By Clara Adesola, National Hospital, Abuja, Nigeria

It was the morning of Tuesday, March 31, 2020, I woke up to prepare for work as usual. I got ready and set out in my car at about 7:30am to arrive the hospital within the usual 20 minutes drive. I live in a satellite town, outskirt of the capital city of Nigeria (Abuja). I had barely driven for five minutes when I met a military check point with many vehicles in a long queue, taking turns to be cleared, before continuing their journey. More than half of the vehicles were sent back. As I approached the check point,, there were fierce looking police and military officers and some public health workers in white gowns, checking passengers' temperature and ensuring they wore face masks.

In my car was my white overall hung at the rear seat deliberately, to identify me at a glance as a health worker. I presented my identify card even before I was asked any questions, alas, I was allowed to continue my journey. As I approached the city gate, behold another long trail of automobiles with same encounter!

The previous day, Monday, March 30, 2020, the President of Nigeria had announced a cessation of movement in the Federal Capital Territory, Abuja to reduce the spread of the Covid-19. Law enforcement agents were deployed around the city, restricting movement except for essential workers. Tougher measures were soon to be put in place to make people abide by the lockdown!

I arrived the hospital at about 9.00a.m, a journey of 20minutes took about one-hour 30 minutes because of the traffic hold up arising from the check points. This was just the beginning of the new reality!

Following the conversion of two wards within the building that house the Oncology clinic and pharmacy into ‘Isolation wards' for suspected cases of patients with Covid19, we had to move out the oncology medicines to another building as a temporary location within the Outpatient Pharmacy. This took a greater part of the morning as I had to join other staff in the dispensary to accomplish this before reporting at the oncology ward.

On getting to the ward, the number of patients for the day’s chemotherapy was about half the number expected! Calls were made and the excuse given by most had to do the lockdown. The attendance at the oncology outpatient clinic was not different as many could not keep their appointment.

As I got down to work, I requested for the usual PPE and the number supplied was less then usual! Requesting to know why, the response was, “we have to ration stock since no one can tell the ripple effect of the lockdown”. True to that statement, as simple as it sounded, the supply of everything from PPE to infusion and medicines were soon affected by the Covid-19 outbreak.

Notable was the scheduled supply of some cold chain medicines such as the monoclonal antibodies which never arrived until after four weeks. Although exemptions were given for the transportation of medicines and food the moment the lockdown was eased. Oncology care centres in neighbouring states that could not afford to stock enough of these expensive medicines came to our facility for loan. We could not but oblige, recognising the importance of adherence to the treatment schedule and the cost. This made me to really appreciate my centre, as we were able to cope effectively with little or no shortage(s) of resources or material during the period of total lockdown. However, we soon had to contend with other challenges that came with the pandemic such as increase in cost and delay in the delivery of medicines and consumables. We also had to go below our minimum stock levels for most of our stocked medicines and consumables.

Many patients called to register their anxieties, fears and regrets for missing their chemotherapy sessions, some resorted to consulting on the phone, while others turned up late for their appointments, follow up and therapy.
The clinical activities in the hospital were eventually scaled down in order to maintain a measure of physical distancing as recommended by the relevant Health authorities. However, oncology pharmacy could not scale down, because many patients did not want to miss their treatment. Sadly, news about the death a patient who could not travel down from a nearby state due to interstate boarder closure soon went round causing grief to the rest. This development heightened my concern for my patients - both new and old. I wonder if the logistic challenge caused by the lockdown would not adversely affect the time of presentation for new cases.

Interestingly, in counselling my patients, I now have to purposely include the need to take personal hygiene, physical distancing, stay at home and the use of face mask more seriously.

I am glad to add that till date no patient nor staff of Oncology department has tested positive to Corona virus. The Oncology team, though multidisciplinary, is such a wonderful one to belong to where everyone work compassionately, sometimes longer hours in the interest of the patients.

Coming back to my day after the challenges and new realities I experienced, I was happy to return home without much stress by 4pm. No road blocks on this side of the road!

Clara Adesola working at National Hospital in Abuja, Nigeria
Clara Adesola working at National Hospital in Abuja, Nigeria