A PUBLICATION OF

Thursday 30 July 2020

Maintaining a recovering

attitude

HEALTHSP TLIGHT

on

Thursday 30 July 2020Spotlight on health 2

CREDITS

PUBLICATION: SPOTLIGHT ON HEALTH

MARKETING: Carolin Guriras PROJECT COORDINATOR : Zack SheehamaEDITORIAL: Theresia TjihenunaLAYOUT & DESIGN: Lotta KaapandaSUBEDITORS: Nick de Voss and Karin EloffPRINTERS: Wordpress Namibia (Pty) LtdCOVER PHOTO: Courtesy of Welwitschia Hospital

• ESTER MBATHERA

NAMIBIA recorded its first Covid-19 case on 14 March.When president Hage Geingob on 27 March announced

a total lockdown for the Erongo and Khomas regions, Welwitschia Private Hospital took extraordinary measures to protect its patients and healthcare team.

Not long thereafter, case 22 of Covid-19 at Walvis Bay was admitted to the hospital’s intensive care unit. Although Covid-19 cases are handled by the state, the 63- year -old Rudi Witulski could not be moved to the state hospital as there is no ICU unit.

Dr Andrey Kornilov, who was charged with overseeing Witulski’s recovery says their hospital was well prepared for Covid-19 cases.

“It was not so stressful. Of course, he was a very difficult patient from a critical point of view but thanks to our team, such patients don’t recover without excellent care which our hospital can provide and with all input from doctors, nurses and psychologists, we managed to save his life,” said Dr Kornilov.

According to the doctor who still lives at home with his family, saving lives became a higher priority as he spent most of his time with patients away from his family.

“It’s my job. I don’t spend a lot of time with my family, I spend it with patients. Because we wear full personal protective gear

Healthcare worker perspective on fighting Covid-19

The new normal demands resilience

on duty, I was not worried about the family,” he says.Nursing manager at the hospital, Dicksey Kuiiri, added that

for the hospital staff, it was a new ball game.“It was not easy at the beginning because it was all new to

us. The staff was afraid that they would get infected but the preparations helped us to grow a lot and do a lot of adjustment. You just need to make the best of the situation,” said Kuiiri.

She adds that balancing life and work during the pandemic is a challenge.

“Your family is also a priority at home and when you come to work you need to look after the patients and staff . It’s not easy to put this together. When at work, you have to make sure that everyone follows the guidelines, make sure all necessary PPE are in place for your staff not to be infected. If you go home you also have the fear of exposing the family. It’s not easy but it is necessary,” she adds.

STATE READINESSA few streets away is the Walvis Bay State Hospital which staff

says is operating under severe shortages of essential equipment, supplies and medical staff.

Because of increasing cases at Walvis Bay and a shortage of hospital beds, the state opted to move patients to the National Youth Services hostel at Henties Bay to be turned into a Covid-19

isolation facility. Nurses who spoke to The Namibian on condition of anonymity for fear of victimisation say because the place was not set up for medical reasons, they are now forced to work under immense pressue.

“The place is not medically equipped, we do not even have oxygen cylinders. If I am with patients, I should expect anything to happen and I must be ready medical-wise.

They are supposed to prepare the place before they bring anyone here. All these things the director is aware of but when will they sort out these things,” said the nurse.

The insider says there are no ambulances stationed at the facility either. The nurses claim that when they arrived at the facility there were no showers and they went for days without a proper bath.

“They gave us a house at Henties Bay in town only to hear that there is no electricity. The staff must top up.

My point is, why would they bring us here if there is nothing prepared?”.

We are just here for the sake of the patients, other than that, we won’t tolerate this.

The state health workers say they are yet to be provided with a strategy on how to deal with the pandemic.

Erongo health director Anna Jonas did not respond to questions sent to her regarding the concerns from the hospital staff.

IN times of global crises , one truth remains, and that is that the human spirit is resilient.

The outbreak of Covid-19 has brought about an unprecedented crisis that has impacted the way we view our world.

At the heart of this crisis, the human spirit is tested to the core. So great is the impact of Covid-19 on the global community that experts are looking for insights from historic global events such as the 1918 Spanish flu and the Great Depression to find out how populations survived.

Amid the daily rising number of cases, we are forced to quickly readjust our lives. Practising regular hand washing, general hygiene and social distancing is only a fraction of what is required to respond to the virus.

Coupled with mass retrenchments across industries, remote schooling, working from home and the added pressure of taking precautions in public, the pandemic has shaped every facet of our lives. Retrenchments and the subsequent loss of income can trigger anxiety and depression, leaving psychological scars. Those in self-isolation or quarantine

may experience mental distress due to fear, loneliness or stigma. As a result, focusing on mental health should be part of our response to the pandemic. History has taught us that global disasters almost always trigger post-traumatic stress, increased alcohol and substance abuse, domestic violence and child abuse and neglect.

These are social issues that require our immediate attention and focus. As we navigate through unchartered waters it is easy to forget the heroes at the front line of this battle; the doctors and nurses who tirelessly work around the clock, risking their lives.

Never before has the importance of occupational safety and health been more crucial, more so in the health sector, as you will found out in one of our stories.

Working long hours with l imited resources and minimal protective personal equipment, healthworkers are prone to self-neglect while putting the needs of their patients first.

The shortage of medicine in the country has also been exacerbated by the prolonged lockdown. The pandemic has exposed Namibia’s heavy reliance on South

Africa for basic pharmaceutical supplies and equipment.

A wide range of medication delayed at the border include for example Salbutamol, a drug that helps open the airways in asthma patients. It is widely known that those with underlying respiratory conditions, such as asthma, are at higher risk of developing complications due to Covid-19.

The availability of life-saving medication to successfully manage their conditions should not be taken lightly. While minister of health and social services Kalumbi Shangula announced the ministry managed to secure these drugs, the country needs to look at long-term solutions.

The government should implement p o l i c i e s e n c o u r a g i n g t h e l o c a l manufacturing of pharmaceutical products. As we seek to address challenges facing our health sector today, let us celebrate the milestones achieved in controlling diseases that were once life threatening.

The World Heal th Organ isat ion announced that Namibia has made strides in eradicating polio with the last reported case in 2006.

In addition, the country has also managed to contain diseases such as

HIV, tuberculosis and malaria through targeted intervention programmes.

This should be testament to the country’s ability to tackle pandemics if equipped with adequate resources and strengthened capacity. Finally, our hearts go out to the families that have lost loved ones to Covid-19. In the words of author and poet Jaeda De Walt:

“When we learn how to become resilient, we learn how to embrace the beautifully broad spectrum of the human experience.”

It is this resilience in the face of adversity that will bring us on the path to recovery.

Happy and healthy reading!

Theresia TjihenunaSupplements Editor

Foreword

Photo: Ester MbatheraAndrey Kornilov and Dicksey Kuiiri

Thursday 30 July 2020 Spotlight on health 3

• TUTALENI PINEHAS

MONIQUE la Cock was diagnosed with breast cancer eight months ago.

Contrary to popular belief, this has been a most rewarding spiritual journey, as she set out on a path of self-discovery, she says. The former national netball player said this journey taught her how strong she is.

“It all started in September 2019 when I discovered a lump in my left breast,” (29) says.

The newly wed is currently employed as a conveyancing secretary at a law firm in Windhoek.

After discovering the lump in her breast last year, she visited a doctor who did a biopsy on her, but the results took a while.

“The doctor was certain it was not cancer because of how dense my breasts were,” she says.

“After two months of waiting I was finally told I had infiltrating ductal carcinoma.”

Invasive ductal carcinoma (IDC), sometimes called infiltrating ductal carcinoma, is the most common type of breast cancer, accounting for 80% of all types of breast cancer.

Invasive means the cancer has permeated or spread to surrounding breast tissue.

La Cock knew it was serious when she was eventually referred to an oncologist. She commenced with chemotherapy soon after. The treatment took four hours at a time, the mother of two says, after which nausea, exhaustion, body aches and shivers followed.

“I slept in the bathroom the first time I had chemo because the pain was so intense. I could not keep anything down, so I only ate jelly, and sometimes the jelly wouldn’t stay down either,” she says.

