The novel coronavirus causing COVID-19 has been classified as a pandemic by the World Health Organization (WHO). Reports from impacted countries to date indicate that individuals with noncommunicable diseases such as diabetes, hypertension, cardiovascular disease or chronic respiratory disease are at higher risk of developing severe complications from the disease. Children and adolescents appear to have mild symptoms when infected.
A gray area remains, however, for young people with chronic diseases such as type 1 diabetes. Anecdotal evidence collected so far does not indicate a higher risk of COVID-19 infection or complications for this population, and organizations such as the International Society for Pediatric and Adolescent Diabetes (ISPAD) and the European Society for Pediatric Endocrinology (ESPE) assume for now that the viral infection does not result in a worse prognosis in children with diabetes.
Diabetes clinics are nevertheless preparing for the possible impacts of this sanitary crisis on their young patients. And facing a pandemic can be a daunting task for facilities in resource-limited settings.
We spoke with Dr. Ketly Altenor, medical director of Kay Mackenson Pediatric Clinic located in Montrouis, Haiti, to find out how her team is preparing to battle this unknown but potentially dreadful enemy.
What is the role and mission of Kay Mackenson Clinic?
Kay Mackenson (KM) started operating in January 2013. Initially, the center provided care for pediatric diabetes only. Once these children were discharged from the hospital, we would offer self-management education, medical follow-up and would provide them with insulin, glucometers, strip, etc. free of charge. Before KM existed, these children were often left to fend for themselves in finding insulin and other supplies they need to survive. This is an extremely difficult task in a country like Haiti, where access is limited and medical equipment is very expensive. A lot of families have no or little income, so these young people would quickly succumb to their condition from lack of access to insulin.
Over time, the clinic evolved. We started from a center for children with diabetes to a clinic treating a variety of chronic pediatric conditions. Our mission is to have a novel approach in the management of chronic pediatric pathologies. Our medical team is made up of 5 nurses specializing in pediatric diabetes, a pediatrician, a psychologist, and a social worker. Our patients come from all across the country and we have a clientele of over 200 children, the majority of whom are living with diabetes. We are one of three clinics offering free specialized care for chronic pediatric conditions in the country.
What are the directives and recommendations issued by Haitian government authorities since the start of this pandemic?
The government has issued directives encouraging people to wash their hands, stay at home as much as possible, avoid touching their face, and use a mask or scarf when going outside. The populations at risk identified are the elderly, people with chronic pathologies and healthcare professionals. These populations are subject to the same recommendations as the general population. However, there is a general distrust towards national authorities, and a large portion of the population does not take directives seriously, so life goes on almost as before.
"We've established special shifts for the medical team and we provide transportation for our staff so that they can avoid public transportation"
How is the clinic preparing to the pandemic?
Since February, our team started educating families and patients on the potential risks and complications they face, as well as measures to take to protect themselves. All of our patients received medication and supplies for 3 months, and our less stable patients are residing at the clinic until further notice. We stay in touch with families by phone and triage is also done over the phone. We have sanitary stations for hand washing and we do not receive any non-essential visits. Everyone must follow a strict protocol to enter the center. We've established special shifts for the medical team and we provide transportation for our staff so that they can avoid public transportation.
Are you supported in your preparations by local organizations and / or international partners?
Our efforts are supported by the KM team and we manage them according to our budget. There is no national plan to support our efforts.
Has the medical equipment supply chain been affected by the pandemic?
We are ok for now. We estimate to have enough medical supplies for the next 3 months. However, a lot of equipment comes from abroad, and we are aware that shipment arrival could be disrupted. We are in contact with local suppliers. We will use alternative sources in the event that the situation persists.
For more information, please consult Kay Mackenson Clinic's website or contact them by email: info [at] kaymackenson.org. You can also follow them on Twitter.