Nigerians were treated to at least two ‘comic’ dramas during the week in the ongoing battle by authorities to check the spread of COVID-19 in the country. The dramas depicted a subtle war the government may soon have to contend with: stigma.
PREMIUM TIMES reported how health workers at the University of Uyo Teaching Hospital (UUTH) in Akwa Ibom State fled from their duty posts because of COVID-19, which has infected over a million persons across the globe and killed over 60,000.
The report indicates that the health workers at the UUTH claimed they had contact with the confirmed cases in the state and decided to ‘flee’ for their lives.
The UUTH, a leading tertiary health facility in the South-south, was the centre of the controversy during the week. The five confirmed cases of coronavirus in Akwa Ibom are mostly healthcare professionals.
Just as the UUTH drama was playing out, another drama was playing out miles away in the South-west.
Six of 127 people who recently returned from Ivory Coast to Osun State, and tested positive for coronavirus, reportedly escaped from the dormitory of the Unity School, Ejigbo, where they had been isolated.
A frantic state government said only one of the confirmed cases had escaped. It later reported that the ‘escapee’ was found and returned.
According to data released by the Nigeria Centre for Disease Control (NCDC), 18 of the 20 Covid-19 cases in Osun State were among the 127 returnees camped in Ejigbo, headquarters of Ejigbo Local Government Area.
A few days ago, Channels TV showed a footage of a traumatised middle-aged man, standing in front of a medical facility for infectious diseases, threatening to evacuate his wife, whom he claimed had been diagnosed with COVID-19.
The visibly angry man, who claimed nurses at the facility were reluctant to attend to the patient, threatened to take his wife forcefully from the centre. “It is better I take my wife away to go and die at home than to watch her being treated ‘shabbily’ here as if she is not a human being,” the man exploded at the television camera.
In Nigeria, 214 cases have been recorded, four deaths and over 20 recoveries.
In the wake of the first case of the dreaded virus in Nigeria, authorities had decried the unwillingness of many public officials just arriving from foreign nations to get tested to know their status, noting that this could worsen the pandemic when it eventually takes its toll in Nigeria.
As at the last count, the NCDC said it was on the trail of over 5000 contacts of coronavirus cases. Health experts say its job could have, perhaps, been made easier, if the current stigma attached to the ailment was absent and more contacts voluntarily come out for the testing.
A medical practitioner, Moyo Awoyokun, said stigmatisation is a problem Nigeria needs to solve quickly as it fights the incursion of the infectious disease.
“Right now, there is a possibility that people will try to avoid Covid-19 patients and that is why most people are hiding their status and many are afraid of testing,” he said. “The government will have to take action and continue to educate the people about understanding the diseases just like it is being done with HIV and other viral diseases.”
“As it is now, there is no overwhelming evidence that people infected with Covid-19 have permanent disabilities or complications from the disease,” he added.
When the HIV/AIDS pandemic first broke out in parts of the world, stigma was one battle many nations, including Nigeria, had to contend with. But, nowadays, with appropriate legislation and orientation, the pall of stigma has substantially reduced over persons living with the ailment. Many have now publicly come out to reveal their status.
“People should not stigmatise (coronavirus) infected people, it is not a long-living infection like some other viral infections,” Mr Awoyokun said. “The body can develop immunity/antibodies against the disease. The people who have been having issues are people with severe cases and those with acute health challenges, many people have been recovering from the virus so there is no need for stigmatisation. It is just like any disease such as malaria.”
Not Nigeria’s battle alone
Other nations seem to be experiencing subtle cases of stigmatisation of patients as the virus wrecks economies and livelihoods across the globe.
In India, for instance, doctors are being evicted by landlords worried they will spread coronavirus to other tenants, the Washington Post reported.
“In the town of St. Michel in Haiti, people stoned an orphanage after a Belgian volunteer was diagnosed. In Indonesia, an early coronavirus patient was subjected to cruel innuendo suggesting she contracted it through sex work.
“Psychologists say the desire to identify and castigate those who are ill harkens to an age-old instinct to protect oneself and relatives from catching a potentially fatal disease — and a belief, however unfounded, that those who get it bear some responsibility.
“Studies show that when people link disease to behavior, they are more likely to blame the sick and ostracise them. Researchers have found people harbor negative attitudes towards individuals with a wide range of illnesses, with HIV/AIDS often at the top. But even those with seemingly lesser conditions can experience stigma,” the report added.
Glimmer of hope
Back in Nigeria, with more prominent persons coming out to disclose their positive test results for coronavirus, experts believe stigma may be halted in its tracks before it becomes full-blown.
Some prominent persons who had taken the bold step in recent weeks include a former vice president, Atiku Abubakar, who disclosed his son’s status; the President’s chief of staff, Abba Kyari; Bauchi State governor, Bala Mohammed; Kaduna State governor, Nasir El-Rufai, amongst others.
Meanwhile, global body, UNICEF, has already commenced an online campaign to stem the tide of stigma, as the pandemic continues to rage unabated. It also gave tips on how governments can battle stigma.
