Rwanda was among the first countries in the world to enact stringent measures to control the spread of the pandemic. To date, this strategy has been successful, but it has meant that we have radically changed the way we bring our services to the people in need. Our projects there have always utilised person-to-person counselling and group therapy. However, COVID-19 has meant our counsellors now provide telephone-based counselling, working with the peer support counsellors at a distance. This isn’t ideal, but thankfully, due to a further injection of funding means we have been able to reach more beneficiaries. A number of newly-trained peer support counsellors have also started work.
Thanks to Rwanda’s success in containing the coronavirus, the lockdown has recently been eased: people are now able to move around and work within their province, with the prospect of travel between provinces soon. When this happens, our counsellors will be able to go beyond their base in the capital, Kigali, providing supervision for the peer support counsellors in the field, as well as more training. This training will happen in small groups of no more than 10-15 people, in line with the social distancing guidelines.
This year, survivors of the 1994 genocide were unable to commemorate the genocide in the usual manner because of the lockdown. This led to an increase in cases of severe depression which put an extra burden on our peer support counsellors. A small number of them struggled during this time, and were offered support from counsellors.
Further impact on communities
Being locked down meant that some vulnerable families were unable to get out and earn money: our partner delivered emergency food supplies during this crisis.
The Ugandan authorities moved quickly to mitigate COVID-19. Our partner, BNUU re-shaped some of its activities to fit government guidelines which are aimed at protecting staff and preventing the spread of the pandemic. Inevitably, some essential activities such as self-help group meetings, training and advocacy activities have had to be temporarily suspended.
Since March, there have been prohibitions affecting the use of public transport, private cars and boda-bodas, together with gatherings of more than five people. All shopping malls, arcades, and shops that sell non-food items have been closed, while essential services continue. In April, motorcycles could extend their hours of operation for motorcycles from 2pm to 5pm. This was important for us because it meant that BNUU could visit clients and health centres, whereas previously, counsellors needed to get movement permits.
Our partner, BNUU, continues to offer the following services to people in need:
Mental health clinics – The attendance rate of people with mental health issues, depression and epilepsy (PMDE) has been good, despite the current challenges. We are offering many more mental health clinics than previously to make sure people can maintain social distancing. Everyone is given an appointment time with no more than five people waiting at any one time. Previously, 120 clients would attend each mental health clinic day. Now, there is a limit of 25 a day, with five times as many clinic days as before.
Telephone calls – BNUU keeps in touch with its clients and caregivers in Kalongo Town Council, Lokole and Wol Sub Counties by ‘phone to set their appointment dates. For those that have poor network coverage and are unable to charge their ‘phones because of lack of electricity, the village mental health focal persons are able to help with letting people know about appointment times.
Radio announcements – patients who do not have phones are reached through radio broadcasts. Regular radio announcements (5 times a week) are aired to remind people of the mental health clinics and to convey key messages about Covid-19 in an effort to reduce stigma and fear.
Delivering medicine to PMDEs’ homes – BNUU delivers mental health medicines to elderly people, the physically disabled and any other extremely vulnerable individuals who have challenges in accessing health facilities.
Home visits and individual counselling – BNUU staff do socially-distanced home visits to provide counselling and check on patients with severe conditions.
Community education – BNUU is continuing to educate the community on how to cope amid the pandemic, sharing tips for relieving depression through its radio broadcasts. We will support re-integration of people affected by COVID-19 to reduce stigma and discrimination. With the support of local leaders and other community structures, we will sensitize community members about the danger of stigma and discrimination against those affected by COVID-19. Community Education sessions now take place on the radio, an effective
way of reaching a wide audience.
Livelihoods – The lockdown has led to an economic slump across Africa, as it has elsewhere. Unfortunately, our self-help groups have been earning less income, and are unable to save as much as they were previously. Hopefully, as the economy recovers after lockdown, our clients and their caregivers will be able to return to their work (farming, selling firewood, etc.) Some people have already relocated to villages where they have access to farm land.
Other factors impacting the communities
Stigma – There is some stigma and fear around Covid-19 due to lack of information. Just as in the developed world, people are avoiding hospitals. If they do attend, they are reluctant to return to their villages in case people think they are bringing COVID-19 with them. Therefore, our counsellors are visiting villages before people return, helping to dispel myths, and making sure people are welcomed back into the community.
Food Aid – The lockdown has limited the amount of money people can earn, and the amount of food they have. This has serious implications for people taking medications, especially psychotropic drugs, on an empty stomach.
Livelihood activities – The activities of most of our self-help groups have been limited by the pandemic: group training isn’t possible, and we cannot distribute agricultural inputs for the time being. However, BNUU checks in with the groups by ‘phone, offering support to those who are trying to continue their activities.
