Announcements March 11, 2020

Preparing for the Threat of COVID-19 in Madagascar

By Dr. Alishya Mayfield, PIVOT Chief Medical Officer

As a physician working first with Partners In Health and now with PIVOT, I have been involved in addressing both acute and chronic infectious outbreaks, including Ebola, measles, tuberculosis, and plague. These outbreaks are usually far from home and have a limited impact on us here in the United States. But I write to you today from my new home in Seattle, which, strangely enough, has become an epicenter of the rapidly spreading outbreak of this novel coronavirus (now called SARS-CoV-2) and the disease associated with it (known as COVID-19). And all of us are now acutely aware of this disease and its deadly implications. 

In the last few weeks, I have heard from many friends and family who are concerned about my safety given the current situation here. While this outbreak has been extremely difficult for many in Washington State and across the US, I am fortunate to say the outbreak hasn’t affected me personally in any significant way, and I feel quite safe knowing we have one of the best healthcare systems in the world here in Seattle. 

Professionally, of course, as PIVOT’s Chief Medical Officer, it is a different story.

What is keeping me up at night now is concern for what will happen to my friends, colleagues, and the billions of people living in countries with weak healthcare systems around the world. Today, my attention is focused on how we at PIVOT can best support our Ministry of Health colleagues in their efforts to prepare for a likely outbreak in Madagascar, and how we can work together to protect the people in Ifanadiana District and nationwide. As always, the poor and vulnerable are the ones who will be most affected by this, and, as a health systems strengthening organization working alongside the government in a country with some of the lowest per capita spending in health, PIVOT has a major role to play.

Just today, Dr. Tedros Ghebreyesus, the Director General of the World Health Organization, announced that this infectious outbreak can now be considered a pandemic. Cases of COVID-19 are increasing here in the United States and around the world.

As far as we know, there are not yet any cases of COVID-19 in Madagascar, but it seems as though it will only be a matter of time. We are therefore making every possible effort to prepare in advance so that we can respond swiftly and effectively if and when cases of this novel Coronavirus surface in Madagascar. We held a call with our Board of Directors today to discuss emergency funding for an urgent preliminary order of tests, as early testing and detection will be key to containment of this deadly disease. We have postponed all large gatherings we had planned to organize or attend in order to avoid exposing ourselves or others. We have also halted all non-essential travel to Madagascar in order to minimize the risk of introducing the disease to its vulnerable population.

Addressing a large infectious outbreak is always complicated; the challenges public health officials are facing here in the United States have clearly demonstrated this. But containing and managing a large infectious outbreak in a country with limited resources, weak supply chain systems, and poor health outcomes is significantly more complicated. 

That’s why we are proactively developing ways to ensure the availability of the equipment and supplies that will be needed (such as additional oxygen canisters, personal protective equipment, and testing kits), the human resource implications, methods of prevention, awareness-raising in the communities we serve, and of course, how to continue to provide high-quality, dignified care to all those in need, including anyone directly impacted by this new disease. 

Our aim during this time is to prepare for the worst while hoping for the best, and to keep our critical clinical programs and services on track while simultaneously developing ways to address and contain this potential outbreak. We will remain vigilant in the midst of this global crisis, and keep you apprised of ways you can help us ensure the safety of our patients and colleagues in Ifanadiana District while you do the same for yourself and your loved ones. Thank you for being in this fight with us, and please let us know if you have any questions.