Dead before hospital arrival

The Covid pandemic, blamed for overstretching healthcare service delivery systems and running down economies such as Malawi’s, has also brought new words to the vocabulary of Malawians: Brought-in-dead, which Presidential Taskforce on Covid co-Chairperson Dr John Phuka describes as a situation where a patient is brought to a health service provider already dead.

The phenomenon of brought-in-dead cases has hit the country’s major hospitals, with medical experts attributing the trend to people’s fear of Covid. It is said that people with other ailments are not presenting themselves to hospitals, where they would access medical services, due to fear that they may end up contracting coronavirus there.

The trend is said to be common in all major hospitals, notably Queen Elizabeth Central Hospital (QECH) in Blantyre, Mzuzu Central Hospital (MCH) in Mzuzu, Kamuzu Central Hospital in Lilongwe and Zomba General Hospital.

QECH and MCH directors Frank Sinyiza and Samson Mndolo, respectively, blamed, in earlier interviews, late reporting of patients on rising cases of death even as stakeholders battle the Covid pandemic.

In this case, patients end up dying outside hospitals or within 24 hours after seeking medical attention.

Data from QECH, collected between January 25 and February 8, and MCH— gathered between January 22 and February 8— show that the two hospitals received a total of 72 patients that were brought dead.

However, officials at Kamuzu Central Hospital have been playing hide-and-seek on the issue, opting to keep mum despite getting numerous reminders for, at least, two weeks.

But, at QECH and MCH, most of those that were brought in already dead tested negative for coronavirus.

At QECH, for example, out of the six people that checked in already dead on January 27, four were coronavirus-positive while the other two tested negative.

However, all five cases of brought-in-dead registered on January 30 tested positive for coronavirus.

Then, on February 2, the Blantyre-based facility had a mixed bag as, out of five people that checked in already dead, three tested positive for coronavirus while two did not have the virus.

During the period in question, the two hospitals registered a combined 85 Covid deaths, with 68 of the cases being registered at QECH while 17 were recorded at MCH.

In total, QECH recorded 44 brought-in-deads while MCH recorded 28 brought-in-deads in the period in question.

However, Sinyiza and Mndolo reiterated that late hospital reporting was to blame for the situation.

Mndolo also said there could be other factors at play.

“It is a sign of loss of trust between hospitals and the general public. This is happening because of lies people are spreading on social media. We have enough capacity and space to provide care to all the people having Covid symptoms and other sicknesses as well,” Mndolo said.

True to his words, the two hospitals combined discharged 193 people who literally walked out of the facilities disease-free.

Mndolo, however, said most of those dying of Covid in hospitals report to the hospital critically ill such that they die oftentimes, even before their Covid results are out.

Sinyiza, on his part, said there is a need for patients to report to hospitals in time.

“The only challenge we have in case management is that most people come in very sick. Our plea is that people should be coming fast when they feel sick because, when they come late, most of them come in critical condition and chances of survival are reduced,” Sinyiza said.

Nursing officer Winnie Mwawa concurred with the MCH director.

She, however, added that another emerging challenge was that a good number of people were in self-denial after testing positive for the novel coronavirus.

“Some people are in denial when they test positive for the virus and we cannot force them to get treatment because they also have rights. The problem is that, when they go back to the community, they infect other people with the virus, which further exerts pressure on the healthcare service delivery system,” Mwawa said.

She said the situation also puts healthcare workers at risk as they are exposed to the virus.

Mwawa added that the admission of more preventable Covid cases affects healthcare workers, who are required to spend more hours at the hospital.

Calls for timely reporting to health facilities are coming from all directions, with Health Minister Khumbize Kandodo Chiponda— who is also co-Chairperson for the Presidential Taskforce on Covid— making such calls during the taskforce’s daily updates.

Malawi Health Equity Network Executive Director George Jobe said it is high time the country dealt with misconceptions that hospitals are killing people and that everyone who is dying in hospital is being declared coronavirus-positive.

“We need to start emphasising the difference between Covid, as a disease, and coronavirus, which is a virus. This way, people will be able to say this one died of malaria but also had coronavirus,” he said.

He also asked hospitals to allow patients to use their self-administered remedies within the premises.

Psychologist Moses Muotcha said the problem is that people were initially made to fear the pandemic.

He said there was a need to flood both social and mainstream media with positive messages.

“To a certain extent, the solitude and loneliness Covid patients are being subjected to without relations is also not helping matters. The moment a person is cut off from his loved ones, that is an automatic death to them,” he said.