La Cock has a family history of breast and other cancers.Her maternal grandmother died from cervical cancer, and her

paternal grandmother succumbed to breast cancer. Her niece was diagnosed with lung cancer around the same

time La Cock received her diagnosis.She is eager to see herself through this journey, she says.“I have learnt to accept what God has put on my path, and

move forward,” she says. La Cock has refused an operation to remove the cancerous lump.

When lumps are removed, they are likely to return, she believes. “After research, talking to my doctors, and a lot of prayer, I opted for a no-operation approach. This was a fantastic choice for me, and I do not regret it.

“My husband has been very supportive all through my journey,” she says.

“It is amazing that God has given me the grace to endure this process in my life. I cannot explain it, but it’s a kind of relief,” La Cock says.

Adriaan l a Cock, Monique’s husband said: “When we got the news, I was very shocked.”

However, La cock just took it day by day and tried to stay positive. Prayer became a norm for them. “We also received a lot of support from family and friends which definitely helps a lot,” he said. The father of two said the cancer brought them closer together. I always tried to be as supportive as I can be and positive.

“I think it is very important to try to be as positive as possible even though it is very tough.We have been through a together. We have been together for eight years now and I am just glad I could be by her side to support her during this difficult time,” he said.

According to the Cancer Association of Namibia (CAN), breast cancer has been on the rise in recent years.

In 2013, only 315 cases were reported in Namibia while in 2014, 558 women were diagnosed with breast cancer.

In 2015, the country recorded 547 diagnoses, in 2016, 539, and 520 in 2017.

BREAST CANCER IN NAMIBIABreast cancer is the number one cancer among women in

Namibia. Most women diagnosed are over 40, but it can also occur in

younger women.

RISK FACTORS:• Family history – in about 10% of breast cancers

patients are older than 40 and have a family history of cancer

• Early menstruation – before the teens

• Late menopause – after the age of 50• Long-term hormone replacement therapy• No children, or the first child born after 30LIFESTYLE FACTORS:• A diet high in animal fat• Consuming more than two drinks a day• Smoking• Obesity or being overweight• Lack of exercise

WHAT CAN I DO?• Get to know your breasts, their shape, size and feel• Do monthly breast self-examinations (BSE) a week after

your last day of menstruation• Go for clinical breast examinations at a healthcare provider

once a year• Women older than 40 need to regularly have mammograms

My breast cancer journey

Photo: Garwin Beukes

GRACE ... Monique la Cock at the law firm in Windhoek where she works as a conveyancing secretary.

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Thursday 30 July 2020Spotlight on health 4

• ESTER MBATHERA

YVONNE Witulski lost two weeks of her life wandering around Walvis Bay in a state

of shock.All she can remember is asking

her domestic worker to go home and self-isolate, and making a phone call to staff at the workshop her husband worked at to lock up and go home.

This was the day Yvonne received news from the Welwitschia Hospital that her husband, Rudi (61), had tested positive for the novel coronavirus.

She struggles to remember the exact date. It must have been early in May, she says.

“I can’t even remember if the sun was shining, or whether there was a fishmeal smell in the air.

I only remember it was before lunch when the hospital called me,” she says.

Apart from what she has been hearing on the news, she had little information about the virus at the time, and the call left her terrified for days.

“I was very scared and nervous at first, because he is diabetic.

I was also scared because I have heard rumours about people with underlying conditions not making it,” Yvonne, who has an underlying health condition herself, says.

She was tested twice and her results came back negative on both occasions.

Before his Covid-19 diagnosis, Rudi fell ill at home.

He visited the family’s doctor and was diagnosed with gastro-enteritis, but was sent home. His temperature kept rising and Yvonne called the doctor again.

“They told us to wait for the medication to work. When he wasn't getting any better, I took him back to the doctor, who then admitted him to hospital,” she says.

Days later, Yvonne received news she did not expect.

Rudi was admitted to hospital, went into a coma and was put on a ventilator within days.

She was worried he wouldn’t make it. “When Rudi first went to hospital, I walked around like a zombie for two weeks. I couldn't eat or sleep. I was worried constantly.

Every time the phone rang, I thought it was the hospital.

I just carried on regardless; fed the dogs; did a bit of house cleaning – nothing major. I actually couldn't do much.”

Yvonne says she had to pull herself together and inform the couple's two adult children about their father's diagnosis.

Her son had just returned from the Democratic Republic of Congo and was in mandatory quarantine at

the time, while her daughter was in Windhoek. Yvonne says the children were not too emotional about the news as they expected it because of their father’s symptoms.

COMMUNITY SUPPORTThroughout this time, Yvonne

says she was not alone. She received daily phone calls, SMSes of encouragement as well WhatsApp messages from people offering support.

“I had a friend who brought me food daily and sweets, and she would call me at least twice a day to check on me. Another friend dropped off nutritional supplements to make sure I stay healthy. It was fantastic,” she says.

The Ministry of Health and Social Services also did their part through daily phone calls, offering her much-needed counselling.

Yvonne says the doctor treating her husband was amazing as he would phone her daily with an update on Rudi’s condition.

He was extremely compassionate, she says. She also had the full support of the Welwitschia Hospital staff and management.

HOMECOMINGIt took a month before Rudi was

removed from the ventilator, and it was declared safe for him to return home.

He was finally discharged early in July.

“When I heard he was coming home, I told myself to clean the house. I didn't get around to it, because I was too excited. They phoned me on the Thursday at 11h00 to tell me he was coming home,

I was in the process of putting my cat of 18 years down.

He was waiting for his daddy to come home, but he couldn't wait any longer. “I was so excited I wanted to get everything ready for him, but I didn't get a chance. It was great seeing him wheeled down the hospital corridor and out of hospital. It was so amazing,” Yvonne says.

ABOUT RUDI Rudi was Namibia’s 22nd

Covid-19 case. A refrigeration engineer for the

past 45 years, Rudi spends his free time fishing and occasionally hunting on a friend’s farm.

He is suffering the temporary loss of mobility in his arms and hands due to severe carpal tunnel syndrome caused by Covid-19, which frustrates him endlessly.

He was not available for this interview since he is still recovering.

Yvonne is currently nursing Rudi at home and taking care of their four Siberian Huskies.

‘My husband survived Covid-19’

SURVIVOR ... Yvonne Witulski says she feared her husband might not survive Covid-19 due to his age and diabetes. The couple is pictured here with their dogs.

Photos: Contributed

I was very scared and nervous at first, because he is diabetic. I was also scared because I have heard rumours about people with underlying conditions not making it.

- Yvonne Witulski

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• CHARLOTTE NAMBADJA

CECILIA van der Westhuizen never imagined she would become a nurse when she was employed as a cleaner at the Katutura

Intermediate Hospital in Windhoek a few years ago.Van der Westhuizen’s leap from cleaner to nurse

was no surprise to those who saw her passion.It was the dedication she showed that convinced

the Ministry of Health and Social Services to enroll her for a nursing course.

At the age of 44, the mother of two says she studied nursing and is proof that it is never too late to accomplish one’s dreams.

Van der Westhuizen says some patients who have known her as a cleaner at the hospital say

they are proud of her for becoming a nurse.“I enjoy my work [cleaning]. Some patients

who have known me for years have wished me well because of the way I used to clean,

which they said I did well,” she says.“When it comes to cleanliness, I made

sure the ward with was properly cleaned and I did not like to be disturbed while on

duty,” she says. Even though her duties now include attending

to emergency patients and not cleaning, Van der Westhuizen says she still picks up a mop and soap when she finds the time.

She believes one should give one’s best – even when entrusted with simplest tasks.

HUMBLE BEGINNINGSVan der Westhuizen started as a cleaner at

the Katutura hospital in 2007 and worked in that capacity until 2017, when she received two years of nursing training at the Keetmanshoop Regional Health Training Centre.

Upon completing the course, she was appointed as a nurse at the same hospital in 2019.

“I was a proud cleaner, but wanted to fulfil my dream of becoming a nurse,” she says.

“I will forever be grateful to my [hospital] management who sent me to study nursing. We need more encouragement, and other places’ management should follow this example.

“I therefore want more cleaners to take on studying and also enjoy a better salary,” she says.

