET Country Directors COVID-19 updates describing shortages whilst I work safely at the Nightingale North West with no lack of PPE and with adequate handwashing facilities. But what I have also realised is how much, with well-established partnerships, we can learn from each other. For instance, how useful would it have been to agree, and then seek to standardise, PPE use?
This issue was brought home to me while listening to the 25 speakers from three continents who spoke at THET and Esther Alliance’s one-day online conference ‘Partnerships in an Era of COVID-19’, which attracted 750 registered attendees from 54 countries. It was an incredible event with over 100 resources instantly shared, including training packs, hand gel and PPE solutions. It made us all realise that there are gaps in all health systems. The UK do have so much to offer, but also so much to learn and we must not turn inward.
Let me describe a personal example of mutual learning through a long-established partnership with paediatric colleagues in Sierra Leone:
When Ola During Children’s Hospital in Freetown lost all of its paediatricians because the lead paediatrician went down with COVID-19 and all other doctors were immediately isolated, two doctors from King’s College London on placements in Sierra Leone were relocated to step in and keep the children safe. When the lead recovered, I was then asked through the RCPCH, their long- term UK partners, to conference call with her and the CEO to offer support in getting the hospital up and running. We discussed the limitation of isolation nursing when no reliable COVID-19 status was known, and all the children had to be cared for in a Nightingale ward setting. I didn’t know it at the time, but it was an invaluable discussion that would help to inform my flexible considerations of how to keep myself, my team and my patients safe in the Nightingale field hospital setting in Manchester.
Throughout the Conference, all THET partnerships were able to provide their own helpful examples of mutual learning. For instance, Cambridge Global Health Partnerships had advised Mulago in Kampala on how to produce hand gel, King’s Global Health Partnerships and Hargeisa General Hospital in Somaliland had reviewed how they both triaged COVID-19 patients through A&E. Myanmar colleagues described an organised approach for PPE provision. We should have listened to our partners who had managed pandemics before. Following the Ebola pandemic, Sierra Leone concluded that it is vital to not let essential health services collapse whilst dealing with a pandemic. The importance of continued provision of essential medicines was cited as an example of this. We in the UK did not listen and are now hearing horror stories about the failings of the NHS during the pandemic, including the impact on Cancer care and probable increase in mortality in the UK. We also did not initially consider rapidly establishing separate specialist COVID-19 services (as were established in China, Myanmar and Zambia) to allow the essential services to continue running.
All around the world we are now becoming increasingly aware of the long-term impact of health services concentrating their efforts on COVID-19, or of COVID-19 preventing the implementation of public health and non-communicable disease (NCD) programmes. Immunisation rates all around the world, including in the UK, have dropped and we all fear a resurgence of infectious diseases that may kill far more than COVID-19. For example, Measles and TB may well return as major causes of death. The agony of Tetanus deaths – a sight I never wish to see again – could again be witnessed. A reduction in essential immunisations is a global issue and with global migration, it will need partnership work to address it.
In Uganda, nutrition projects have also suffered. How can you get food to those in need when travel is restricted? And as unemployment soars and food becomes unaffordable, illness and deaths from malnutrition will increase. It is easy to see this as a LMIC issue, but as food banks become essential in the UK, UK medics who are former THET volunteers, describe how caring for malnourished children whilst working in LMICs is helping them recognise the same signs in children from the poorest areas of the UK. When I stopped working in partnership with the team at the paediatric malnutrition unit in Mulago, Kampala I never thought I would need to be concerned about seeing children with similar symptoms back home in Blackpool. Having returned from Ethiopia just before lockdown and having visited centres established to address NCD issues – family and community-based support centres that could be models for the UK – I have also listened with horror at the cessation of this kind of work globally due to COVID-19 restrictions, knowing that deaths from NCDs will outstrip deaths from COVID-19.
As we continue to battle to get this pandemic under control globally, and indeed to rebuild our global health services, the UK’s funding of partnership work is more important than ever. Partnership models may well be different, with less global travel and more use of digital communication, but what we now all understand is the interconnectivity of global health and the need to work together and to learn from each other. We need, for example, to protect each other through immunisation programmes, to expand our global health workforce and to make better use of available resources through antimicrobial stewardship and NCD programmes, for example. We must always be on the look-out for frugal innovation, the best and most cost-effective way of doing things. THET and UKAID continue to have a vital and unique part to play in strengthening UK and LMIC health systems. Through partnership, we are all more resilient to cope with the long-term impact of COVID-19 and indeed the next pandemic.