Contact Tracing: There’s an App for That

By: Central Health - Grenada

During an interview with a citizen of South Korea as part of an online series entitled, “COVID-19 & Those Most At Risk,” Central Health – Grenada learned that South Korea uses a Smart Phone App to track airport arrivals who embarked from countries with high incidences of COVID-19.  This Self-Diagnosis Mobile App allows users to record if they develop a cough, sore throat, temperature and difficulty breathing (dyspnea).   In fact, you cannot leave the airport without downloading it.

All persons arriving receive a two-page document that provides the required protocol. Instructions range from who should take a designated airport bus to who is required to be tested and it ends with the information to download the App for both Android and iPhone users. To view document – click here.


South Korea has received positive press and general respect from around the world for its quick action in stopping the initial spread of COVID-19.  When asked what citizens had to do to assist with that process, Jenny Lee said she had to use the App, “I had to actually download the App about three weeks ago because I flew in from San Francisco. We were told to wear masks, stay inside a lot and avoid large contact with people, and report when we can to the government if we have any health issues.”  


Lee went to say, persons arriving from Europe had to go to a special facility as the outbreak was far worse than that of her destination. Meaning, they went to a quarantine area not into the general public.  Lee was allowed to go to her home, which is equivalent to Grenada’s two-week self-quarantine and instructed to put into the App, which is connected to the authorities, if she developed any of the four symptoms. If you do indicate that you have a symptom you are given the option to speak to medical personnel who will discuss over the phone your symptoms; give consultation and/or direct you to get tested at a nearby site. “I actually went to get tested because I thought I had kind of a sore throat. My results came back within 20 hours and I was tested negative so I knew I was okay but I still stayed in my room just in case.” To see full interview - click here.


The helpfulness of this App has caught the attention of Google and Apple. According to https://9to5google these two tech giants are working on a cross-platform solution, “When two people are in close range, their phones will exchange anonymous identifiers that change daily. If an individual gets diagnosed with COVID-19, they can have their device transmit a list of everybody they’ve been in contact with to the cloud. Meanwhile, the second person’s phone will periodically download a list of everyone that has tested positive in their area. If a match occurs, they will be notified and prompted to contact health authorities.”


How this App will work in Grenada’s context is yet to be seen, or if it can.  Further, during press briefings on COVID-19 on island, there has been a reluctance to share which community or parish  infected or affected persons reside. The decision to withhold seemed to be based on our population size, ways of movement  and especially to prevent ostracization of said persons.  If that App can be downloaded globally, there will be no way to stop that information from becoming public knowledge, unless someone develops an App that is appropriate for our cultural context. 


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For permission to publish email: centralhealthgnd@hotmail.com 

Should Grenada Cancel Carnival?

 By: Central Health - Grenada

 

Every year, directly after Carnival, many Grenadians and its nationals catch a bad cold.  This ‘carnival cold’ is such the norm, it is commonly given the name of one of the popular Soca or Calypso tunes of that year. In light of the rapid spread of the Coronavirus around the world, should Grenada cancel Carnival?

To date, Grenada’s Ministry of Health has done an admirable job in keeping the Coronavirus (NOCOVID-19) out of Grenada. Effective Sunday February 2, 2020 a travel ban was put into place.  Nationals coming from China may return, however they are automatically quarantined for 14 days – symptoms or no symptoms.  All foreigners attempting to enter Grenada from China, may not do so until 14 days have passed. To date, those quarantined, proved not to have the illness, and one by one are being released after their quarantined period ends.  

Additionally, effective February 26, 2020 Grenada’s Ministry of Health released a statement saying our island is now on an Importation Transmission Watch (ITW), which includes assessing exposure to risks monitoring events in the region, and providing pre-travel training.  This move to ignite this protocol is appropriate since NOCOVID-19 is not limited to just China. This decision is in keep with the protocols of Caribbean Public Health Agency (CARPHA), the Pan American Health Organisation (PAHO) and the World Health Organisation (WHO). So it is clear, Grenada’s Ministry of Health appears to have their finger on the pulse of this situation. However, as of February 27, 2020 Grenada’s travel ban is limited to just China.

On February 26, 2020, CNN provided a report of countries around the world that have confirmed cases of the Coronavirus, here are a few examples:

Italy =322

Hong Kong =89 cases

South Korea = 89 cases

Japan = 147 cases + 691 cruise ship

Singapore =91 cases

Baharain=26 cases

France =16 cases

Iran=95 cases

Taiwan =32 cases

It’s a delicate balance - the revenue gained from Carnival versus a health crisis within our tri-island state. Should Grenada cancel Carnival or adjust its travel ban to include those countries that are being watched under the ITW? Is it safer to have less persons attend Carnival or cancel it all together?