Van der Westhuizen grew up in the //Kharas region on a farm called Kais where she lived with her grandparents, since her parents died when she was young. She moved to Windhoek in 1996.

She is the eldest of five siblings and has now become the breadwinner of her family.

Van der Westhuizen dropped out of school in Grade 9, but later improved her grades through the Namibia College of Open Learning.

“I am now able to take care of myself and my family, and to give my children what I couldn’t afford before,” she says.

Van der Westhuizen has a 23-year-old son and an 11-year-old daughter, and is a single mother. “It was the tough situation in life that motivated me to be who I am today. I had the financial crisis of just working for rent money and taxi fares. Sometimes I couldn’t afford basic necessities. I didn’t give up on myself and told myself I deserved better,” she says.

Van der Westhuizen hopes to inspire her former colleagues to follow their dreams.

Van der Westhuizen works at the Katutura Intermediate Hospital’s casualty department, which she says can be very hectic – especially at month-end and weekends.

But she is not complaining.“To work requires determination and passion,”

she says. Emilie Jacobs, a nurse who has been working at the Katutura hospital since 2008, said at the time she started working at there she found Westhuizen working as a cleaner.

She described Westhuizen as a hardworking and dedicated cleaner.

“We always used to send her to get us certain instruments like cylinders or thermometers or anything we might need at hand, she showed interest in becoming a nurse and used to ask a lot of questions.

“There was a day she asked me if she was fit to become a nurse someday and I told her she was, and that she just had to study and learn more of what she did not know. She knew most of the basic things we nurses did as she observed what we did like putting drips and drawing blood from patients,” said Jacobs.

From hospital cleaner to nurse

LEAP OF FAITH … At the age of 44, Cecilia van der Westhuizen is proof that it is never too late to accomplish one’s dreams.

Photos: Charlotte Nambandja

Thursday 30 July 2020 Spotlight on health 7

• TUTALENI PINEHAS

WORLD Health Organisation (WHO) officer on immunisation in Namibia, Rosaline de Wee says

the country is on track with global polio eradication.

Namibia has since 2008 maintained its status as a polio-free country, she says.

The last wild polio virus case in the country was reported on 26 June 2006.

“No case has been reported since 2006,” she says.

Polio is a highly contagious disease caused by a virus that attacks the nervous system.

Long-term concerns of people who contracted paralytic polio in childhood include post-polio syndrome, with symptoms appearing 15 to 30 years after recovery from the original paralytic attack, which occurs in 25% to 50% of cases.

Symptoms include acute or increased muscular weakness with the affected limb typically shorter and thinner than other limbs, muscle aches and fatigue.

De Wee says: “In 2019 more than 70 000 children were vaccinated orally and 63 000 with inactivated polio, which is complementary to oral polio to increase immunity.” This is not optimal due to the lack of vaccines experienced in 2019.

However, this was addressed in late 2019 with the procurement of vaccines with the support of Unicef through the UN-Pooled Procurement Mechanism. The WHO polio programme has always been ahead of other programmes, De Wee says.

To strengthen surveillance for polio, the WHO supported the polio programme of the Ministry of Health and Social Services

Namibia winning the polio warto institutionalise geographical information system (GIS) technologies for tracking and providing ‘real-time’ evidence of conducted surveillance activities using smartphones.

She says the WHO country office supported the health ministry and procured mobile devices for every district and regional surveillance officer to implement e-surveillance.

The Centres for Disease Control and Prevention has always been a partner in polio eradication and is currently also providing technical support with data managers. Director of primary healthcare services at the Ministry of Health and Social Services, Naemi Shoopala says despite the country making progress towards eradicating polio, Namibia is at high risk of polio importation due to the vaccine-derived polio virus type 2 from neighbouring countries such as Angola and Zambia.

Both countries reported confirmed cases in 2020, hence, Shoopala says, it is crucial that children receive all recommended vaccines – especially the inactivated polio vaccine that will protect the child against the circulating vaccine-derived virus type2.

Shoopola says it is also important that surveillance for all cases of acute flaccid paralysis under 15 years are detected and investigated to rule out polio.

“The incubation period is usually 7 to 21 days,” she says.

CHILDHOOD DISEASEWindhoek resident Tileni ‘Tile’ Shiimi

(49) was two years old when he contracted infantile paralysis or poliomyelitis (polio).

At the time he was living with his aunt at Lüderitz.

“I can’t remember how I caught the polio

ONE of the numerous complications of diabetes, is diabetic eye disease. This is called diabetic retinopathy. Diabetic

retinopathy is a leading cause of blindness. With early detection, this retinopathy can be treated. Such early detection and treatment can reduce the risk of severe vision loss by 90%.

Diabetes, especially Type 2, is on the rise and optimal management is vital.

How can blindness as a result of diabetes be prevented? It is now possible for your doctor to arrange for a real-time scan and examination of your eye at the Olympia Eye and Laser Centre in Windhoek. High quality photographic imaging of the inside of the eye can accurately detect diabetic retinopathy in the early stages of the disease.

This information is also valuable in evaluating the overall diabetic status of the patient. The retinal image captured is immediately evaluated by software powered by Artificial Intelligence and will also include a risk report for worsening of the retinopathy if not treated and if the general diabetes control is not improved.

“This improved evaluation of your diabetes control can be helpful in your understanding of your general diabetes control,” says Dr Jonathan Joffe, a well-known eye specialist from Windhoek. “Your GP or physician and an eye specialist can support you by advising on preventative measures to avoid you losing your eyesight. This modern technology is now available in Windhoek and can play a vital part in helping to protect your vision.”

If you are a diabetic, it is highly recommended to do this scan as part of your regular diabetes evaluation and pro-active management of your health and eyesight. Detected early, you have a good chance to protect your eyesight. For more information, you can contact the Olympia Eye and Laser Centre.

For further information: Birgit Hoffmann 061 372 612, 081 1223 302

How to protect your eyes when you suffer from diabetes

Rosaline de Wee

virus, nor should I say this virus caught me, but I remember growing up with it. It was not easy as, apart from the stares and taunts from other children, I was suffering from severe muscle aches and weakness in my upper legs and hips,” Shiimi says. Shiimi was diagnosed with paralytic polio, although his limbs are not deformed, but his feet and hips are weak and lack appropriate orthopaedic bracing.

IMMUNISATIONThe national immunisation programme

uses two types of polio virus vaccines, an oral polio vaccine (OPV), which protects against wild polio virus type 1 and 3, and the inactive polio type, which protects against all three polio types. The vaccine is given in addition to the oral vaccine to boost the immunity of the child and provide protection against type 2 polio.

The national immunisation schedule for polio vaccination is as follows:

• At birth (OPV)• Six weeks after birth (OPV)• Ten weeks after birth (OPV)• Fourteen weeks after birth(OPV) • Five-year booster (OPV) and• Ten-year booster (OPV)

Thursday 30 July 2020Spotlight on health 8

• CHARMAINE NGATJIHEUE

THE Ministry of Health and Social Services has put mechanisms in place to ensure essential health services such as infectious

disease support continues during the Covid-19 pandemic.

This is with the support of partners, including the World Health Organisation (WHO) and other United Nations (UN) agencies.

Infectious diseases as explained by the WHO are caused by pathogenic micro-organisms, such as bacteria, viruses, parasites or fungi. The diseases can be spread directly or indirectly from one person to another.

The common infectious diseases in Namibia are HIV-AIDS, malaria, tuberculosis (TB), and hepatitis E (HEV).

The WHO’s health promotion officer, Celia Kaunatjike, says the country is finding new ways to ensure it continues to provide services to those living with HIV-AIDS.

Moreover, the country is also adapting its response to malaria outbreaks in parts of the country, as well as to the burden of TB in Namibia.

She says although the response to infectious diseases amid the Covid-19 pandemic may be affected, monitoring, training and treatment activities are ongoing.Kaunatjike says the situation with other infectious diseases is currently generally under control, and essential health services are monitored and supported as part of the Covid-19 response.

“The health ministry continues to provide services, but by using various innovative mechanisms to limit visits to health facilities and to prevent overcrowding and the spread of Covid-19,” she says.

Infectious disease control ongoing

PILL MOUTHFULS ... A drug resistant tuberculosis patient taking her daily medication. The government says it is working to ensure that support to infectious diseases such as TB are not interrupted amid the fight against Covid-19.

