Lifebox Interviews Partners on COVID-19: Dr. Praxy Okutoyi



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Preparing for COVID-19 in Kenya

Dr. Faye Evans is an anesthesiologist in the Department of Anesthesiology, Critical Care & Pain Medicine at Boston Children’s Hospital and an Assistant Professor in Anesthesia, Harvard Medical School. She also serves on the Medical Advisory Board of Smile Train. 

Faye Evans: Officially recording. Um, hey Praxy, it’s Faye. It’s good to see you. I’m just letting you know, we’re recording and that’s okay with you right?

Praxy Okutoyi: That’s fine.

FE: Okay, so I’m going to go through and thanks a ton for doing this, this means a lot to, not only me and Lifebox, but really to all the colleagues you have in Kenya and in the rest of East Africa. And hopefully by, you know, hearing what you’re facing on the front line can be shared and will benefit all of them as well and all the patients that they can take care of. So the first thing is if you can first of all just sort of for the purposes of the recording just state your name and maybe tell us a little bit about who you are and maybe how we know each other, cause that’s a good story.

PO: Okay so my name is Praxy, it’s short for Praxedis, a pediatric anesthetist based in Nairobi, Kenya. I work for Kenyatta National Hospital which is the country’s biggest hospital but I also work in private practice and especially at a children’s hospital at Gertrude Hospital which is also the largest private hospital, children’s only hospital in Eastern Central Africa. So I’ve known Faye for a long time now, we went on the pediatric fellowship program in Kenya and so we worked together with Faye coming in as expatriate support for about, I think it’s about 7 or so years.

FE: It’s been a long time! Just for Kris’ purposes and for Lifebox, can you tell a little bit about – cause Kenyatta’s a public hospital – how many beds are currently in Kenyatta and how many operating rooms do you currently have?

PO: Um, Kenyatta has a bed capacity of about 1000 beds. The ORs are about – about 18 ORs

FE: Right, and then you have an ICU as well – how many beds are in the adult ICU?

PO: The adult ICU has 20 beds

FE: 20 beds – and does each one of them have a ventilator?

PO: Yes.

FE: Okay. What about the new pediatric ICU – how many beds in there? Do you know?

PO: The new pediatric ICU has about 8 cots, it’s a small area – about 8 baby cots.

FE: Okay, and does it have ventilators as well or not?

PO: Not per bed – I think it has 4 ventilators.

FE: Okay, just curious. And then as far as Gertrudes – how many beds does Gertrudes have? Do you know?

PO: Gertrudes has 10 beds, yeah.

FE: In the ICU?

PO: In the ICU, 10 beds – each with a ventilator.

FE: Okay and then as far as the number of beds in the hospital?

PO: In Gertrudes Hospital?

FE: Yeah – cause it’s much smaller cause it’s private.

PO: I’m not very sure – actually I’ve never counted. But I think it’s about 100 beds.

FE: Okay, so a much smaller hospital. Where is Kenya currently – whats the current situation in Kenya regarding COVID-19?

PO: Okay, the current situation is that in the latest press release this afternoon, there are 42 cases – 42 confirmed cases. 39 of those cases are in Nairobi and the other cases are in Kilifi on the coast, the latest is in Machakos which is in the Eastern Province and we also have cases in Nyanza province. So pretty much, they’re beginning to spread around the country.

FE: How easy is it for you to test in Kenya?

PO: It’s not easy. Firstly, we don’t have enough kits 4:32 – 4:34 it’s only patients with compelling evidence that are being tested. There is no room for walk-in testing, it’s only evidence testing that’s happening cause we are short of kits.

FE: So you’re thinking it’s probably way underestimating the amount of positive cases out there?

PO: Yeah that’s probably the case, yeah.

FE: And what, I guess to start with, on a government level, what’s the government – I mean, what’s their reaction to all of this? Do you feel like they’re acting quickly or what’s going on?

PO: Um, I think in the beginning, they may not have 5:21 the impact seriously but it’s slowly evolving so there’s more action, there’s more action now than in the first week. In the first week, when the first case came out as positive, there is more momentum at the moment.

FE:  And has there been much, I mean have they been um, are there any rules in place regarding social distancing, anything about the borders or are they just—

PO: Oh yes. No no no no, pretty much that was organized in the sense that, the first thing was to close the schools, to come up with the social distancing rules, you know the public health rules – washing hands, sanitizing, distancing – all that came with the announcement of the first case and has continued to going on you know with all the public em, with all the radio, TV, social media – all those channels and that’s the message 6:21 -6:22. Em, the border, the borders are – within the country, I mean county to county hasn’t been closed. It’s only today that people have been advised not to leave the city to go out of the country. The Uganda border closed, the Tanzanian – I mean every East African border is actually closed. It was a country to country agreement but then Kenya also closed the airspace so I mean as it has only permitted the number of flights that are coming, they’re still getting cargo flights coming in and the Minister said today that the reason why that’s happened is so that 7:01 – 7:05. However, 7:06 was told except I think the last 7:10 – 7:12 the people who need to be 7:15 to Germany and I think there are also people who are returning to the UK.

