How Catholic aid agencies are preparing for the pandemic in the developing world

A health care worker holds a newborn in the neonatal care center at St. Joseph's Catholic Hospital in Monrovia, Liberia. (Photo by Michael Stulman/CRS)

This is the first in a three-part series looking at the potential impact of Covid-19. Look for reports from Lebanon and India soon.

Around the world, Catholic relief and development development agencies are gearing up to respond to the challenge of caring for Covid-19 victims and checking the spread of the coronavirus, but they are also contending with revising practices on the fly so that their “normal,” life-preserving programs can continue.

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Obviously, work during a pandemic can be dangerous and the thought of falling ill themselves cannot be too far from the minds of medical and sanitation teams stepping up to respond to the Covid-19 crisis directly. But thousands of other relief and development staff and volunteers will face many of the same risks and fears as they maintain outreach to relieve hunger, improve sanitation and keep distributions of seed and agricultural tools on target during these crucial weeks before growing seasons begin all over the world.

Jennifer Overton is Catholic Relief Services’ regional director for West Africa. “We know that we’re at our best when there’s an emergency and people come together,” she says. “This is what we signed up for it; this is the work of C.R.S. We respond when people need us.”

Humanitarian assistance is not a job that can be phoned in during a stay-at-home lockdown. “You have to be face-to-face,” Ms. Overton says. “We can’t forget about all the people that are vulnerable and all the people that are counting on us.

Jennifer Overton is Catholic Relief Services’ regional director for West Africa. “We know that we’re at our best when there’s an emergency and people come together.”

“I think, sure, in the beginning, people were scared for a little bit, but I think they were more nervous about passing the virus to the people in the communities rather than thinking of themselves. They don’t want that on their conscience.”

To continue assistance programs with poor farmers, among refugees or within some of the world’s most densely populated urban communities, “we have to protect the frontline workers,” Ms. Overton says, and “protect them from…inadvertently transmitting the virus to a population in conflict or [to those] who live very close together in urban low-income areas.”

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The coronavirus has been slow to spread in Africa, but numbers are rising. More than 85,000 cases had been confirmed by May 18, with more than 2,800 deaths, according to the Africa Centres for Disease Control and Prevention.

Ms. Overton expects that should Covid-19 make a hard landing in West Africa, it will be Catholic religious women and laypeople who will be at the forefront of the crisis response and, as a result, at the greatest risk. “I’ve worked for C.R.S. for over 25 years, and I can say across Africa, 30 to 40 percent of health care is provided by Catholic and faith-based institutions, predominantly Catholic.” And while government-provided health services in Africa have improved, “people will tell you [Catholic institutions provide], hands down, the best services that are being offered.”

That means that staff at Catholic health care facilities could be overwhelmed during a significant outbreak. C.R.S. is gearing up to help out, Ms. Overton says. As an example, she reports that the agency is stocking up on basic supplies at 23 Catholic health facilities in Liberia with “bleach, hand-washing facilities, buckets” and “of course the masks and the gowns, hair netting, shoe-covering—everything you can think of” in terms of personal protective equipment that will allow staff to confront an outbreak.

“In a developing country, people can’t go buy a lot of groceries and stay in their house,” Sister Brillant says. “It just doesn’t happen.”

“We have to make sure that the health care workers stay healthy,” she says.

Less obvious commodity purchases are also on her list, too, like diesel fuel for hospital generators and cellphone credits for hospital staff “to make sure they can stay in touch, they can support each other, they can be contacted.”

Prepared but worried in Liberia
In Liberia, Barbara Brillant, F.M.M., dean of Liberia’s Mother Patern College of Health Sciences, has been keeping a close eye on the progress of the coronavirus since the first case was reported in the capital of Monrovia on March 16. Whether it is the climate or the particular coronavirus strain that managed a landfall in Liberia, she cannot say, but so far the outbreak in this West African state has not produced the same degree of virulence and mortality as experienced in Europe or the United States. It has been enough, however, to provoke a national lockdown.

Like the health ministry officials who ordered those national measures on April 11 after 48 cases and five deaths, Sister Brillant worries that a significant Covid-19 outbreak will overwhelm Liberia’s health system. “If we peak early in May because we’ve done the right things, [the infection rate will] go down and we won’t have a hard time,” she says. “If it goes beyond that, we can go well into August and it can be a disaster.

“Our primary objective now is to keep our health workers safe,” she says. “And I have to say, we’re not doing so well.” According to Sister Brillant, a significant percentage of people falling ill so far in Liberia, where she has worked for 40 years, have been among its hospital and medical staff.

Already in Monrovia two medical centers, one a maternity ward, had to briefly close for decontamination after multiple staff members tested positive for Covid-19. She worries the same may happen at other hospitals, potentially crippling Liberia’s response and producing secondary casualties of the pandemic.

“I can sit in the same room as somebody, no signs and symptoms, nothing, and I can get it. It’s totally different. I think this virus is extremely scary and extremely contagious.”