File photo

STATISTICSAs of 17 May 2020, a total of 7 711

hepatitis E cases were reported since the outbreak began late in 2017, according to the WHO.

HEV deaths reportedly stand at 65 currently, of which 26 involve maternal deaths. Meanwhile, the prevalence of HIV as per the 2017 Namibia Population-Based HIV Impact Assessment (Namphia) report involves 12,6% of the population.

This means approximately 200 000 people are living with HIV.

There were 7 700 tuberculosis cases in 2019, a decline from 8 800 in 2018.

The country reported roughly 148 deaths related to TB last year, or 7,4% out of a total of 2 004 cases during the first quarter of that year.

During the first quarter of 2020, the country recorded 1 992 TB cases, with cases expected to rise to 8 000 or 9 000 by the end of 2020. Meanwhile, the WHO estimates Namibia reported 13 000 TB cases in 2018, with around 3 100 deaths.

Kaunatjike says to minimise the spread of Covid-19 and protect TB

patients, community health workers should monitor patients taking their medicine at community level instead of at health facilities.

From January 2020 to May, the country reported 32 malaria deaths. Cases jumped from 2 405 in 2019 to 10 921 over the review period, figures from the health ministry show.

In 2018 malaria cases stood at 26 050. “Currently the number of malaria cases is below the

outbreak threshold levels,” Kaunatjike says. She says Namibia continues to demonstrate best practices on HIV-AIDS, which have been shared across the African region.

“Key among this is the community dispensing antiretrovirals (ARVs) to people living with HIV to minimise hospital or clinic visits,” she says. Minister of health and social services Kalumbi Shangula told The Namibian that the ministry’s programmes continue despite the pandemic.

“We have appointed additional staff to deal with Covid-19, while the existing staff continues with the normal ministerial responsibilities, including the control of malaria, TB and HIV-AIDS,” he says.

The minister says efforts to improve access to sanitation combats both hepatitis E and Covid-19.

He says the government is looking at a multifaceted approach to contain the disease, which has seen most informal settlements in the country at risk because of the unavailability of potable water and ablution facilities.

Khomas governor Laura Mcleod-Katjirua says although the hepatitis E outbreak was first declared in Windhoek, in the Khomas region, it spread to other regions, including Erongo, Kavango, Ohangwena, Omusati, Oshana, Oshikoto, Omaheke and Hardap.

“Cases were reported mainly at informal settlements such as Havana and Goreangab in Windhoek, DRC at Swakopmund and similar areas in other regions, where access to safe water, sanitation and hygiene is limited.

A cumulative total of 3 819 cases were reported in the Khomas region,” she said in her recent state of the region address.

Lady Pohamba Private Hospital is a Namibian state-of-the-art hospital that providespatient care through specialised staff and equipment. The hospital is situated in Kleine

Kuppe on the corner of Frankie Fredericks and Ombika Drive in Windhoek.

The Hospital has a 24-hour 14-bed Trauma Unit, 7 Operating Theatre's, 2 SurgicalWards (which include 41 beds), a 7-bed Gastrointestinal Unit, 10-bed Intensive Careand 11-bed High Care Unit, a 34-bed Medical Ward, 11-bed Paediatric Ward, 6-bed

Neonatal Intensive Care Unit and a 12-bed Maternity Ward with a team of Midwives,Nurses, Obstetricians and Paediatricians working collaboratively to provide women

with a memorable childbirth experience.

Supportive services such as a Hospital Pharmacy, Radiology Department andPathology Department also form part of this dynamic team.

MEDICAL CARE THAT TOUCHES THE WORLD

Thursday 30 July 2020 Spotlight on health 9

Infectious disease control ongoing

Founded in 1998, Medical Imaging has established itself as a leading radiology practice of Namibia. By utilising state-of-the-art equipment, coupled with a team of dedicated radiologists, radiographers, ultrasonographers, and ancillary personnel, the best possible patient service is ensured.The whole spectrum of radiological imaging of the human body is offered, with specific mention of the following modalities:

Computed Tomography (CT):Multiple x-rays from different angles around the body are reconstructed in a complex manner in order to achieve detailed three dimensional information, effectively enabling radiologists to visualise any anatomical region of a patient. Every organ system can be individually assessed, including the vascular system. It is a particularly powerful tool in the trauma setting, where internal injuries can be detected efficiently and effectively.

Surgeons can plan operations based on information obtained by CT.

Several specialised uses of CT are available, including high resolution scanning of the lungs and temporal bones (including inner ears), angiography to assess vascular structures, cardiac CT and imaging of cancer patients.

Magnetic Resonance Imaging (MRI):Powerful magnetic fields are used to create detailed 3D images of almost any structure in the body. This modality is most often used for neurological imaging (brain and spine), but also for musculoskeletal and even intrauterine imaging.

MRI has become the most versatile and powerful imaging modality due to constant advances in technology. Several specialised uses of MRI have surfaced in recent years, including breast MRI, cardiac MRI, MR angiography and MR imaging of the hepatobiliary system.

The use of MRI in oncology patients has undoubtedly improved the management relating to diagnosis, pre-operative planning and follow-up imaging, particularly in the setting of prostate, cervix and rectal cancer. The introduction of whole body diffusion imaging has established itself as the gold standard for the detection of metastatic deposits from a primary cancer, and has replaced older, less sensitive investigations.

Ultrasound:Harmless sound waves are used to generate 2D and 3D images. Abdominal and pelvic organs are most often imaged, followed by musculoskeletal structures.By using different transducers (low frequency, high frequency, transvaginal, etc.) specific regions of the body can be assessed in detail.

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Roman Catholic HospitalTel: +61 256 452/3Fax: +61 256 837

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Mediclinic SwakopTel: +64 403 876Fax: +64 407 029

Computed Tomography (CT):Multiple x-rays from different angles around the body are reconstructed in a complex manner in order to achieve detailed three dimensional information, effectively enabling Radiologists to visualise any anatomical region of a patient. Every organ system can be individually assessed, including the vascular system. It is a particularly powerful tool in the trauma setting, where internal injuries can be detected efficiently and effectively.

Surgeons can plan operations based on information obtained by CT.

Several specialised uses of CT are available, including high resolution scanning of the lungs and temporal bones (including inner ears), angiography to assess vascular structures, cardiac CT and imaging of cancer patients.

Magnetic Resonance Imaging (MRI):Powerful magnetic fields are used to create detailed 3D images of almost any structure in the body. This modality is most often used for neurological imaging (brain and spine), but also for musculoskeletal and even intrauterine imaging.

MRI has become the most versatile and powerful imaging modality due to constant advances in technology. Several specialised uses of MRI has surfaced in recent years, including breast MRI, cardiac MRI, MR angiography and MR imaging of the hepatobiliary system.

The use of MRI in oncology patients has undoubtedly improved the management relating to diagnosis, pre-operative planning and follow-up imaging, particularly in the setting of prostate, cervix and rectal cancer. The recent introduction of whole body diffusion imaging has established itself as the gold standard for the detection of metastatic deposits from a primary cancer, and has replaced older, less sensitive investigations.

Ultrasound:Harmless sound waves are used to generate 2D and 3D images. Abdominal and pelvic organs are most often imaged, followed by musculoskeletal structures.By using different transducers (low frequency, high frequency, transvaginal, etc.) specific regions of the boy can be assessed in detail.

Ultrasound is available at all our branches, and is a cost-effective and quick method of imaging.

Mammography:A dedicated breast cancer screening service is offered. Advanced techniques are implemented as standard, including 3D digital tomosynthesis and computer aided diagnosis (CAD). Specific breast-related pathology is also addressed in addition to mammography, by means of ultrasound and MRI. Biopsy samples of suspicious lesions are collected by radiologists under ultrasound or stereotactic guidance.

Bone Densitometry:The bone mineral density of the skeleton is measured by utilising low dose x-rays. It is an excellent tool for the early detected of osteoporosis.

Radiography (X-rays):Almost any body part can be imaged quickly and cheaply by means of low dose x-rays. This provides 2D information about the skeleton, soft tissues, lungs and bowel, to mention a few.