FE: Got it. What about are they, have they gone as extreme as the US as far as closing all businesses except for essential businesses or – like the markets and things like that where its so difficult to do social distancing.

PO: All the social business, I mean all the social businesses were closed like – it’s been a week now. All pubs, all bars, all eating places were all told to be closed. The only areas that are open are the ones that supply food that you can order to take home – no sitting in to eat 7:58. Markets are still open but I think they are still thinking about 8:02 because they are cleaning up, fumigating and doing all that but those are still open.

FE: Okay.

PO: Also, the public transport, they reduce it. They have reduced the number of passengers and with strict instructions about sanitization, washing hands with boarding and coming out 8:30 – 8:31. Today they also – you know we use motorbike transport. That also has been given restrictions, only to carry two people at a time with a helmet and both passengers must have masks on. So I don’t know how that’s going to be enforced and listened to cause that’s a challenge you are having. Those rules are made and there is some resistance and unrest in some places 8:58 We also are having a curfew. So the day starts at 7am, no the day starts at 5, but we must finish by 7. So by 4, everyone must be allowed to go home.

FE: Wow. And then what about at your hospital? I guess it would be interesting to hear if there’s a difference between Kenyatta and Gertrudes, especially because Gertrudes is a children’s hospital, but what preparations are being made at the hospital level? Let’s start with Kenyatta first, what’s been going on? Either is it being done through leadership or through…

PO: There’s leadership. The hospital has the rapid response team which is working together with the national rapid response team. So what has been happening is that they give feedback to the national team on a daily basis. They are responsible for taking care of all cases – you know the cases, they get the information and so they are the ones who then decide what the next steps should be. That is one. Two, most of – we are not doing elective cases anymore. Elective cases have been stopped and we are only dealing with 10:15 cases and so the number of staff that are actually in the hospital has changed down but, however, in preparation for what is being seen ahead, em, in terms of training we’ve had training you know about the disease, what it needs to do this and that and then how the frontline workers are supposed to take care of themselves, in manners of dressing and approaching that area that is, you know, dangerous. However, with that it’s still not the real thing because I don’t think that simulation has been done with the actual staff. In fact, just now before I came to the call, I was talking to Doctor Dashi and so I was telling him, I was asking him, Mark, are you ready? We have not seen any of these things, we really need somebody to come and do a practical demo so that we actually understand what the actual steps are. We cannot do this practically by, you know, watching a video or something like that. So, that is where we are at. But staff are, I mean I’ve heard on the radar, worried about it, supplies, you know the short coming here and there. Their protocols have been developed in management, but supplies and coordination are actually going to be the main problem. For example, there’s a certain category of staff that really should not be there, you know people with comorbitities, there is no official communication on that line. People with comorbitities, they themselves or maybe looking after somebody like a child who can be affected. So we don’t have a policy guiding that. So, sort of, you know, we are still working out but it’s not firm, it’s not something that has been 12:15. There is official communication but it’s a bit disjointed. It’s still a work in progress. Everyone is coming with this idea, this idea and this idea, you know so…

FE: Is it being led – and believe me this is the same this going on in our hospital, and what we’ve done is we have the administration but then we have our own COVID task force with an anesthesia that’s trying to put together some principles around patient care and I’d be happy to share them with you. I don’t think they’re all completely relevant but some of them might be, and there’s no reason for us to be recreating the wheel. Obviously you want to take what guidelines have been put together and adapt them for whatever it is your setting is.

PO: Yeah, yeah, yeah.

FE: So you know I can share all of that with you. But I think simulation – yeah we did that not enough but around donning and 13:06 around airway management and around transport in the hospital. All three were considered critical areas, at least for us as anesthesia providers, making sure to know that we are A – adequately caring for the patient but at the same time, protecting the health care worker.

PO: Yeah, yeah.

FE: So you know I think, and you don’t need anything fancy to do that, I think that is stuff that you can do really easily with any – you know you just gotta put people together and start practicing and putting together some policies for Kenyatta. What um, do you feel like you guys have enough supplies right now? What’s your situation with like um, M95’s, those types of things? Do you have them?

