EG Justice: Recently, news sources in the diaspora reported that you were stopped by the traffic police, I assume, who refused to allow you to go visit and care for a patient on a medical emergency?  Could you confirm that story?

Dr. Mansogo Alo: The story that appeared on social media was truthful, and that was what happened.  After approximately 20 minutes… waiting there with them… they claimed that I did not have the right paperwork to circulate, finally they told me they would let me go, as a favor.  Of course, there were more than eight men in uniform and armed. I have the impression that at least two of them were drunk. So if I continued, under those conditions, I was taking the risk of running into another group that would again bother me.  In those instances, they are very daring and aggressive; so, afraid of running into another group, I chose to return home.

2. You run a private medical clinic, L'Espoir in Bata, Equatorial Guinea, what adjustments have you had to make, to prepare for possible patients infected with Covid-19?  Is the government working with your clinic, or at the very least, have they made sure that you and other private physicians follow an established protocol, and that you can access the state's medical supply stock?  

Dr. M.A.: To my knowledge, there isn’t a national or official protocol. No one has requested my assistance. As always, I am working at my clinic, with my staff. They have not sought my assistance.  But, it is true that they [the government] have not officially sought the assistance of anyone. They are working the best way they see fit. My clinic uses its own resources to make water and soaps available.  We have built a makeshift space where we have big containers of water with a faucet, soap and paper towels, so that people that come to our facility, everyone, can wash their hands. We also leave out alcohol and gels, when we can find it.  At the beginning we purchased all these for our own use.  Regarding the medical stock available, while I am not a member of the government taskforce I would love to know when and how it is used. Because no one has any official information about what is there, what was purchased and what was not purchased.  

I have had a case, a medically suspicious case at my clinic, and the contact with the taskforce was—to say the least—tedious.  It was not easy. I had to call the Minister [of health]  to let him know that I had a possible person infected in my clinic.  The patient was seating, a meter across from me. We were looking at each other, with our face masks on. I could not let him go. I told him to stay there until the taskforce people arrive.  And thanks to the call I had placed to the Minister, the people arrived three hours later.  So, it is not at all easy.

3. We understand that the government has set up a committee to respond to this pandemic; what is the pre-established medical plan if there is a health crisis in the coming weeks?

The medical plan I do not know anything about the Technical Monitoring and Response Committee’s plan.  I do not know if there is a plan and how it is designed. My experience here is a system that does not work instinctively; a system that is not well-oiled and that needs more training and competence. Let’s suppose, for instance, that in a neighborhood here in Bata, we find a suspicious case, this person comes to your medical clinic. You do not have the appropriate setup to receive a covid-19 patient, right, and you do not know what to do. This person is in your facility.  If this person is indeed infected, as you do not know for sure given that this is a disease with some similar symptoms to those associated with malaria. It could be a case of malaria, or it could be a case of Covid-19. Malaria can presents symptoms of fevers, headaches, diarrhea, much like Covid-19. What do you do? Well, first you must protect yourself, because you are unsure about the diagnostic, and avoid having the patient propagate the infection to others around him/her, in case they are infected.  What do we do?  Well, you call the taskforce.  But, the taskforce is not available; or they promise they will come in 2-3 hours. You decide to retain the patient. But the patient did not come to your office to stay there all day, waiting.  Because he/she does not believe he is that sick. Right. So, you both stay there looking at each other. What do you do?  These are questions that should be examined. These are issues that are real and that point for the need for a directive to healthcare professionals about what to do.  

4.  What do you know about the medical supply stock available to respond to this health crisis?

I am not on the taskforce, I do not work with them, and, as I mentioned earlier, they have not sought my assistance.  All I can say about this question, is that we have often seen the arrival of a lot of supplies from China, from Turkey, etc.  But I am completely unaware of how these supplies are used, aside from the supplies we all watch on TV, as the First Lady was offering to the military, saying that they [the military] were on the first line of response, while medical professionals did not receive anything.  That is all I have seen.  I have no idea about the rest of supplies.

5. What capacity exists at the hospitals in Bata and Malabo; how many ICU units, beds, ventilators, doctors and nurses per patient are available?