Fluoroscopy:X-rays are used in a dynamic, real-time fashion, providing both anatomical and functional information. Common procedures to investigate the gastrointestinal tract include barium swallows, meals and enemas, as well as defecating proctograms, while cystograms, micturating urethrograms and intravenous pyelograms (IVPs) are employed to assess the genitourinary tract. Hysterosalpingography is performed as part of infertility workup.Imaging of the salivary glands can be performed by injecting a water-soluble contrast agent into the ductal systems of these structures.

Musculoskeletal Imaging:With the general trend of supplying more and more specialised clinical, orthopaedic and surgical options in Namibia, Medical Imaging has a dedicated program of continued education. We have sourced and trained a team of specialised orthopaedic and sports diagnostic sonographers and this, together with the needed special investigative scanners and radiologists with musculoskeletal interest, provide a local service of high and competitive standard. Ultrasonographic evaluation of tendon and muscle injuries are performed on a daily basis. MRI scanning of joints, cartilage, sports injuries and degenerative disorders also form part of our rendered services and routine.

Cardiac Imaging:Echocardiography is an ultrasound technique which provides functional and anatomical information of the heart. Cardiac CT is recommended as the first line investigation for low and intermediate risk patient’s presenting with new onset chest pain due to suspected coronary artery disease. Our team at Roman Catholic Hospital is well trained in obtaining diagnostic images of the coronary arteries to help referring clinicians to treat patients. Cardiac MRI is offered as a one-stop-shop multi parametric non-invasive tool for evaluation of myocardial function and accurate tissue characterisation. Functional studies include valvular assessment, myocardial viability and perfusion.

Prostate Imaging:While ultrasound and CT are useful screening tools for the detection of prostate disease, advanced MRI equipment and techniques are used for the detection of prostate cancer. Accurate staging, treatment planning and follow-up form the basis of this investigation.

Oncology Imaging:We provide a systematic and thorough service for oncology patients - from the initial imaging of a suspicious lesion, the biopsy sampling thereof, the characterisation and staging of disease burden, the radiation planning, to the surveillance and follow up after treatment.

Interventional Radiology:Invasive procedures are performed by radiologists for various reasons. This includes drain insertion for abscess or pleural fluid drainage, biopsies of suspicious lesions in the lung, liver, kidney, lymph node, muscle or skin, and stent placement within various organs.

Emergency Radiology:We provide a 24-hour emergency radiological service in Windhoek and Swakopmund, covering the disciplines of Internal Medicine, Surgery, Orthopaedics, Ophthalmology, Otorhinolaryngology and Obstetrics&Gynaecology.

Prompt radiological diagnosis of acute injuries, as well as the swift communication of these findings to the referring clinicians are critical in the management of acute care patients.

Founded in 1998, Medical Imaging has established itself as a leading radiology practice of Namibia. By utilising state-of-the-art equipment, coupled with a team of dedicated radiologists, radiographers, ultrasonographers, and ancillary personnel, the best possible patient service is ensured.The whole spectrum of radiological imaging of the human body is offered, with specific mention of the following modalities:

In our strive for excellence, the Medical Imaging team will continue to serve the people of Namibia across the private and public sectors. Our decision making is ethical and evidence based. We regard it our moral and professional obligation to ensure that prompt radiological service delivery will address the healthcare needs of the public, ultimately leading to physical, emotional and spiritual wellbeing.

Ultrasound is available at all our branches, and is a cost-effective and quick method of imaging.

Mammography:A dedicated breast cancer screening service is offered. Advanced techniques are implemented as standard, including 3D digital tomosynthesis and computer aided diagnosis (CAD). Specific breast-related pathology is also addressed in addition to mammography, by means of ultrasound and MRI. Biopsy samples of suspicious lesions are collected by radiologists under ultrasound or stereotactic guidance.

Bone Densitometry:The bone mineral density of the skeleton is measured by utilising low dose x-rays. It is an excellent tool for the early detection of osteoporosis.

Radiography (X-rays):Almost any body part can be imaged quickly and cheaply by means of low dose x-rays. This provides 2D information about the skeleton, soft tissues, lungs and bowel, to mention a few.

Fluoroscopy:X-rays are used in a dynamic, real-time fashion, providing both anatomical and functional information. Common procedures to investigate the gastrointestinal tract include barium swallows, meals and enemas, as well as defecating proctograms, while cystograms, micturating urethrograms and intravenous pyelograms (IVPs) are employed to assess the genitourinary tract. Hysterosalpingography is performed as part of infertility workup.Imaging of the salivary glands can be performed by injecting a water-soluble contrast agent into the ductal systems of these structures.

Musculoskeletal Imaging:With the general trend of supplying more and more specialised clinical, orthopaedic and surgical options in Namibia, Medical Imaging has a dedicated program of continued education. We have sourced and trained a team of specialised orthopaedic and sports diagnostic sonographers and this, together with the needed special investigative scanners and radiologists with musculoskeletal interest, provide a local service of high and competitive standard. Ultrasonographic evaluation of tendon and muscle injuries are performed on a daily basis. MRI scanning of joints, cartilage, sports injuries and degenerative disorders also form part of our rendered services and routine.

Cardiac Imaging:Echocardiography is an ultrasound technique which provides functional and anatomical information of the heart. Cardiac CT is recommended as the first line investigation for low and intermediate risk patients presenting with new onset chest pain due to suspected coronary artery disease. Our team at Roman Catholic Hospital is well trained in obtaining diagnostic images of the coronary arteries to help referring clinicians treat patients. Cardiac MRI is offered as a one-stop-shop multiparametric non-invasive tool for evaluation of myocardial function and accurate tissue characterisation. Functional studies include valvular assessment, myocardial viability and perfusion. Prostate Imaging:While ultrasound and CT are useful screening tools for the detection of prostate disease, advanced MRI equipment and techniques are used for the detection of prostate cancer. Accurate staging, treatment planning and follow-up form the basis of this investigation.

Oncology Imaging:We provide a systematic and thorough service for oncology patients - from the initial imaging of a suspicious lesion, the biopsy sampling thereof, the characterisation and staging of disease burden, the radiation planning, to the surveillance and follow up after treatment.

Interventional Radiology:Invasive procedures are performed by radiologists for various reasons. This includes drain insertion for abscess or pleural fluid drainage, biopsies of suspicious lesions in the lung, liver, kidney, lymph node, muscle or skin, and stent placement within various organs.

Emergency Radiology:We provide a 24-hour emergency radiological service in Windhoek and Swakopmund, covering the disciplines of Internal Medicine, Surgery, Orthopaedics, Ophthalmology, Otorhinolaryngology and Obstetrics & Gynaecology.

Prompt radiological diagnosis of acute injuries, as well as the swift communication of these findings to the referring clinicians are critical in the management of acute care patients.

Thursday 30 July 2020Spotlight on health 10

• ARLANA SHIKONGO

WALKING through the streets of Windhoek, one would not think the country has a comprehensive public smoking ban that has

been in place since 2014.In fact, Namibia’s government adopted its tobacco

products control bill in 2009, voted it into law in 2010 and put it into effect in 2014.

That piece of legislature was written under the leadership of former minister of health and social services Richard Kamwi.

However, Kamwi says Namibia has taken a step backwards.

“We wanted to prevent second-hand smokers from suffering, especially expecting mothers and children,” he said a recent interview with The Namibian. He says the act came with support, but also a multitude of opposition.

“In terms of the piece of legislation, we went further to be challenged by the American-British tobacco industry. They threatened to take me to court.

“With the support of the World Health Organisation (WHO) and our government, I was given the go-ahead [to challenge them] and they took me to court,” he says.

Kamwi says Namibia ultimately won its challenge as the bill got the stamp of approval in the National Assembly in 2010.

“Before we could go to court, I consulted Margaret Chen, the WHO director general [at that time] about this big challenge, and we received experts from the WHO to defend our case,” he says.

Regarding public smoking, the law prohibits this at all indoor public places, indoor workplaces and on all public transport.

“Our goal was to target all public institutions to ban smoking. That included offices, public and private; including vehicles, and when you speak of vehicles you are talking of any type of machine, including aeroplanes, cars, taxis, buses. “This includes the airport. At Hosea Kutako there used to be a smoking area. We fought to make sure all those were demolished,” Kamwi says.

