The Executive Secretary of Anambra State Health Insurance Agency and Special Adviser on Health to Governor Willie Obiano, Dr. Simeon Beluonwu Onyemaechi has disclosed plans for the deployment of Fr. Arazu’s acclaimed coronavirus drug ‘Chioma’ to different hospitals in Anambra State, especially those with ASHIA enrollees for the effective management of coronavirus patients.
Dr Onyemaechi in this interview with Fides reporter, Chioma Ndife, looked at the various possibilities for effective management of COVID-19 patients in Anambra State.
Below is excerpts of the exclusive interview.
As the mantra of the Health Insurance Agency is Good Health to Ndi-Anambra, What has the Agency been doing since the outbreak of COVID-19?
What we have been doing is one question, but what we did, even before it became a serious thing in Anambra is another question. Now, to put it together, I will say that, from very early in the year, the Governor of this State, his Excellency, Chief Willie Obiano, in his trademark visionary style of leadership called together the members of the state executive council, which I am a member of and assigned us the task of going to different markets in Anambra State because our people are majorly traders to sensitize them on the prevention of COVID-19.
As at that time, it was still called China Virus because it was in January. We started this sensitization effectively 29th of January. What that meant was a governor who saw that most of his people travelled to China and all other part of Europe and America where COVID-19 was at that point beginning to be a major challenge for their business activities. Concerned with the fact that these people may have inadvertently contacted persons with COVID-19, and maybe infected, he decided that we should start very early to talk about the preventive measures.
So, we keyed in as an agency of government, following on from that lead by his Excellency. We developed risk communication messages, that as an agency, we went round all the health care providers’ premises in Anambra State Health Insurance pool. I was part of it, at least I went to sixty of those facilities myself of the over 200 hospitals that we have providing services in this scheme.
We looked at it holistically, that as an agency, health care workers who are supposed to be rendering services to Anambra State Health Insurance scheme enrollees were in the frontline, weather they work for the government or in the private sector, it is immaterial, our enrollees will go everywhere to access care.
A health care workers who doesn’t feel sufficiently protected or a health worker who is not knowledgable enough in the prevention of Covid-19 as well as in its early diagnoses may not be able to render proper care to ASHIA enrollees. So we approached the governing council, led by Prof. Ilochi Okafor, and there was an approval for us to go out to procure personal protective equipment to give to hospitals rendering services to our enrollees.
The equipment we brought were the very basic things that were necessary; face mask, hand sanitizers, hand gloves and these things have become outrageously expensive. The prices have skyrocketed across the entire world, so giving someone these PPEs at this time, is a big deal. So we went out of our way, procured, even though we are not owing any hospital capitation neither are we indebted to anybody in the payment of fees for service.
So essentially, there is no financial obligation we owned them at that time that was outstanding yet we decided to pay for service and capitation very early for that month, that was March, when all of this started. We paid it very early, as well as went ahead to procure these things and shared across all of our providers. At each of the places we went to, we gathered the health care workers, educated them on Covid-19, the pathophysiology, Epidemiology, as well as factors for prevention, early diagnosis and treatment.
This was carried out through interpersonal teaching experiences at all of our health care providers’ premises. There was question and answer section. We did these to ensure that our people will feel a sense of belonging. Reaching out at that time to health care workers was a very big plus for us. Following on from our engagement with them, different health care providers began to rearrange the way they saw patients in their premises, creating avenue for proper physical distancing between enrollees who would come to access care.
Ensuring that every health care worker had their face mask on and wearing it properly, that is very important, so that the health care worker doesn’t infest himself or herself by wearing of the face mask. And most importantly, ensuring that any patient who works into any health care providers premises, must have face mask on, covering their nose and mouth to avoid infecting people who come into hospital innocently to access care. We encourage our providers not to deny care to anybody, all they needed to do was to take these precautions and we did all of these physically, so that is the extent we went to support them, because it is one thing to teach people what to do, without giving them equipment, you have done nothing.
That is the very key thing when you are talking about health education advocacy targeted at behavioural change, in society, because when you teach somebody, this is what you are supposed to be doing, then you give him what he was supposed to work with to do that new thing you want the person to do, that way, you achieve attitudinal change.
We went to them, educated them, told what they should be doing and gave them PPEs but this was limited to only the hospitals weather public or private to mission that are signed to ASHIA. Even those who had just one life in our scheme, we gave them respectively. That was for us, the height of corporate social responsibility from a government agency to people who are clients and providers within our network. That went a very long way in encouraging our health care workers to continue to see ASHIA enrollees during this Covid-19.
Talking about the PPEs that were distributed, can you quantify the quantity that were given to hospitals because there were cases during the heat of the Covid-19 were hospitals rejected people on the ground that there were no PPEs to be used?
I am aware that such things happened. We kept talking about it, of course I’m a member of COVID-19 action team, which is led by the governor himself. These are issues we discuss every day and his Excellency kept giving directive on that and even made broadcast, where he spoke against it. He said nobody has the right to deny health care services to anyone, because we were trained for these as medical doctors and health care workers generally in this time. But I can assure you that ASHIA enrollees were not denied services.
It is on record because we sensitized our enrollees that these are times when certain things like these can happen, but they should make sure that they don’t take it from the providers and once it happens, they should call us. We have 24 hours call line but that is what we prevented because the prevention and mitigation strategies that we put in place helped us a lot, going round our own facilities to tell them not to do such that there was no need, all they needed was to protect themselves. We gave packages of gloves depending on the number of enrollees that a particular hospital is managing.
There are hospitals that are managing upwards of 9,000 lives in our scheme, you wouldn’t expect that for the volumes of patients that they see, that we are going to give them the same personal protective equipment volumes we give to someone managing 10 lives in our scheme. Those who have more enrollees got more and those who have fewer enrollees got less.