The Centers of Disease Control and Prevention (CDC) says there are three ways the Coronavirus is spread person to person:

• Between people who are in close contact with one another (within about 6 feet)
• Via respiratory droplets produced when an infected person coughs or sneezes.
• These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

Their website also states that although it is not the main way, it can be spread when a person touches a surface where the virus is on and then touch, "their own mouth, nose, or possibly their eyes." Large public events will automatically put people in close proximity and raise the occurrence of secondary forms of transmission.

It will be interesting to see what is decided in the upcoming days or months.

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Practice Sneeze Etiquette On The Bus

By: Central Health – Grenada

Considering hundreds of Grenadians travel on buses every day, and seated in close proximity to one another, all passengers should practice Sneeze Etiquette to prevent the spreading of germs. There are some people who hold no bar when sneezing, and seem oblivious to how much germs they are spreading in an enclosed space.  Although Grenada’s Ministry of Health has implemented a travel restriction on persons departing from China, part of the World Health Organization’s (WHO) constitution implies that citizens must co-operate to reduce the spread of general illnesses. 

The Centers for Disease and Control and Prevention’s (CDC) fact sheet entitled, ”Do Your Part to Slow the Spread of Flu” says sneeze droplets can travel as far as six (6) feet. Their website also states that, “Serious respiratory illnesses like influenza, respiratory syncytial virus (RSV), whooping cough, and severe acute respiratory syndrome (SARS) are spread by: Coughing or sneezing.” 

When asked what type of precautions passengers should take on the bus, Managing Director and Resident Physician of St. Augustine Medical Services Dr. L.N. Amechi says, “The best thing to do is to cough or sneeze into tissues and discard them into a paper or plastic bag which you are carrying for that purpose.  In the absence of tissues use a handkerchief, towel or “rag”. Last resort, cover your mouth with your sleeve and cough or sneeze into your elbow.  Always carry hand sanitizer, and clean your hands after every cough and sneeze.”  

Dr. Johansen Sylvester’s advice matches Dr. Amerchi’s, he said that if using a cotton cloth/bandanna these materials must be washed in bleach or disposed of at the end of the day. He also said do not sneeze into a cuffed fist and throw away used tissues as soon as possible, “When you sneeze turn away from others especially the elderly or very young.” Dr. Sylvester went on to say, “Avoid sitting in the very middle of the bus and reduce handing or holding on to the seats, when not necessary.” The physician also encourages bus drivers and passengers to use hand sanitizers, and especially after exchanging money.  He also recommends gargling with warm salt water two to three times per day, especially just before bedtime.

Most health practitioners, favour washing hands with soap and water. However, if not possible a hand sanitizer with at least 60% alcohol can help prevent the spread of germs.

Should Grenada Consider a 14 Day Ban on Travelers from China?

By: Central Health – Grenada

Although Central Health – Grenada’s focus is educating nationals about Chronic Non-Communicable Diseases, it is important to acknowledge that the World Health Organization (WHO) on January 30, 2020 declared the new coronavirus outbreak a public health emergency of international concern. Therefore, it is important to share general facts about how this decision came to be, as our tri-island state is not immune to the possibility of it affecting us and appreciate how travel bans are decided and ultimately approved. 

Well-structured organizations, such as the World Health Organization, usually assemble an elite team of qualified persons to provide recommendations to Dr. Tedros Adhanom Ghebreyesus the Director – General. He in turn reviews all the facts within their reports and in particular their recommendations. His decision must embrace the principles of the WHO’s constitution, two of which are whether the health situation requires: 

• Active co-operation on the part of the public.
• To remind governments that they have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures. 

To read the others – click here  

At the meeting held on January 30, 2020, arranged by the Director- General, in addition to the said Emergency Committee, representatives from the People’s Republic of China’s Ministry of Health provided a report. Two key points extracted from their reported are: 

• There were 7711 confirmed and 12167 suspected cases throughout the country. Of the confirmed cases, 1370 are severe and 170 people have died. 124 people have recovered and been discharged from hospital. 
• There were now 83 cases in 18 countries. Of these, only 7 had no history of travel in China. There has been human-to-human transmission in 3 countries outside China. One of these cases is severe and there have been no deaths. 

Those numbers may have increased or remain same since then. 

Although the coronavirus is still an evolving situation, the committee made noteworthy recommendations, here are poignant ones:

• It is still possible for the virus to spread.
• The outbreak now meets the criteria for a Public Health Emergency of International Concern
• Countries need to put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk.
• Provide support to low- and middle-income countries to enable their response to this event, as well as to facilitate access to diagnostics, potential vaccines and therapeutics.
• WHO should provide intensified support for preparation and response, especially in vulnerable countries and regions, rapid development and access to potential vaccines, diagnostics, antiviral medicines and other therapeutics for low- and middle-income countries should be developed.
• Investigate the animal source of the outbreak.
• Investigate the clinical spectrum of the disease and its severity
• Investigate the extent of human-to-human transmission in the community and in healthcare facilities, and efforts to control the outbreak.
• It is important to study the possible source of the virus, to rule out hidden transmission and to inform risk management measures.
• Enhanced surveillance in regions outside Hubei, including pathogen genomic sequencing
• WHO should assess how best this outbreak can be contained globally. 

