A senior Medical Practitioner has pushed holes in Zambia’s response to Covid-19 stating that the response is characterized by confusion.
Dr Mwaba Kasese-Bota, a Public Health Expert and Epidemiologist who is currently undertaking a Harvard University Advanced Leadership programme in the U.S.A says the Zambian Cabinet is in a dichotomous state of affairs with a fairly sized lacuna in the middle.
Dr Kasese-Bota has lumped the blame squarely on Health Minister Dr Chitalu Chilufya stating that the Minister is making statements which are re-interpreted in less than 24-hour period by rank and file without the science and the political economy astuteness.
She also accused Dr Chilufya of mismanaging the experienced human resource available that the Ministry.
“The Ministry of Health is one ministry that has had a rich investment in the skills of the administrators and the health workers albeit inadequate resources for tools of the practice (technology, drugs, PPE). The Directorate experts including those in Public Health and Zambia National Public Health Institute are seasoned technocrats who have prevailed over various epidemics including HIV par excellence as the case could be, given our environment and circumstances. What is it that is making them fail to come to the grade expectation of their potential with Covid19? Why are they failing to provide the necessary advice worth the science so akin to them?”
She added, “In 2017 alone, the Directorate of Public Health had 4 directors changed one after the other. Furthermore, the roles of the directorates and those of the PS seem to fuse into the Minister’s job.”
Dr Kasese-Bota who also served as Zambia’s Permanent Representative to the United Nations under late President Michael Sata stated that Zambia is downplaying the seriousness of Covid-19.
“In Zambia, I see a tendency to minimize the seriousness of covid19 and always bring in another disease as being responsible for consequences including death. The press statements on mortality are relegating Covid19 and giving a sense of affected people as in a moribund state and covid19 being incidental finding.”
Dr. Kasese-Bota received her medical training at the University of Zambia, and earned her Master of Public Health, with an epidemiology major focused on HIV research, from the University of Alabama at Birmingham in the United States.
Below is her full statement
DR. CHITALU CHILUFYA MUST GO BACK TO HIS MINISTERIAL DUTIES
By Amb. Dr. Kasese Botha, Medical Doctor and Epidemiologist
My 2 cents worth No 2: May 10, 2020
DIAGNOSIS: MISDIAGNOSIS OF ZAMBIA RESPONSE TO COVID 19.
It is interesting to see ourselves as a country in such a frenzy of short shifting decisions and pronouncements over Covid19 leaving people of Zambia in a memory hole including my 13 year old daughter who has been asking such pertinent questions around decisions made on covid19, which remind me of the Emperor’s new clothes.
Covid19 has demonstrated the uniqueness of the globalized community and interconnectivity as well as interdependence of human race on each other including the whole environment as a place of commons in spite of the artificial borders and boundaries. With the world so globalized today, one wonders why Real time communication of events could not have helped us to prepare a better and well-coordinated response to Covid19.
Stately seems to be making statements which are re-interpreted in less than 24 hour period by rank and file without the science and the political economy astuteness.
DIFFERENTIAL DIAGNOSIS No 1:
Mismanagement of Human Resources at MOH.
The Ministry of Health is one ministry that has had a rich investment in the skills of the administrators and the health workers albeit inadequate resources for tools of the practice (technology, drugs, PPE). The Directorate experts including those in Public Health and Zambia National Public Health Institute are seasoned technocrats who have prevailed over various epidemics including HIV par excellence as the case could be, given our environment and circumstances. What is it that is making them fail to come to the grade expectation of their potential with Covid19? Why are they failing to provide the necessary advise worth the science so akin with them?
MOH has had 3 incidences in its journals where doctors have lost jobs enmass: The First one was under President Kaunda and the second one was under President Chiluba with Prof Nkandu Luo as Minister. In both instances, the doctors had declared a labour dispute boycotting delivery of health services over a period of time. One can argue the pros and cons of both actions but that is not in point at this juncture. The third round is under Minister Chitalu Chilufya where doctors have been fired, retired, demoted, and relegated to the observer positions except in the wards, without any industrial dispute or any documented stimulus framework requiring such action. In 2017 alone, the Directorate of Public Health had 4 directors changed one after the other. Furthermore, the roles of the directorates and those of the PS seem to fuse into the minister’s job.
DIFFERENTIAL DIAGNOSIS no 2; Mis-quantification of morbidity and mortality.
Covid19 is a new disease that has a whole array of symptoms and signs with the list evolving every week. Top-class scientists are locked down in labs to try and understand what the new disease is about and what it is doing to the human body. I was talking to a colleague whose perfectly healthy young brother suffered Covid19 and has sequalae of myocarditis post Covid19. The other suffered a blood clot etc…These cases are outside Zambia.
In Zambia, I see a tendency to minimize the seriousness of covid19 and always bring in another disease as being responsible for consequences including death. The press statements on mortality are relegating Covid19 and giving a sense of affected people as in a moribund state and covid19 being incidental finding. Having a quality and productive life with chronic morbidities is very normal in our environment ( as many people are from the 4th decade of life). Death due to covid19 is a preventable death even in one with comorbidities. The cause of death on the death certificate should be what transpired in the last minute of life and include as a consequence of Covid19 on existing conditions e.t.c. asthma if any. Briefing communication will give Covid19 as the cause and nothing less nothing more.
DIFFERENTIAL DIAGNOSIS No 3: Mismatched balance of Social and Economic Covid19 Response
It’s common knowledge that Zambia is in a difficult position for economic buoyancy. BOZ and the Minister of Finance have both given the difficult position that the country finds itself in. WHO has also given the position of covid19. Furthermore, Zambia itself has tested the effects of covid19 with significant disruption in health services even with such small numbers of confirmed cases. While covid19 has brought so much panic and fear for the disease by its very nature of infectivity and the severity of the disease in both wellness and existing morbidity state in people including the Minister of Health, the cabinet is equally panicky over covids19 effects on the economy. We saw one minister completely overlooking his public service role to inciting the union to rise against an employer. We saw Government detain a foreign national investor, grabbing his phones and stopping him from leaving the country until he reversed his company’s covid19 response which was not anyway different from what others were doing the world over. It would seem to me that Cabinet is in a dichotomous state of affairs with a fairly sized lacuna in the middle.
DIFFERENTIAL DIAGNOSIS No 4: Misdirection of Science in Policy Statements:
Zambians both young, old and all walks of life have received covid19 policies with some disquieting enthusiasm due to disconnect in policy with the Covid19 issues. We now have the policy of the New Normal which is likely to drive down the efforts of fighting covid19. Globally accepted and agreed principles of disease epidemiology define a new normal as an endemic state. Endemic refers to the constant presence and/or usual prevalence of a disease in a population. Hence Inference of a new normal for Covid19 entails endemicity with covid19
MANAGEMENT: Is as per the differentials…
- Stabilization of MOH.. the minister to go back to his job of policy guidance, PS to take over the realms of controlling officer and Directors to be themselves as Technocrats and advisors who discharge their professional services without fear or favour.
- Cabinet to possibly move from the fences and fill the space of the lacuna in the middle. That’s where the political economic solutions balance is.
Amb Dr. Mwaba Kasese-Bota
Harvard Advanced Leadership Initiative Fellow 2020
Ambassador Representative to the United Nations 2012-2017
Medical Doctor/Epidemiologist
Political/International Relations/Public Health/ Sustainable Development Consultant