Smoking was also prohibited in certain outdoor areas, as well as at the entrances and exits of public places and workplaces. The public smoking ban has, however, only strictly been enforced in enclosed, indoor areas.

Malls, for example, have pinned ‘no smoking’ signs on their entrance walls, but they still accommodate smokers by having ashtrays in outdoor areas close by.

Hosea Kutako International Airport once again has a designated smoking area by way of an ashtray dustbin located at the arrivals section exit door.

Kamwi believes the role of policymakers has been fulfilled as far as enacting the legislation and that the police should take it from there.

“Is it not true to say, when laws are there, the defenders of the laws are the police?” he asks.

‘THEY DON’T REALLY CARE ABOUT THAT LAW’A Windhoek-based smoker, Gerarld Basson, questions

the existence of such a law.“I would [initially] get a fright when seeing a police

Is Namibia’s public smoking ban all smoke and mirrors?

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officer while smoking in public, but then I’d realise they don’t really care about that law,” says Basson, who has been smoking for seven years. He says refraining from smoking in confined spaces is a given, but questions the logic of an overall public smoking ban. “I’m not sure why the law on public smoking was enacted, but the implementation thereof is a clear indication of how illogical it is at the end of the day,” he says. He says even when smoking was permitted in malls, it was restricted to open areas.

“Restrictions are a bit strict now – especially at Grove Mall where we are only permitted to smoke in the parking lot. “Smoking areas would have been ideal to be progressive and considerate,” he says.

Another smoker says she has observed no regulations at all, except the intuitive knowledge to refrain from smoking indoors.

The Namibian visited indoor/outdoor places in Windhoek where patrons are permitted to smoke as long as they are seated outside.

SMOKING AND COVID-19Smoking has been categorised as ‘high risk’ amid the coronavirus pandemic by the WHO. According to the organisation, research suggests smokers are at higher risk of developing severe symptoms and death if they contract Covid-19 due to the affect on the lungs.

“The act of smoking involves contact of the fingers (and possibly contaminated cigarettes) with the lips, which increases the possibility of the transmission of viruses from hand to mouth. “Smoking

waterpipes, also known as shisha or hookah, often involves the sharing of mouthpieces and hoses, which could facilitate the transmission of the virus in communal and social settings,” the organisation says.

NO POLICING NEEDEDChief spokesperson of the Namibian

Police, deputy commissioner Kauna Shikwambi says they will not be policing people who smoke in prohibited areas. However, she asserted that despite relaxed enforcement of public smoking regulation, the law has not been forgotten.

“We also have limited resources and personnel so we can’t be expected to go around looking for who’s smoking at the wrong place. People should not wait to be reminded,” she said.

In addition to being strapped of resources, she said the police is overwhelmed with responsibilities.

“Leaving everything to the police is not fair. Do you really want to be regulated by the police when you know it’s wrong?

“We know it is our mandate to enforce the law, but sometimes moral consciousness should also help people make that distinction,” she asserted.

Shikwambi proposed a series of educational public campaigns jointly rolled out by the police, health ministry and the media. The idea is to remind the public of the dangers of smoking and second hand smoking to incentivise self-policing. “The law was publicly made known. So, why are they [the public] not abiding by that?” she said, emphasising the need for public education.

Thursday 30 July 2020 Spotlight on health 11

• CHARMAINE NGATJIHEUE

NAMIBIA is trying to ensure that people living with chronic ailments are catered for despite the Covid-19 pandemic

disturbing health systems globally.The country has been grappling to secure

chronic medication among private healthcare facilities last month because Namibia imports its chronic medication from South Africa. Some of the chronic medication that was out of stock include those used to treat cancer and asthma patients.

Although the situation has been rectified, the shortage was due to the neighbouring country’s regulation to disallow the export of certain products.

South Africa are dependent on multinational

companies with hubs in neighbouring countries. As a result, South Africa requested wholesalers supplying Namibia to apply for export permits as a way to curb shortages in that country.Health minister Kalumbi Shangula said the country has since managed to have the bulk of the medicine delivered.

The Centres for Disease Control and Prevention (CDCs) defines chronic diseases as conditions that last a year or longer, requiring ongoing medical attention and limiting daily activities or both.

The major chronic diseases are cancer, diabetes, asthma and heart disease. “The Ministry of Health and Social Services continues to provide services through its facilities all over the country to people

living with chronic diseases,” World Health Organisation (WHO) health promotion officer Celia Kaunatjike says.

She says all services for chronic diseases are provided for at all health facilities, with some follow-up visits or treatment for stable patients spaced two to three months apart to reduce facility visits and the risk of acquiring the coronavirus.

Kaunatjike says people with chronic diseases like asthma, cancer and diabetes are more vulnerable to becoming seriously ill when contracting Covid-19.

“Reports from several countries show many are unable to access the treatment they need to manage their illnesses during the pandemic,” she says.

People with chronic diseases should be

informed and counselled to avoid being infected.

They should also continue their treatment in the safest way possible, receive prescribed medicine in advance and have access to telemedicine for counselling.

“Health systems all over the world are facing a lot of pressure. A lot of health resources must be utilised in the response, thus limiting resources available for other programmes,” she says.

Kaunatjike says the health ministry has provided guidance on maintaining essential health services, and put on hold non-emergency, non-essential health services.

“The health ministry is monitoring the utilisation of these services to intervene in a timely manner,” she said.

Supply of chronic medicine on the radar

Photo: Contributed

Is Namibia’s public smoking ban all smoke and mirrors?

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The medical superintendent of Onandjokwe State Hospital in Oshikoto region, Dr Akutu Munyika, has listed a few points on how pensioners and those living with chronic diseases can protect themselves against Covid-19 complications:

• Try to avoid the market place except when necessary to limit your risk of getting sick

• Wash your hands with soap and water before and after putting groceries away every time

• Get long shelf medical prescriptions to avoid frequenting the hospital where there is a higher risk of getting infected with Covid-19

• Take advantage of virtual care to protect yourself against exposure at clinics and hospitals and seek early treatment

• Seek mental support as much as possible• Take vitamins and supplements to boost your immune system and avoid

large gatherings

Compiled by Hileni Nembwaya

PROTECTION TIPS:

Thursday 30 July 2020Spotlight on health 12

• CHARLOTTE NAMBADJA

IT IS a cold Friday evening at the Katutura Intermediate Hospital’s casualty department, and patients are

queueing up outside the emergency room.Registered nurse Ruben Kankondo (36)

is attending to a drunken patient who just walked in with a broken, bleeding finger.

“What happened to you?” Kankondo

SCRIBBLING … Joyce /Khoeses, a registered nurse, takes records of patients for the night.

BLOOD CHECK … Nurse Malala Kolofu takes the blood pressure of a patient.

EMERGENCY ROOM ... A nurse checking the stability of a patient brought into casualty.

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An evening at Katutura hospital’s casualty department

The Namibian visited the Katutura Intermediate Hospital’s casualty department in Windhoek on 17 July to see what a typical night shift for frontline health workers is like.

asks as he cleaned the wound with disinfectant, careful not to further damage the finger. The man mumbles that he was cut with glass.

Kankondo says it is a quiet evening. The busiest time is at month-end when people have had too much to drink, he says.

“If you come to the emergency unit at month-end, you will not only see nurses and doctors, you will see and smell patients’ blood on the floor,” he says.

Fridays and Saturdays are the busiest times – especially between 22h00 and 03h00, he says.

As Kankondo attends to the intoxicated man, a woman and a 14-year-old boy walk out of the emergency room towards an ambulance waiting outside.

The woman is carrying a white plastic bag. She explains that the boy, who is her nephew, was severely assaulted at a bar in Golgotha during a drunken altercation and had lost all his front teeth. She is carrying some of his teeth in the plastic bag.

The ambulance wi l l be transporting them to the Windhoek Central Hospital where he was referred to for further treatment. As she speaks, more patients are wheeled into the emergency room.

At the opposite side of the room, a cleaner is mopping the floor, filling the room with the strong odour of disinfectant.

Here, floors are mopped regularly to rid them of blood and other bodily fluids – especially to lower the risk of the coronavirus. The department also has a room designated to any patient showing symptoms of Covid-19.