PO: No. Not in Kenyatta. I mean, I don’t know whether they have come, you know cause we have these things which are coming in through the ministry then the ministry will supply to the various institutions. But I haven’t, I haven’t seen that in Kenyatta yet. I’ve not heard that they’ve been supplied yet. What we were given two weeks ago were just the normal masks, the ordinary, the usual 14:21 mask and then some bottles of sanitizer but not those specialized masks yet.

FE: Are there people concerned about that? Because of the fact that this virus has spread – especially anesthesia providers and people on the front line and the ICU, are they worried? Because we know that the virus is aerosolized and spread mostly through droplets. Are 14:51 concerned for those frontline workers who are caring for these patients as well as, you know people like you, anesthesia providers getting sick from the patients?

PO: Oh yes. Well people are terrified about that and right now the conversation going on is how – doctors need more protection because people have actually been running away from patients. Well not in Nairobi but it – well it happened in Nairobi with the first set of patients because they were brought in and people 15:20 – 15:23. In the districts, in the counties, it’s happening. There’s a doctor who’s been, who’s making news because he’s categorically said he’s not touching, and now he’s going for a disciplinary action by the county government.

FE: Because the government hasn’t made it so it could be safe. Any you know, we think about, in your setting where healthcare workers are a precious commodity, there’s not enough and if they start getting sick caring for these patients then, it really will be – not only will the patients be harmed but the infrastructure will be devastating.

PO: That’s true.

FE: What in your setting, just so Kris knows, what, as an anesthesiologist in your setting, what are your primary responsibilities? Is it just for surgery or what other responsibilities do you typically have?

PO: Actually now, we’re being relied on for critical care. So it’s for ICU and for surgery.

FE: Got it. And then, it sounds like anesthesia providers, they’re really at risk because – have there been much discussion about personal protective equipment at all?

PO: 16:40. Everybody feels that’s where we are deficient. There’s a great deficiency in that area and we are hoping that in the coming days, probably in the next week, that the government will actually demonstrate that they now have acquired the supplies. But as at now, no.

FE: And then what is, is KSA lobbying to the government. KSA for the purpose of this is the Kenyan Society of Anesthesiologists. I know, I’ve seen the guidelines that they put together for the care which looked great but are they using that to lobby the government and the Ministry of Health to try to get these supplies?

PO: Um, I think that all the medical associations are out of the government advisory team so I want to assume that that has been heightened or underlined. So it’s just that we were waiting for their response. But for sure, all the medical associations are represented on 17:41.

FE: Do you think the other hospitals in Nairobi that are private hospitals, do you think they have the personal protective equipment, M95 masks or equivalents or no, probably not?

PO: Actually I’ve been to – I work for Gertrudes so that’s one of the big hospitals in the sense that its specialized and I also work at Nairobi hospital but there’s a lot of discussion 18:11 – 18:14 As of today, they still don’t have their M95 in yet.

FE: How do you, what do you guys do when you have tuberculosis patients? What do you do to protect yourself?

PO: We just wear the usual mask.

FE: Do you have, in a hospital are there negative pressure rooms anywhere?

PO: Isolation rooms?

FE: Yeah like negative pressure rooms – not just an isolation room.

PO: Negative pressure rooms, yeah, in some areas. Like in Kenyatta, there’s a new area that was set up for isolation so that has negative pressure rooms.

FE: So, I think, how, if you were to plea to the global or ask the global surgery or global community for help in your setting, what would you ask for right now?

PO: Okay, two things. One, the personal protective equipment and number two, information. You know there’s a lot of information flying in here and there in terms of which drugs 20:04 – 20:11.

FE: Yeah, it’s confusing.

PO: Yes, em proper information. It could also share the protocols that had been used in places you know that are already up and running.

FE: Right, yeah. And then I think, I have to ask you just as a mum, as a, just a normal person in your community, but also as a healthcare worker and an anesthesiologist, as this COVID starts to spread around the world and probably starts to spread into East Africa and into Kenya, what you do most fear?

PO: What do I most fear? I fear to be a patient. First and foremost that’s my fear. Yeah, I mean, I really think that’s my number one fear. I don’t know whether I need some kind of assurance that I will work and come out safe but who’s going to guarantee that? I don’t know.

FE: What gives you the most hope?

PO: Pardon?

FE: What gives you the most hope that we’re going to get past this?

PO: Because it’s, okay it’s a different kind of disease, but if you look at history, we’ve had these types of things happen and people have survived and lived on. Obviously there are casualties but it’s inevitable but that just has to be.

FE: Alright, I’m going to stop the recording now and chat with you but that was really good and very very helpful, thank you.