Dear Editor,
Deputy Chief Medical Officer Dr Karen Gordon-Boyle in the COVID-19 Daily Update of May 14 described the conditions at the quarantine and isolation facilities. Included in the quarantine facilities she said are games, free internet connection and television, telephone services to call family and friends and psychosocial support sessions. For the isolation facilities, she added, “the conditions are the same, access to free Wi-Fi, three meals, [and] outdoor space to move around.”
“I am sure that some of you have fears about quarantining and isolation but be assured that the Ministry of Public Health has set up these facilities bearing in mind that you are away from home and so is trying to make you feel as comfortable as possible,” Dr Gordon-Boyle said.
Though I hesitate to contradict the doctor, her comments have been widely shared and having been in the isolation facility at the Diamond Hospital for several weeks now, I know that the reality is different.
I initially chose to refrain from a public airing of the conditions here. As I have explained to others, public awareness of the situation here may deter others from testing if they fear coming and experiencing these conditions and this would have major implications for efforts to stem the spread of COVID-19 in Guyana.
However, for weeks, we have been pleading for improved conditions but little has changed. The only tangible response to date has been from UNICEF which donated some items on Friday. With more persons being admitted including minor children, the situation has moved from tolerable to dire and working with the system has brought little results.
There is little comfort here. Though officials speak of free internet access and televisions, at the Diamond facility, there are none. Forget about games or psychosocial support.
More troubling, however, are the circumstances under which patients are expected to combat the virus and work towards recovery. Conditions here are not conducive to rapid recovery and processes are such that trust in the system diminishes daily.
Based on the number of persons at the facility at any one time, some patients have to sleep two persons to a room which, at most, measures 12 feet by 10 feet. The situation now is that some rooms have two patients inside with beds three feet apart while others have one person inside. However, this would change as more persons are admitted. In such close confines, we are advised to leave the room only when necessary, to get food and go to the toilets and shower. On most days, the rooms get very hot during the day, notwithstanding the ceiling fan, and as everyone by now knows, the minimum distance advised to keep apart is six feet which is all but impossible in such a cramped space.
The blocks for the male section are set up so that 12 persons have to share two toilets and a shower. At present, the block I’m in has nine persons. Now, hygiene practices for a typical day involves spraying the doorknobs of the room, shower and toilets, the toilet handles and seat, the knob for the shower, the taps, the chairs and any place that we lean when we go to the verandah for fresh air, with sanitising liquid. That rapidly diminishes the supplies sent by families and though we have pleaded with the medical teams here for more, only a very limited amount is provided from time to time.
Further, patients are expected to use one mask for two days and are advised to sleep with a mask on, particularly those who share a room. At the beginning of my stay here, I had to use one mask for almost three days (forget about cloth masks and washing; we have to make our own lines in already cramped rooms to hang towels, and other items which can take a long time to dry). I dare anyone to try to sleep in a mask and reuse it the next day. It says a lot about Guyanese society that as people die and as patients beg doctors and others for masks that such support is not directed to this critical area as well. Even the medical personnel have to reuse their masks.
The medical personnel continually emphasise the importance of social distancing due to the high risk of cross contamination or reinfection but if we want hot food (the food of variable quality invariably arrives cold) or a hot cup of tea or hot water or cook, we have to use the one microwave and stove that many others are using in the male section. That obviously increases the chance for reinfection. For the males, who are housed in the upper flat, there are two kitchens but only one is equipped.
Most critical, is the unstable water supply. In the past three weeks, for at least five days at different periods, there was no running water in the upper flat. The latest was from the afternoon of May 13 to the afternoon of May 14. It has been drilled into the population to wash our hands, and enhance hygienic practices to combat the spread of the virus. In all matters hygienic, water is a main component. How then are the persons here expected to practice good hygiene when sometimes there is no water? The situation is such that once I woke at 3am to shower and we keep the single bucket made available filled with water just in case.
Contracting COVID-19 is bad enough; being forced to endure such circumstances for recovery is worse. Say nothing of the impact to mental health. As I mentioned, the conditions here are not conducive for rapid recovery.