Locust invasion – In March, desert locusts invaded Uganda from neighbouring Kenya. A second wave arrived in early April. This will greatly affect farmers/food security in the region since 95% of the households in Agago District (where we work) depend on farming for their livelihood.
Cattle rustling – In March and April, cattle rustlers attacked the communities in which we work. Some people are now fleeing their homes and are taking refuge in the bush. The Ugandan government has responded by deploying soldiers, but cattle rustling is not a new problem; and it affects most local people – 82% of the households in the district are engaged in livestock farming. Farmers depend on cattle for ploughing fields and milk production.
As of June 2nd, there have been 896 cumulative confirmed cases of Covid-19, 528 of which have occurred in the capital, Freetown. 480 cases have recovered and 46 people have died. Though the number of new cases continues to rise, the rate has started to plateau. To date, there have been two nationwide lockdowns, each three days long, at the start of April and start of May. During these lockdowns, there has been comprehensive testing and contact tracing.
Since April, there has been a national ban on travel between districts, other than for transportation of food and goods. There has also been a nationwide curfew in place since April, from 9pm to 6am. It’s not clear when either of these measures might be lifted.
Facemasks (previously only mandatory on public transport) are now mandatory in all public spaces. There are limits on the capacity of different modes of public transport, to try and enable some form of social distancing.
Sierra Leone’s one international airport – Lungi – has been closed since March, as have Sierra Leone’s land borders with Guinea and Liberia.
Impact on communities
There is a great deal of anxiety in communities:
- fear about the effects on their livelihoods by the ongoing nightly curfew and the restriction on travel between districts, with no end in sight;
- fear about being unable to afford to provide for families, as prices are rising due to the border closures, the free movement of goods, and the effects of stockpiling;
- fear of punishment for breaking the curfew, or for being caught in public without a mask;
fear of attending hospitals for reasons other than Covid-19, in case of catching the virus in hospital. During the Ebola epidemic, this was a big cause of excess mortality, especially maternal mortality; and
- memories/flashbacks to the Ebola epidemic of 2014-2015, the loss of life and livelihoods, the increase in stigma – and the feelings of abandonment following that crisis, with people not receiving the ongoing support that they’d been promised by government and NGOs.
The war survivor amputees that the team supports in Port Loko are unable to travel to Freetown to beg, which is how many of them usually support themselves and their families.
All schools are closed indefinitely.
There are reports of increased drug and alcohol abuse as coping mechanisms for people increasingly facing hunger during the pandemic: https://www.youtube.com/watch?v=7doYl1BayJE&feature=youtu.be
Impact on healthcare workers
There are some concerns about the mental health and wellbeing of health workers – both due to burnout and stigma because people are afraid that health workers might be infected. Their stress has been compounded by the delays in the receipt of hazard pay they are
Impact on work in Port Loko district
- All staff are wearing face masks, and regularly cleaning hands with sanitiser – and especially before and after interactions with community members. Our beneficiaries in Port Loko were particularly grateful for the facemasks and veronica buckets that we were able to fund.
- Gatherings are officially limited to 50 people in Sierra Leone, which does not affect the meeting of self-help groups (maximum 20 people) or community education sessions.
- All staff already travel to communities by motorbike, so they do not face the risks associated with taking public transport.
- The team are able to visit their communities and work largely as normal within the confines of the curfew and inter-district travel restrictions. If the lockdown continues, it will be difficult to do counselling/check-ins via phone because of the lack of phone signal, and low levels of phone ownership. However, because our team is part of the official Covid-19 response at district level, coordinated by the Ministry of Health and Sanitation, they have had permission to continue visiting their communities.
Port Loko team’s involvement in the official Covid-19 response
The Port Loko team was asked by the government to be a part of the Port Loko district level response, coordinated by the district branch of the Ministry of Health and Sanitation (MOHS), alongside 9 other NGOs/MDAs. Each organisation covers its existing beneficiary communities.
The team was asked to be part of the official response to COVID-19 because of their track record during the Ebola epidemic, their ongoing relationships with their communities, their work with the Port Loko mental health nurse and other key stakeholders such as the District Medical Officer. Our team is also the only organisation with a dedicated mental health focus in Port Loko district. They are members of all three ‘pillars’ of the response: social mobilisation (disseminating accurate information about the virus and its prevention), psychosocial support, and child protection.
This work has meant members of the Port Loko team have been granted special permission to travel to their beneficiary areas during the lockdown, to continue their Covid-19-related outreach work.
There is no financial support for this work from government. Each organisation is expected to contribute what it can, financially or in-kind, which is then distributed to members for fuel to travel into their respective communities and to attend district meetings.