On this late-August morning, the sky is grey and the traffic is heavy outside the main gate to Zinder, Niger’s second city. Ali looks at the long line of trucks loaded with goods stretching in front of him, but despite the traffic jam and the threat of rain, he keeps on with his work. In charge of health promotion for MSF, Ali is determined to stop the spread of COVID-19. The virus, which appeared in Niger in March, has caused around 60 deaths so far. Ali and his team in Zinder are responsible for raising awareness about the disease, sharing good hygiene practice and distributing masks, or “mudflaps" as they are known here.
In a tent at the edge of the road, staff from the Ministry of Health are checking the temperature of everyone who wants to pass through the barrier and enter Zinder. "Please wash your hands here," they say, pointing to the soap while courteously turning on the tap. At the end of the line, Ali's team take the opportunity to hand out washable masks and give instructions on how to use them.
"The epidemic is far from over"
"Since the beginning of the epidemic, out of 420 people suspected of having COVID-19 in the Zinder region, 140 patients tested positive,” says Dr Ali Mamane, head of MSF’s coronavirus project in Zinder. "Unfortunately 20 of them died.”
"Compared to the 1,160 people who have tested positive for COVID-19 nationwide, the number of positive cases in Zinder are relatively low. However, the city is the second epicentre of the virus after the capital, Niamey. “Today the number of cases is not alarming but the epidemic is far from over," says Dr Ali Mamane. “The epidemiological situation remains fragile and depends on the continuity of the control measures that have been implemented."
Since the outbreak was declared in Niger, MSF has been helping to transport test samples to Niamey, 900 km away, and more recently to a laboratory in Maradi, 290 km away.
"Even though local transmission has been limited, there is concern that, as Niger reopens its borders with neighbouring countries, the number of people entering the country who are potentially infected may lead to a further introduction of the virus," says Dalil Adji Mahamat, MSF head of mission in Niger. He calls for "preventive measures, which aim to preserve the health of all. This means understanding and strict compliance with barrier measures, in order to limit the circulation of the virus and limit its transmission at the local level."
Faced with the dangers posed by the new coronavirus, MSF has reinforced preventive measures in all its projects in Niger, setting up isolation areas and carrying out community awareness activities.
Temperature check at the entrance gate of the town of Zinder. MSF has installed a hand-washing and temperature control point at all entry and exit points in the town of Zinder to prevent the spread of COVID-19 in the region. [© MSF/Mack Alix Mushitsi]
"In Niamey, we built a centre to care for patients who tested positive and needed inpatient care,” says Dalil Adji Mahamat. “Elsewhere in our projects and in the health facilities we support, our teams have reinforced hygiene measures, provided masks and handwashing facilities, and trained medical staff in infection prevention and control. Protecting our patients and staff was immediately the top priority."
At Charézamna health centre in Zinder, the head nurse is jubilant. MSF has just equipped the centre, as well as 14 other health centres across the city, with water tanks, giving them running water around the clock. “Here, we only had running water every other day," says the head nurse. "We were far from satisfying the measures taken to combat coronavirus.”
During August, the city’s residents take advantage of the cool temperatures and the rain which sometimes floods the alleyways. In the neighbourhoods, young people do "fada" – where they gather on a street corner and drink tea, as nearby street vendors shout at each other. One detail stands out: nobody is wearing a mask. Masks to protect against coronavirus can be bought at the market for just 150 CFA francs (US$0.22) each.
"There is a slackening off"
In Zinder, in the south of Niger, MSF's health promotion team is raising awareness among young people in discussion groups called "Fada" about the coronavirus and methods to protect themselves from the disease. [© MSF/Mack Alix Mushitsi]
Adoua, a neighbourhood chief, notices the lack of masks too. "Despite the fact that wearing a mask is compulsory in public places, some people still don't believe that the disease exists,” he says. “When places of worship and offices were closed, people were afraid of the disease. Since then, there has been a slackening off."
MSF has mobilised a team of 140 community health workers who go from house to house and visit health facilities and other places where people gather to raise awareness of the disease and how to protect against it. "We also broadcast messages on the radio to reach a lot of people," says health promoter Ali. "There are many rumours and lots of misinformation accompanying this pandemic, so we are working actively with the community to share the right informations about the disease and to ensure that everyone is part of the response.”
Across the country, there has been a drop in the number of people testing positive for COVID-19. In late-July, MSF ended its COVID-19 project in the Maradi and Madarounfa districts after training staff in 50 health centres in infection prevention and control, as well as raising awareness about the disease. Now MSF is preparing to hand over its 50-bed coronavirus patient care centre in Niamey to the Ministry of Health. In Zinder, MSF’s awareness raising and infection prevention and control activities will also be handed over to local health authorities.
"We will continue to support the emergency call centre in Niamey,” says Dalil Adji Mahamat. “We will also continue to raise awareness about the disease in all the towns where we have projects, and we will contribute to epidemiological surveillance. MSF remains ready to respond if necessary.