For now, it remains empty, and the emergency staff is yet to come face to face with a Covid-19 patient.

Kankondo says as emergency healthcare workers, their night

shift begins at 19h00 and lasts till 07h00.

Katutura Intermediate Hospital is the backbone of the country’s state hospitals, with hospitals at other towns referring patients here.

“We attend to most patients who are referred here. Even before they go to the central hospital, they have to come here first,” Kankondo says.

He says being a frontline worker requires strength and the ability to deal with stress and pressure – especially when there is an inflow of patients who all need urgent medical attention.

Kandondo proceeds to take us on a tour of the different departments at casualty: pediatrics, surgery, gynecology, the emergency area, and orthopaedics.

THE PANDEMICKankondo and his colleagues

say they are always ready for any situation that may arise – even Covid-19.

“The fear [of Covid-19) will be there, because you don’t know when you come across a patient who has it, even though we are dressed in our personal protective gear,” he says.

A registered nurse and midwife at the department, Malala Kolofu (30), agrees.

She says when the country reported its first Covid-19 case, she feared she may contract the virus on the job and pass it onto her family. She says they have now accepted it as their duty.

“We are just here to serve the nation. Being a nurse is a calling, and we took a pledge to become who we are. We are here to overcome all our fears,” she says.

Another casualty department worker says they are forced to overcome their fear of Covid-19

and focus on the task at hand.They say they always take

preventative measures by wearing masks and gloves as they cannot be sure when they are dealing with a Covid-19 case.

“Social distancing is a challenge, especially in the emergency room where we must work on a patient,” another nurse says.

WORKING WITH DEATHA staff member of the hospital’s

mortuary walks into the emergency room. He has come to collect the body of a sick baby who had died a few minutes ago. Just an hour before that, the body of an adult wrapped in white sheets was wheeled from the room and transported to the mortuary.

Kankondo says seeing death has become common for him.

“I used to dream of dead bodies when I first started working here.

But I have since become accustomed to it,” he says. On this particular Friday two babies did not make it, despite the team’s best efforts to save their lives.

SAVING LIVESLoise Epafras (25), a registered

nurse and midwife, who has worked at the hospital since last August, says they always work as a team, and nurses screen patients before referring them to doctors.

She says seeing a patient recover from a critical state is extremely rewarding – especially from resuscitation. She says that is the area of the emergency department where patients are given immediate life-saving treatment.

“When a patient comes into resus, and we bring them back to a stable condition, it is a great feeling I would say,” Epafras says.

Nurse Kolofu says they do not give up on patients who do not

Photos: Charlotte Nambandja and Henry van Rooi

Thursday 30 July 2020 Spotlight on health 13

• TUTALENI PINEHAS

LUYANDI Engelbrecht is a practising mobile massage therapist in Windhoek and has been self-employed since 2019.

She is trained in Swedish and hot stone relaxation techniques, and visits her clients in the comfort of their homes.

Engelbrecht says: “Helping people deal with stress and relieve body aches is my forte.”

She highlights the importance of wellness spas in combating stress – especially during the Covid-19 pandemic.

“When we’re feeling stressed, we need to address it as soon as possible,” she says.

“One of the best ways to do this is through massage,” she says.

She says making massages part of one’s lifestyle will not only improve well-being, but also help to maintain wellness for years to come.

The young business owner recommends that people drink lots of water throughout the day, do spinal exercises and meditate to improve focus and mood.

“Finish it off with one page of writing a journal. I do it myself,” she says.

Engelbrecht lists activities people can indulge in when

they feel stressed. Do a home workout at least three days a week, she says. “I know we can get lazy sometimes, but sit less, and take breaks from your computer, tablet or cellphone every 20 to 30 minutes.

“Make stairs your new best friend, dance the Covid-19 blues away, or give pets and kids more play time than they ever had,” she says.

Engelbrecht advises people who are dealing with Covid-19 stress at work to talk to their supervisor to get support; keep a journal; develop healthy responses to challenges, and establish boundaries.

“It is imperative to take time to recharge and learn how to relax,” she says.

Engelbrecht says 60% of people are always interested in attending wellness programmes – especially if there are treatments involved.

Her massage therapy sessions usually last for an hour and a half, which involves a full-body massage, and a back-and-neck massage which is normally 45 minutes long. She says there has been a decrease in clients since the outbreak of the virus, but she continued working during the lockdown while adhering to safety measures.

Engelbrecht says her spa accommodates mostly men.“Not everyone can afford to go to a spa to get pampered,

but I have specials regularly to accommodate everyone,” she says.

Wellness at your doorstep

As a responsible corporate citizen, and a long-term partner of the Namibian government, Namdeb is proud of the pivotal role it plays in the fight to mitigate the impact of the COVID-19 pandemic. As part of our comprehensive response plan, we have now introduced our own fully-fledged testing facility in the town of Oranjemund. This is a massive step in safeguarding the health and safety of our employees as well as local communities. Namdeb remains committed to extending its support towards building a healthy Namibian nation.

WORKING TOGETHER IN THE FIGHT AGAINST COVID-19 FOR A BETTER AND HEALTHIER TOMORROW.

Photo: wallsheaven.com

immediately respond to treatment, and often keep trying for up to five hours to stabilise them.

As the evening draws to an end, patients still keep arriving at the department at midnight during our visit – some with stab wounds and others bleeding from accidents.

For Kankondo, Epafras and Kolofu, the busiest part of their shift has just begun.

*On 17 July 2020 when The Namibian visited, the casualty department alone had recorded 170 patients and 107 patients on 18 July.

NIGHT CREW ... Night duty staff at the hospital’s casualty reception.

Ruben Kankondo

Thursday 30 July 2020Spotlight on health 14

• CHARLOTTE NAMBADJA

AFTER reading about people taking their own lives in the news, Jesaya Shilongo says he revisited the time

he attempted to take his own life.“Most of the causes of suicide I’ve read

about are problems that can be solved, but people choose to take their lives instead of consulting a psychologist who can help,” the 33-year-old, who claims he attempted suicide three times, says.

Shilongo, who is currently unemployed but does odd jobs, says he has learnt lessons through his experience and now appreciates the gift of life.

The father of one says when he suffered from depression he was looking for an escape.

“I had a great job and salary [as a customer care agent], but I was in terrible debt. I borrowed money through cash loans, banks and overdrafts, and I owed on phone accounts, furniture and clothing,” he says.

Shilongo says while suffering these financial woes, his relationship with his girlfriend took a turn for the worse, which to him, was the last straw.

He recalls trying to take his life after she left him due to his depression.

“ I received my payslip [at the time], and my salary just wasn’t enough, which

made me think it was better to die. I failed to support my daughter financially and couldn’t afford my rent, and I lost interest in going to work because I felt like I was working for debt, and started making excuses not to go to work,” he says.

Shilongo says he spent the little he earned on alcohol and was later forced to resign due to his habit becoming an addiction. In an attempt to end his life in 2016, Shilongo says he overdosed on pills that landed him in the intensive care unit of a hospital.

A cousin of his had found him lying on the floor at his place and had called the ambulance.

One of Shilongo’s cousins, Onsemsus Shimwino, said Shilongo’s suicide attempts started as a teenager when he tried to hang himself but the family intervened.

Shimwino says the family was fortunate to have found him lying on the floor of his apartment in 2016, because they could phone an ambulance and get him to hospital on time.

At the time, Shimwino says he knew his cousin had been battling depression for a while. Following these suicide attempts, Shilongo sought professional help to overcome his depression.

He started to accept reality and took counselling to heart. He says taking advice

from his psychologist helped him pick up the pieces.

The single father now says he wants to be a responsible family man and further his studies at the University of South Africa, majoring in information technology to enable him to support his daughter.

Windhoek-based psychologist Dr Joab Mudzanapabwe, who treated Shilongo’s depression, says different types of depression can lead to suicide attempts and thoughts.

“It can be an element of hopelessness when a person feels there is no escape from an unbearable emotional pain. They feel like the pain of dying is better than the pain they are in,” he says.

Major causes of depression are grief and the loss of wealth or possessions, among others, Mudzanapabwe says.

