"Forcing people to stay at home is very difficult, because most people work in the informal sector to earn a daily living."

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Five questions to Sandra Galbusera
country representative in Niger

In Niger, a first Covid-19 patient was reported on 19 March 2020. Since, a total of 701 people have tested positive for the coronavirus. Of these, according to official figures, 29 have died and 385 patients have recovered (latest update on 27 april). We asked Sandra Galbusera, the country representative of Enabel who is based in Niamey, how the situation is on the ground.

We have the impression that the epidemic has stabilised in recent days, but we have to be careful with that statement because there is not much information available about the situation in the rest of the country. At Enabel we also had a few suspicious cases and people were quarantined, but so far they have all turned out negative, so that's good news.

Can the health care system in Niger cope with this crisis?

Across the country, there are only 12 anaesthesiologists, for a total of 12 hospitals. They are the only ones who can operate the 12 available ventilators. By comparison, in Belgium there are more than 2000 ventilators in the intensive care units. We only have about 20 ambulances in Niger with built-in oxygen equipment. 

Specific situations in the country also impact the health situation, especially in the border areas with Mali and Burkina Faso where there is much violence from terrorist organisations, which makes it harder to transport medical equipment and personnel or patients. 

We are currently also in a period between two harvests: People have little to eat, the reserves are low and we have to wait for the next harvest. Moreover, Ramadan has just started, which could create additional tension.

How are people coping with the epidemic?

As a resident of Niamey I notice two extremes: Some people comply with the instructions completely; they wear masks, stay at home, wash their hands regularly and work from their homes. Then, there is the other extreme: Some people pretend that nothing is wrong and are convinced that the lockdown of the capital was imposed for political reasons: they think it's a way to postpone the planned elections at the end of the year.

Since last week, more and more young people are starting to protest the lockdown because they are not allowed to go to the mosque. That has already led to confrontations with the police, street protests, burned houses and car tyres.

The situation is also interpreted in two different ways by the population, which is very religious: Some think that this disease is something that was imposed by God. They believe that the virus only affects white, rich people who travel often, and so they move on with their lives. Others believe that God wants them to protect themselves and they strictly live up to the rules, both in terms of hygiene and in terms of ceremonies and social customs.
"Enabel helps spread awareness messages through local radios in certain communities. This is done in local languages so that the entire population is made aware of the preventive measures against Covid-19"
picture by Tim Dirven
What is the government of Niger doing?

The government took preventive measures very quickly, even before the first patient in the country was confirmed. In Niamey, large billboards were put up with messages asking people to wash their hands, wear masks and comply with other hygiene rules. Materials such as masks were also distributed and some government buildings have already been completely disinfected several times to prevent further spread.

Measures have also been taken to care for infected persons and there is a national telephone number that anyone can call who suspects having symptoms. They can be helped by telephone and, depending on the situation, a team is sent to the patient to investigate the next step: Does the sick person stay at home, or should they be admitted and cared for in a hospital?

What actions does Enabel take to assist the government in its response?

Enabel, like in all its partner countries, will support the government's national response plan. Here in Niger, this means that we have supported the coordination of that response plan. That team consists of officials of Niger as well as people of the United Nations, Unicef and other organisations. It may not seem much, but for example, by handing over laptops to the Department of Public Health and promoting distance communication with videoconferencing equipment, it becomes easier for people on the response team to work. We are also present in several meetings of that team to provide support where necessary. In the logistics meetings we share insights about the distribution of materials and also offer assistance to transport goods, and in the communication meetings we help in the preparation of sensitisation messages.

In addition, we support medical personnel with training in the detection and prevention of Covid-19. We bought test kits for the laboratory and masks and we also purchase other materials such as disinfectant and soap that we distribute in the regions where we operate, such as in Dosso and Zinder.

We also helped spread awareness messages through local radios in certain communities. It is very important that this is done in local languages and by region, so that the entire population is made aware of the preventive measures. We will also, together with other European countries, buy ventilators. The intention is to install ventilators in 5 ambulances and to purchase 10 ventilators and 70 oxygen concentrators for hospitals. This equipment will be used both in Niamey and in other regional hospitals where Covid patients have already been reported. 

picture by Tim Dirven
How is the situation in Niger compared to Belgium?

In Niamey there is not a complete lockdown, but people are asked to work from home and school-age children have to stay at home, but shops remain open. Also, no travel is allowed between the capital and the rest of the country. Fortunately, goods may be transported. The entire country is under a curfew: between 21:00 and 05:00 no one is allowed to come out.

The lockdown is therefore not like in Belgium, but the general situation is also very different. There is no social security here with the government intervening when you become temporarily unemployed owing to Covid-19. So forcing people to stay at home is very difficult, because most people work in the informal sector to earn a daily living. For instance, they have to go to the market every day, both to make money and to buy food.

Practically speaking, the lockdown is very difficult: Women have an average of 6 children here, so there are easily 10 people living in the same place. The houses are much smaller than in Belgium and it is also currently between 35 and 45 degrees, which makes it even harder to stay indoors. In addition, people often have limited access to running water, which certainly complicates complying with hygiene measures. And then there are the social customs like greeting each other: Older people here consider it very important to shake hands; there are a lot of ceremonial meetings just because the families are so large. These gatherings easily bring together 200 to 300 people, who eat together, spend the night together, greet each other. Food is shared from one bowl and the deceased are washed and touched, which is no longer allowed.

Social distancing is already quite hard in Belgium, let alone in countries where the families are so large and people live much closer to one another.

 

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