Continuing to “Let Hope Grow” for children with developmental disabilities and their families in Rwanda in the COVID-19 era

The past few months of 2020 have pushed the world into unfamiliar and uncertain territory, with the COVID-19 global pandemic directly leading to illness, incapacity and death, in addition to the substantial but yet unquantified indirect effects of ‘lockdown’ restrictions. Whilst strict lockdown measures have helped to slow the spread of COVID-19, they have impacted heavily the lives of vulnerable populations such as children with disabilities and their families. These families encountered many challenges such as increased poverty, increased risk of malnutrition and difficulties in accessing healthcare services.

When we started our AGP grant in May 2019 to implement an evidence based early intervention programme (ABAaNA) for young children with developmental disability in existing Paediatric Development Clinics (PDC), we could never of possibly have foreseen the challenges of 2020 and COVID-19. Working together Partners In Health/Inshuti Mu Buzima (PIH/IMB) in Rwanda, Kyaninga Child Development Centre (KCDC), Uganda and the London School of Hygiene & Tropical Medicine (LSHTM) & UCLH NHS Trust have carefully assessed and managed COVID related risk whilst balancing the high need for therapeutic interventions and ongoing monitoring for children with disabilities.

From October 2019 to March 2020, 12 EIP groups with about 107 children were established. In March 2020 EIP groups meetings were discontinued when the first case of COVID19 was identified in Rwanda and lockdown was commenced to contain the spread of COVID19 transmission. In Rwanda, ‘lockdown’ measures have been strict with restrictions including border closures, school closures, religious service bans, curfews, closure of public transport and physical distancing measures.

Lockdown was partially lifted on 4th May 2020 and movements were opened between provinces on 1st June. We have worked on integrating the local government guidelines on easing of restrictions to enable the EIP program within PDC to restart and offer much needed peer support and education to the families. Groups are being run using ‘Safe group guidelines’ that were developed around recommendations from the African CDC and Rwanda Ministry of Health and through consultation with Rwandan EIP Facilitators on messaging and telephone calls.

Key considerations for running groups during the COVID-19 pandemic are:

• Run groups outside where possible.
• If indoors, maximise ventilation by opening windows and consider reducing group size.
• Practice physical distancing according to local guidelines.
• Provide facilities for handwashing i.e. soap and water or hand sanitiser.
• Disinfect toys & equipment between use.
• Provide and promote correct use of face masks for caregivers.
• Encourage good respiratory hygiene.
• Ask families and facilitators not to attend if unwell.

We are very happy to see our EIP groups running again and feedback from our families has shown that they are equally glad to be back with their group as highlighted by the following quote from one of the Rwandan group caregivers:

“Before the lockdown, group members, we were like families. We encouraged each other as we all had the same challenges, but during the lockdown we were not able to meet and share our experiences as we used to, like me, I felt lonely because of community and some family members’ stigma. As we get back together in group, we are happy together. There is still stigma but I knew at least I do hope that once or twice in a month I will meet with my colleagues, which is one of happiest moment of both me and my child.”

For more information on the Pediatric Development Clinic & Early Intervention Programme in Rwanda please contact mnemerimana@pih.org.

For general programme enquiries, visit https://www.ubuntu-hub.org/ or email cally.tann@lshtm.ac.uk or rlassman@hotmail.com.

– University College London Hospitals – Partners in Health/Inshuti Mu Buzima partnership.