Some individuals may take their own lives due to feelings of guilt, shame, embarrassment and the failure to achieve goals, or failed relationships.

He says at times, some people may try to escape their problems by abusing alcohol or drugs and could start considering suicide.

This is caused by anger at oneself, among other things. Mudzanapabwe urges victims of depression to seek counselling.

‘Appreciate the gift of life’... suicide survivor opens up

-Joab Mudzanapabwe

It can be an element of hopelessness when a person feels there is no escape from an unbearable emotional pain. They feel like the pain of dying is better than the pain they are in.

Jesaya Shilongo

24 Hour EmergencyServices

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Ondangwa Private HospitalYour health is your wealth

Thursday 30 July 2020 Spotlight on health 15

• YOKANY OLIVEIRA

WHEN entering any shop these days, you are expected to fill in a register with your contact

details and sanitise your hands.In addition, you are also required

to wear your mask before entering any establishment and to have your temperature checked. ‘No Mask No Entry’ reads the sign on some shop windows.

The above scenario has become the new normal for people everywhere since the outbreak of Covid-19 with all businesses required to have a registry at the entrance for purposes of contact tracing.

“It’s definitely a tedious process because you have to do it at every shop and still do social distancing,” says Tutala Uushona, who lives in Windhoek.

Uushona says she would prefer to register with a hands-free registry to avoid possibly touching contaminated pens and standing in queues.

Uushona also suggests that malls register people upon entry at the mall instead of every shop entrance.

Fatima Bailey, a Windhoek resident, agrees that this process takes time, especially after it became mandatory. “Most businesses now have more than one book or sheet available, meaning at least it is now quicker,” she added. She also added that some personal information was not necessary to provide.

“I did have a problem with them asking for my identification number as I do not understand the significance of it,” she says.

Bailey says she had gotten into a minor argument with a security guard at a shop because she was refused entry for not filling in her identification number. Health minister Kalumbi Shangula says the process is necessary for contact tracing.

“The law requires that people visiting public places provide all contact details. These are required for contact tracing,” he said during the country’s state of emergency announcement earlier this year. The health minister said these records of information are kept safe and must be produced to an authorised officer and shops are not required to make a database.

However, this manual process has proven to be cumbersome and some businesses have no way of effectively tracing customers who have visited their establishments. The sharing of pens from one customer to another also poses a health risk.

Some businesses have come up with a safer and easier way for customers to register at shop entrances without having to touch a pen and manually fill out their details.

Intouch Interactive Marketing believes it has come up with a solution. In July, the technology hub launched Namibia’s first digital registry platform called C19 Registry, which is accessed through the user’s mobile phone.

The registry system has been deployed to selected businesses at the Grove Mall, including Shoprite Checkers in Windhoek, Pick n Pay Wernhil and Namibia Media Holdings, among others.

The first plan for the C19 Registry starts at N$39 per month for one business. The service is, however, free for churches, schools, and charities as well as business that occupy floor space of less than 100 square metres.

In an interview with The Namibian, Intouch Interactive Marketing chief executive officer Derrick Briers said it takes 20 seconds or less to get into a business using the C19 Registry.

One important benefit of using this system is that it automatically signs you out when you move from one business to another which is using the same system.

The system will also automatically sign you out at midnight in case you have forgotten to sign out throughout the day.

This is because each business has a unique QR code, which is scanned using the C19 Registry app, which in turn is able to detect a new QR code when entering another business using the same system.

“In a book system you will see that someone was there but you don’t know when someone has left,” Briers says. He said if a business is making use of the C19 Registry system it would also be easier to pull records of information digitally as opposed to going through records on information manually.

“When a positive case is tracked somewhere, the health ministry can approach the business and the business can extract information from their

database immediately and provide it to them,” Briers explains. The business however, would only have access to the people that went through their doors and not access to who entered another business.

If the health ministry needs all the information regarding a customer’s whereabouts, the full traceability of a specific customer can be obtained through the C19 Registry system.

In order to protect people’s privacy, Intouch Marketing does not give out people’s information to the public or other businesses other than the government authorities.

“We value the information as confidential. By using the system, people consent that they will adhere to rules and regulations,” Briers says.

HOW IT WORKSWith the C19 Registry system,

all a customer has to do is register themselves via www.C19.com.na

You then enter your information once off. This includes your full name, ID number, email address, cellphone number, residential address and password for the system.

After registering, the user or customer checks into a business by scanning the QR code upon entry.

Briers also noted the technology gap between people with smartphones and access to the internet and those who do not have access.

“We are working towards some other options [for those without smartphones] but the problem with that is we’d have to use an SMS confirmation and there are costs involved in the current economic circumstances,”he says. Shoprite Namibia’s deputy divisional manager Schalk Pienaar said the retailer has depleted the registration books available and will be making use of the new and advanced registry system soon.

“We are almost at the end of the books now. You fill in all information on this platform and when you enter the store you just scan the QR code,” says Pienaar.

“We will go that route soon,” he added.Businessman Angelo Prokas, at

The Grove Mall in Windhoek says his company has already deployed the C19 Registry. According to his observations, the only minor barrier is getting the

‘Stop and screen’ – the new normal

CHECKING IN … Some customers fear they may be putting themselves at risk of contracting Covid-19 when sharing pens and papers to fill in mandatory registers upon entering business establishments.

Photos: Garwin Beukes

public to sign up and communicating this new technology to customers.

“People don’t have a barcode scanner app,” he says, while encouraging people to register at home.

“Once they get it, we’ll see how easy it is,” he says.”I don’t go to the shops because of this [manual registration process], with this app it’s so much easier.”

HANDS-FREE … The Smart Shop at Grove Mall has deployed the C19 Registry system upon entry. Customers are encouraged to use their phones to enter the store but are also given the option to manually register upon entry. The C19 registry allows customers and employees to sign in without having to fill in the forms by scanning a barcode, unlike manual registration.

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Thursday 30 July 2020Spotlight on health 16

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Point your camera at this QR code to download the Medici App today to connect with your healthcare provider.

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Your doctor is a click away!

As children are returning to school after three months of not attending school due to the nationwide COVID-19 lockdown, there is a fear that having been isolated for an extended period of time without regular interaction with large groups of their peers, their immune system might not be as robust as it should be. Parents are worried about a compromised immune system and the effect this will have upon their children’s return to face to face schooling. With the fear of catching the Corona virus parents have also been over sterilizing their homes and other environments in which kids live. What parents need to understand is that exposure to naturally prevalent microbes will stimulate and strengthen the immune system in children.

As experts are still learning about COVID-19, part of what they are trying to determine is why there are far fewer cases of the virus reported

For all parents, winter is a dreaded time of the year, as it is flu season and children being like germ sponges tend to bring the flu home with them from school during this period. This year has thrown a spanner in the works with regards to the COVID-19 pandemic.

in children, and why it has caused a milder infection in children than in adults.

It is important for parents to remain calm and not overreact to children over the age of 6 years showing flu like symptoms such as fever, cough, sore throat, runny or stuffy nose, body aches, headache, fatigue, vomiting and diarrhea. However children younger than 5 years, and especially those younger than 2 years, are at a higher risk of developing flu-related complications such as dehydration, ear infections, pneumonia and even inflammation of the heart muscle and brain, so in these cases it is important to reach out to a healthcare professional, especially during the COVID-19 pandemic.

To help assist worried parents, NHP has Babyline available to its members. Babyline is a dedicated 24/7 toddlers PAED-IQ service to

provide information and services to parents and caregivers in cases when a child is not well but does not need immediate medical

attention. With BabyLine NHP offers a paediatric telephone service to parents, which is available 24/7, 365 days a year. The service offers

healthcare advice to parents with children under 3 years of age and is delivered by skilled registered healthcare providers.

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Because we care

Call the toll-free number 0800 255 255 and you will be connected to a paediatric trained registered nurse.

We’re about youtel 061 285 5400, website www.nhp.com.na

NHP introduced the Medici telemedicine app to its members in 2020. The application offers

patients and doctors the convenience of conducting virtual consultations. The COVID-19

pandemic and ensuing lockdown has served to raise awareness regarding the increasingly

important role that telehealth will play in the future in making access to healthcare more

readily available irrespective of one’s location.

Benefits of using the Medici telemedicine app