Moreover, trust in the system diminishes daily. After the initial 14 days spent here, patients would be tested again but the results sometimes takes days to return. One person tested negative in one week and did the second test (two negative tests results are required for discharge) the following day so that he could be cleared to go home but only got the results six days later and it was positive. Another man did not get any results at all but was asked to do another test and days after is still to get the results. Some people tested negative and then positive. And these are not isolated incidents. It leaves people questioning the system and diminishes their trust in it. It also begs the question as to whether reinfection is occurring and at what scale. Given the conditions here, that is not implausible. The doctors continually warn of the risks of reinfection and that is a legitimate concern given that the disease is new and much is still to be learned about it including the role of antibodies. Many persons take longer than two weeks to recover and at least one person has been here for over two months as the tests keeps returning positive for COVID-19.
Claims that services like free internet access are available when that is not the case also undermine that trust so critical to fighting the spread of the virus. Further, many persons have said that when told that they would have to come to the isolation unit here, assurances were made regarding the care and facilities available. However, the reality is different.
Safety is another issue as locks on some doors are not working. Around May 5, someone stole a phone but the police refused to come in here. One policeman eventually arrived on May 14 and reportedly recovered some phones. With the number of children having increased here, safety is critical.
There are several other areas of concern but in the interest of space and time, I shall raise only two more. Victim-blaming and stigma.
In much of the official communication on the pandemic, blame seems to be cast on the victims. But as you learn their stories, you realise that some caught it unwittingly, some were just trying to keep food on the table; one man related that he called the hotline and was told that the loss of sense of smell was not a symptom so he kept looking after a sick friend; both eventually tested positive. Personally, any colleague of mine and my family could attest to the measures I took as soon as the first case arrived in Guyana; among other things, we limited our travel outside the home and anyone who ventured out had to sanitise outside and head straight to the shower upon returning. Nonetheless, I caught it. The elderly folk here did not go out partying or drinking nor the children; others were just trying to put food on their table because there is no other option; no safety net.
The conditions here, and the apparent victim blaming in public communication is demoralizing. And relatives have faced discriminatory treatment. One man related that taxis now refuse to pick up his family members, buses do not pick them up from the road, and the shops do not sell to them. Another man related a similar experience for his family and also said that neighbours no longer speak to them. Another man said that resulting from his positive diagnosis, his family is in quarantine at home but no one wants to drop some supplies there.
There are many aspects to this tragedy. It is humbling to hear some persons plead for rations for their families as they were the sole breadwinner; it is distressing to learn how some live paycheck to paycheck notwithstanding how hard they work, and it is heartbreaking that their families are facing discrimination and struggling to get by.
How are the millions made available for the COVID-19 fight being spent? What would it take to provide every patient with a bottle of sanitizing cleaner such as that produced by DDL? What would it take to provide a microwave and electric kettles for separate blocks so that contact and thus the risk of reinfection could be minimised? What would it take to provide masks so that it could be changed at least once daily? What would it take to fix the locks so persons can feel safer? I have observed some, particularly the more elderly persons, just curled up in bed, staring at the ceiling, with nothing to do. What would it take to provide free internet access? What would it take to provide liquid soap for use after using the toilets? What would it take to provide supplies to families?
While some here can afford some things, many are from a poorer economic background. There are policemen, security guards, drivers, professionals, elderly people, and children among those here. In fact, one section of the unit here has been dubbed by the patients the ‘police section’.
For weeks we have been pleading for improved conditions but little has changed. It is the consensus of many here that if any of the elite or their children were stricken by COVID-19, they would be availed better facilities. No one wants to be here. We would all like to recover.
I must say that the medical teams try their best in circumstances that are far from ideal. They do as much as they can and are also concerned about the situation here. We understand that they work in a system and the numerous complaints made have been referred to a higher level. These frontline workers have the patience of Job to listen to the complaints from dozens of patients every day. They are the true heroes of this time and we are grateful to them (though communication particularly when it comes to test results could be improved). The donation by UNICEF too has boosted spirits as at least, finally someone has shown that they care.
As much as the doctors work hard, the facility here is not conducive to rapid recovery. After the worst symptoms passed, I felt better at home but here some symptoms have returned. We are pleading with the authorities for improvements in the areas mentioned above. We understand, maybe more than most, the risks of COVID-19 and should these improvements be made, I would be the first to trumpet it and also educate people as the overall communication on the pandemic has been poor.
And what of the children? As much as adults can cope with some of the conditions, it is different for children.
For weeks our pleas have gone unheard by those in higher authority. At the height of the water crisis last week, one man suggested that we all walk out of here, that they can’t shoot all of us. I close with question, if you contracted COVID-19, ask yourself, is this the place you’d want to come to?
Yours faithfully,
(Name and address provided)