“The coronavirus’ spread and global reach has been a source of concern and a call for collective action to prevent the virus from spreading further. While you may be feeling worried about how to stay safe amidst this pandemic, it is critical that we keep coronavirus-related stigma to a minimum as it may make this challenging situation worse,” it said.
“Around the world there have been reports of individuals being subject to verbal or even physical abuse as their ethnicity was unfairly associated with the virus.
“Public health emergencies are stressful times for everyone affected. It’s important to stay informed and to be kind and supportive to each other. Words matter, and using language that perpetuates existing stereotypes can drive people away from getting tested and taking the actions they need to protect themselves and their communities,” the agency added.
‘More needs to be done’
Runcie Chidebe, the CEO Project Pink Blue, a cancer treatment advocate, said stigmatisation is a common detrimental factor commonly associated with many diseases in the country.
He said stigmatisation affects people’s attitudes to seeking medical tretment for their ailments.
“Many people who are ill do not seek medical assistance early because they don’t want to be stigmatised,” he said. “This is why some people present cases late at the hospitals or hide the nature of their illness from the world. At times, the stigmatisation is extended to all the family of the sick individual and might affect social interaction.”
“One of the major things that trigger stigmatisation is ignorance, when people are not knowledgeable. Stigmatisation is more horrible if it is coming from someone from a higher status,” he adds.
He said to curb the pandemic, “there is a need for people to trust the system. The lack of trust in the system and government has caused many Nigerians not to believe that the disease is real. This has also not made them believe that the health system can cater for them.”
Emman Shehu, Director, International Institute of Journalism has a slightly different opinion.
“I don’t think its a case of stigma. Its more an act of irresponsibility being showcased, this time by the elite,” Mr Shehu told PREMIUM TIMES. “It’s also a failure to appreciate the consequences of such behaviour which would not only undermine the exemplary work of containment by the federal government but also jeopardise thousands of lives.”
“The National Orientation Agency (NOA) has largely failed in developing a robust strategic nationwide sensitisation campaign. The situation of six confirmed cases from Osun absconding is an indictment of the poor sensitisation by NOA.”
John Azu, a journalist, also says the NOA and information ministry need to do more.
“We need a representation at this moment. The National Orientation Agency, the Ministry of Information and other statutory agencies should rise to the challenge to educate the people that persons who come forward with their health status are providing vital communication for social and community safety and should be commended not resented or stigmatised. This is very important,” he said.
He said ‘stigma’ is a product of cultural orientation.
“Thus, an individual testing positive to the COVID-19 and making a disclosure of that information to help safeguard others, would be viewed from that cultural perspective of bad luck or abomination or sin or other comeuppance attached to that individual,” he said.
The time to act is now as far as curbing stigma is concerned, said NkasiObim Nebo, Founder, PeachAid Medical Initiative.
“Just like we are seeing in HIV/AIDS cases in Nigeria, it will be more harder to contain the spread of COVID-19 if people are afraid of how they would be treated when they come forward for test, including the fear of dying in the isolation centers due to lack of faith in our health system,” she said.
“People who have confirmed COVID-19 have been taken to the treatment centres by NCDC while others who may have been exposed to COVID-19 are advised to self-isolate which is the right thing to do to help protect all of us. So, they should never be harassed and bullied. We should rather offer compassion and assistance as appropriate, but never hostility or judgment,” she said.
‘Medical secrecy, discreetness’
“Social stigmatisation which was initially prevented and managed effectively by the NCDC, with the adoption of medical secrecy and discreetness, is now gradually becoming a source of concern as names of individuals in isolation centres or persons who submitted themselves to be tested are getting into the public domain without their consent,” lamented Ariyo-Dare Atoye, Convener, Coalition in Defence of Nigerian Democracy and Constitution.
“We call on the Presidential Taskforce on COVID-19, Minister for Health and NCDC to urgently review and update the COVID-19 victim manual and standard operating procedures to immediately address emerging concerns over poor isolation centres and the issue of stigmatisation,” the group said in a statement sent to PREMIUM TIMES.
“For instance, the Benue index case had painfully alleged that her status was announced on the state radio station without her knowledge and without her even seeing her test result,” the official added. “She subsequently called for a re-evaluation of her case and a transfer to Abuja, while accusing the Benue state government of stigmatisation.
“Also, some of the isolation centres being put in place in different states across the country, have been described as both structural and location stigmatising because some of the structures are erected with the mindset of a leprosy centre that should be far away from the city cente, They lack conducive facilities.
“These developments have been attributed to and blamed among the reasons why some persons who maybe positive to coronavirus, have refused to come forward to get tested.
“It is therefore important that the COVID-19 stakeholders urgently consider a review of the situation, because Nigeria does not have the critical infrastructures and requisite number of experience medical personnel that can deal with any escalation.”
“To ease the effect of stigmatisation, there is a need for a reintegration program to help ease the acceptance of the person back into the society,” said Mr Awoyokun.
“People will always stigmatise and so we need to start an awareness campaign that treated people are not infectious anymore and do not need to be isolated. It should be a joint campaign by the government and private sector but the campaigns need to be championed by the government.
“This will give the people the confidence to reintegrate and accept people who have been infected back into the society,” he said.