Well this is information that only the Ministry of Health has.  Because a medical organization does not exist in Equatorial Guinea.  There isn’t an autonomous medical association.  In this country [the government] does not like the idea of autonomous groups.  So, the number of beds per person, the number of doctors and nurses per person,… these are figures that are completely unknown to us, in any event, I personally lack that information .

6.  We have all been told about the importance of hygiene to slow the spread of the virus, how easy is it for citizens to wash their hands, take frequent showers and follow other prevention measures suggested by the government?  

Hand washing is a vital measure in the fight against the spread of the virus.  But it is very difficult to achieve that measure here.  Because as you already know how our communities are, there isn’t running water.  Some people have wells.  But unfortunately even in the neighborhoods in Bata, where normally there was water, since a few days ago there is no water.  It’s been several days without water in many neighborhoods in Bata, there’s no water in the faucets.  So, people manage the best way they can.  As I explained earlier, at the medical clinic, we have barrels with faucets.  We find water to fill the barrels and we use that water to wash our hands.  Those that can or have it, use alcohol gels to wash their hands.  But, the problem is not just with this measure, the other measures are equally ignored. For instance, bars have been closed, but private homes have been turned into bars.  So, people get together in those private homes and drink.  The capital cities in every district are under quarantine—for example— but people buy a permit and drive around.  So, the measures announced are not followed.  This is due in part to the rigidity and, at the same time, the negligence of those that impose the measures.  On top of that there is a lack of civic spirit among citizens, because many do not understand that the measures are for their benefit.  Because they do not know that this disease could infect them too, there is little information.

7.  What steps—specific or holistic—are being adopted at the hospitals to ensure that Coronavirus-infected patients do not contaminate other patients or the health care professionals?

Such planning does not exist. Unfortunately, spaces have not been prepared to receive Covid-19 and other patients. In fact, the tests carried out in the Bata hospital have concluded that a large portion of the staff there is infected.  And this is because patients haphazardly go to the hospital, and there is no selection, no discerning or separation of the sick.  This has turned the hospital into a dangerous ground for propagation of the disease, and creates a huge challenge for the functioning of the hospital.  Because now the people will stay away from the hospital and soon there will be no staff there.  So, what is happening there is a serious huge problem.  

8. What would you like to add, or what have we forgotten to ask you?

In order to improve the management of this pandemic, first there needs to be a de- politization of the functioning of the technical taskforce.  Because [currently] everything works on political grounds.   So, one has to first remove the politics and trust medical doctors to assume the technical responsibilities needed, because they are the ones with technical know-how.  They, the doctors would advice the politicians; they would make recommendations. This is how it should be set up, and not the other way around, as it is happening.  Then, there needs to be clear and precise protocols about the handling of sick people; and all medical facilities and personnel in the country should be taught this protocol.  

In other words, this is a big, important and scrupulous work.  The healthcare staff should be trained. All facilities, all, including any small neighborhood clinics, should be trained.   Then, the taskforce should know and have access to all the available resources. They should know what resources exist, how much money there is for the fight.  And, they should know this, and have the resources available to them, and manage these resources in a transparent manner.  Because the rumors on the street, among the population is that the taskforce wants to pocket the moneys allocated to this fight, and for this reason they are not carrying out their duties in a satisfactory way. So, those types of rumors should be avoided.  Efforts should be made to be credible.  We need to foment trust in the task at hand.

Finally, logistical means should be made available, without restrictions, but with the rights control.  The taskforce should be accountable, but it should operate without unnecessary constraints.  And many new healthcare workers should be trained to establish many mobile units.  Because we must know that there will be more calls, there will be more infected patients.  People are concerned, and people should trust those that manage the taskforce. So you build many mobile units that can be dispatched quickly to places where calls come from.  And those same new people you have trained, should be given the knowledge and be dispatched to help monitor the home-isolations. Why? Well, we are eventually not going to have enough space in the public facilities, spaces rented by the government to house all who are infected.  So, home-quarantines should be organized and you need people who will monitor and follow the patients we know are isolated in their homes.  

This is what I believe, for starters, should be done to try to organize a response to this pandemic that very quickly could overwhelm us all.