“When we keep the health workers safe and the people in the community see that they’re safe, they’ll continue on with their health care,” she says. During the Ebola crisis, Liberians became so afraid of infection that they resisted contact with medical teams and hesitated to come to hospitals and clinics for treatment. “We don’t want it to happen with this Covid,” she says, describing a situation where “people die from malaria, die from the measles, die from the diabetes, die from all of the medical problems they have because they don’t go to have them taken care of.”

“Testing, testing, testing”
Strong leadership and “testing, testing, testing” should be enough to get Liberia through the crisis, Sister Brillant says. She would like to see local government leaders and West African Catholic bishops be more forthcoming on the threat from the coronavirus and more frequent in their messaging to the general public.

Stay-at-home orders so far have not been as effective as they need to be, she notes with regret. Many are ignoring them—some out of distrust of the government, many more out of necessity. “As you can understand, in a developing country, people can’t go buy a lot of groceries and stay in their house,” Sister Brillant says. “It just doesn’t happen.”

The chance of exposure remains high, and so far Sister Brillant has not seen much evidence that the general public appreciates the depth of the danger. The initial response in Liberia was promising partly because so many had already learned infection prevention and control protocols because of Ebola. “Within two days, all of the offices, all of the stores had buckets outside to wash hands.”

“But what we didn’t understand was the severity and contagion of this particular virus,” she says. “With Ebola, it was different because you knew very well an Ebola patient could sit across from you, but if you didn’t touch them or touch anything to do with them, you wouldn’t get it. That’s not true with Covid.

“I can sit in the same room as somebody, no signs and symptoms, nothing, and I can get it because he’s either coughing, sneezing or touched something that I’m going to touch,” she says. “It’s totally different. I think this virus is extremely scary and extremely contagious.” And if it hits Liberia much harder than it has already, she fears the national health service “will be totally swamped.”

“People will tell you, ‘Forget Covid, I’m more worried that I’m going to die of hunger.”

At the onset of the crisis, the Liberian health system had one ventilator and 250 test kits at its disposal. Since then, hundreds more test kits have been delivered, many courtesy of the Chinese billionaire Jack Ma, and timely support from C.R.S. allowed Sister Brillant to purchase a significant supply of gloves for health workers that are being distributed among 23 Catholic facilities in Liberia. A good supply of personal protective equipment left over from the Ebola outbreak means that Liberia is well stocked for now. Sister Brillant is concerned, of course, about what will happen when the storerooms run empty and Liberia is forced to compete on the open market for P.P.E. restocking.

When Ebola struck, Liberia could count on support from wealthier states. She worries that will not happen this time should Covid-19 begin a rampage in Liberia. “The rest of the world was feeding us with money and supplies,” she says. “Now the rest of the world is suffering, so we cannot expect that we’re going to get a lot. We’re going to have to really open our eyes, and people are going to have to do the best they can with what they have.”

A great hunger coming?
A rising concern in West Africa is the pandemic’s impact on the upcoming growing season. C.R.S.’s Jennifer Overton says.

“If people don’t plant, they don’t have food for the next nine months,” Ms Overton says. C.R.S. plans to keep its seed distributions and other agricultural supports on schedule despite the crisis. “This is already a very vulnerable population, very food insecure, so they’re counting on a lot of these assistance programs that the church runs,” Ms. Overton says. “The planting season is coming up: How do we make sure they don’t miss that season?”

A recent update on food crises from the United Nations’ World Food Program warns that more than 265 million people in low- and middle-income countries will face acute food insecurity by the end of the year because of the pandemic if action is not taken now to prepare. That figure is almost double the 135 million people the W.F.P. projected would face acute food insecurity just before the pandemic disrupted global markets. (On May 14, C.R.S. launched a new campaign to confront the global hunger crisis, “Lead the Way on Hunger.”)

“People will tell you, ‘Forget Covid, I’m more worried that I’m going to die of hunger,” says Ms. Overton.

Programs in her region, which includes West African coastal states like Liberia and Sierra Leone and extends into the continental interior as far as the Sahel region of Mali, will be modified to maintain social distancing and discourage the large groups that normally assemble around food or seed distributions.

“We’re really organizing micro distributions,” Ms. Overton says. “So we’re breaking down large groups of people into smaller groups, 10 or less, and we bring them into the area where the items are available for them to pick up and take home,” she explained. Only one individual per family will be allowed to wait in queues in positions that will be marked to keep recipients apart, and temperatures will be checked before aid recipients are allowed into waiting areas.

School nutrition programs are an important part of the C.R.S./Caritas’s anti-hunger efforts in West Africa, serving more than 4,000 schools, and that work will continue, Ms. Overton says, even as most schools have been closed. They will now be conducted door-to-door as staff equipped with protective equipment deliver food packages directly to the students’ homes. “So they’re still getting the food because we know how much the family depends on that food.”

Next up: Lebanon reels as Covid-19 threatens

[Explore all of America’s in-depth coverage of the coronavirus pandemic]

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