During the heat of the COVID-19 Pandemic, different isolation centers were setup for COVID-19 carriers and they were treated and released from the centers at different points. What were the measuring tools to ascertain that one was free from the virus and which drugs were used for the treatment of the of the COVID-19 cases.
The criteria, the guidelines keep changing, this is a new disease, a novel disease, it keeps evolving. Initially, you need to get someone diagnosed positive and then you treat the person using any protocol that any particular state had developed and adopted. When you treat, after a certain number of days, depending on the protocol you have shown as a state. In Anambra, we developed our own protocol, customized for our state.
Tell us about the Protocol?
Is unethical to do that. As a medical doctor, I’m under oath not to say such things. And the reason is very clear, there is no secrecy in orthodoxy medicine, we do this, to protect the potency of drugs. Medication is mostly abused, if one don’t have an illness and start taking medication for it, the day the person now have that illness, that medication will no longer work optimally and people could die from that. Just as it had happened with malaria initially, we were treating it with Chloroquine, after a while, it stopped working, we went up to using only Fansidar.
Fansidar was working before people started abusing it also, taking fansidar without going for test, that is sulfadoxine and pyrimethamine people were taking it, meldox, all of those kind of drugs, at a time it was working, after a while it stopped working because we were abusing it. So this is something novel that we must be very careful about not to let out the regiment to everybody and then people now go ahead abusing it. And most importantly, some of the drugs in that regiment, can cause, arrhymia, for the heart to start beating irregularly. And when that happens continuously, a patient could die from it.
So when people are not under supervised care and they take such medication on their own, they may not know the parameters to look out for. Before you place people on such medication, they are base line investigations that you must do. Like to check the function of the heart, kidney, liver and such kind of things. Failure to do so, you will not know what particular regiment to use, because it is not a one-side-fit-all approach to treatment. People could just go ahead and take anything and this might result to death. And when they die, you have killed them that is allegistrojic cause of death.
You the health care provider have succeeded in killing a patient. So why not individualize your treatment, personalize care. When people come down with issues, you detect them early, which is the most important thing, let people come forth, make call to the public health emergency operation center lines to report their symptoms. They will take your sample immediately and start treating the patient early, because it’s instructive to know that most of the mortality that we have had in this state unfortunately, may all their souls rest in peace, happened because of late presentation.
So when people have symptoms early and not go for self-medication, but rather present themselves to the system, and they are diagnosed early, treatment will commence early and they will be treated early by the grace of God and they are fine. So that’s what is important to us, for us to have early diagnosis so that we can have early supportive management for the person to turn around quickly. So the guideline for discharge after someone have been treated, is when you have two negative results consecutively, using the PDR test. Then we discharge the person to go home, we decontaminate the person’s environment and send the person home.
But that guideline has evolved now, you can find the latest guideline on NCDC website. This is a public health advisory now for the country, it’s in public domain, which now gives the number of days you should treat a patient, the number of days a patient should be symptom free, before one is discharged and what have you, so the guideline keeps evolving. As the guideline keeps evolving, in Anambra, we will keep adopting best practices in line with international standard for the management of patients with COVID-19.
Some Nigerians and Anambraians including Fr. Arazu have come up with drugs which they said haves the potency to cure coronavirus. What is the state doing in line with the adoption of the claimed healer drugs just like that of the Madagscar was adopted firstly in the home country of production?
I am happy to tell you that Governor Willie is one of the two governors and he is in fact, the first to appoint a special adviser on indigenous medicine, in the person of Dr. Onyeka C. Ibezim. What that means is that for once, a governor understood the importance of those who trade on herbal medication. In our traditional herbs, that Africans were used to and the kind of things that Asians do, let us formalize what happens there and bring in standards and all of that. And that office has done a very great job with people who come up with traditional and herbal medicine in Anambra State.
To answer that question straight, this same office has since the advent of COVID-19 worked very closely with people who have developed different herbal concoctions that are claimed to be effective for the treatment of COVID-19. The guidelines is that when you have it, you send it to NAFDA (and begin the processes of satisfication and eventually registration, it will be licensed for use.
And Dr. Onyekachi Ibezim is working very closely with Fr. Arazu and others who are actually members of the board of the Traditional Medicine Council in Anambra State. They are all working together and the State Government is promoting what is happening in that sector, and is strongly involved in the processes that they are going through right now in NAFDA. To that extent, once they go through these processes scientifically, and their concoctions are returned as effective against covid-19, why not, this state government will be the first to champion it, because he has not hidden his belief, in the strength of the Anambra Man.
What is ASHIA’s activities lately to contain the spread of the Virus?
ASHIA, we have been going out encouraging people within the limit of social and physical distancing, to encourage people to come on board health insurance scheme. This is a time when it is most important for people to have health insurance scheme, a time when economic crunch with its attendant depression anticipated globally.
This is a time when people should not be pushed to catastrophic health care expenditure, when people will start selling lands, cars and their valued properties to access health care. So, there is no better time to key into a health care scheme that is prone to delivery on its mandate in the last two years, which is what his Excellency did with ASHIA to give our people affordable and quality health care with just one thousand naira a month and twelve thousand naira per annual.
We have ASHIA enrollees who currently have covid-19 and are being treated. ASHIA was informed early enough but because of patient confidentiality) I wouldn’t get into details. Immediately ASHIA was informed, we quickly linked them up with NCDC and they have been calling us because we linked them up to Public Health Emergency Operation Center. Once patient is treated we also facilitate immediate screening of their household members. So there are lot of advantages for enrolling in ASHIA at this time. We are encouraging our people to keep embracing this scheme.