After reading these recommendations, it is interesting that the Emergency Committee does not recommend any travel or trade restriction - or at least at this time. However, should a country make a restriction, they must inform the WHO within 48 hours as to why that decision was made and be ready to accept the WHO’s feedback. 

What is interesting, on the day the Director-General declared the Coronavirus a public health emergency of international concern our neighbour - Trinidad & Tobago imposed restrictions on travelers from China. Their Health Minister Terrence Deyalsingh said, “Persons who are presently living in China or visiting China, regardless of your nationality, will not be allowed to enter Trinidad and Tobago for 14 days after leaving China.” As far as their Health Minister is concerned, the virus has an incubation period of 14 days, so if your passport is stamped/recorded to have left China, regardless of nationality, you cannot enter Trinidad until those 14 days have passed. 

When asked about Grenada’s position, Dr. Francis Martin – Acting Chief Medical Officer for the Grenada Ministry of Health said, “Grenada’s position is to follow the advice of our lead public health agency, as it relates to travel restrictions on the sub region. Those agencies being Caribbean Public Health Agency and World Health Organization- PAHO.” 

The Caribbean Public Health Agency’s fact sheet entitled, “Coronaviruses–what you need to know,” does not provide any travel restrictions, but does say a person should check their local Ministry of Health for information or CARPHA’s website for guidance for travelers. Additional information included: “If you travelled to a country where cases of the novel coronavirus was detected, watch yourself for symptoms within 14 days after you left that country. If you develop symptoms and feel sick with fever, cough, or difficulty breathing, you should:

• Seek medical care right away. Before you go to a doctor’s office or emergency room, call ahead and tell them about your recent travel and your symptoms.
• Wear a mask if available.
• Avoid contact with others.
• Do not travel while sick if possible.
• Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or Wash hands often with soap and water for at least 20 seconds to avoid spreading the virus to others.
• Use an alcohol-based hand sanitizer if soap and water are not available. 

It will be interesting to see how the WHO reacts to Trinidad & Tobago’s 14-day travel restriction. Perhaps if approved, it may allow for other island.

 - END-

Free Event: 5th Annual Too Sweet For Your Own Good - Mini Symposium

After Saraka - River Sallee Gets Free Health & Diabetic Clinic

Free Health & Diabetic Clinic Planners (l-r) Taurah Dizadare SNMA-SGU Chapter Diabetes Coordinator, Pastor Alvin Campbell and Dianne Roberts of River Sallee Evangelical Church, Roslyn A. Douglas of Central Health-Grenada and Michelle Adibe - President SNMA-SGU Chapter

(River Sallee, St. Patrick -  Saturday April 27, 2019) -------The day after Saraka, on Saturday April 27, 2019 over 100 residents of River Sallee, St. Patrick received free health screening services as a result of the continued partnership between Central Health-Grenada and the Student National Medical Association – St. George’s University Chapter (SNMA-SGU Chapter). This year’s event was hosted by the River Sallee Evangelical Church. 

Due to its quaint sized location, the River Sallee Evangelical church secured permission to use the River Sallee Government School. Pastor Alvin Campbell agreed to host the Free Health & Diabetic Clinic because he saw it as an opportunity to assist his community, “I know for the community, especially my community at River Sallee, there are a lot of people who don’t go see the doctor. Even though they are sick, they would stay home. But hearing something like a free health fair coming and covering a number of areas, I believe that is the reason why I said adamantly we should go ahead with it.”

Although they offer other services during their tenure in Grenada, this is the sixth event over a three-year period, that SNMA-SGU Chapter and Central Health – Grenada have collaborated. Michelle Adibe, President of the SNMA-SGU Chapter admitted that traveling so far from campus was a little nerve racking, however it is part of their mission statement, “Coming out into rural Grenada, and helping these individuals be able to obtain health care that they normally don’t see everyday or have easy access, is something that is really important to us – SNMA.”

Founder of Central Health – Grenada Roslyn A. Douglas, MA, ACS, ALB said that prior to River Sallee, the SGU Medical students have offered the same thing in St. David – three times; St. George – once; and Grenville, St. Andrew once also. “The Free Health & Diabetic Clinic in River Sallee was a success because the host church committee Chair - Dianne Roberts was strategic in reaching out to the community group responsible for planning the River Sallee week of activities. They promoted the free clinic along with their plans. In addition, thanks to a private donation, I hired Mr. Lett to drive around the community with his loud speaker to advertise the event – after getting permission from the Commissioner of Police.”

The services provided were eye examination, glucose testing, blood pressure readings, diabetic foot examination, nutrition counseling and feedback from onsite doctors.  Also offered was private prayer by the River Sallee Evangelical Church prayer team in a nearby classroom.

Ms. Douglas provided tokens of appreciation to the church’s leaders and volunteers during their Sunday service, “This event would not have been possible without the volunteers from the church. Imagine, they not only walked around the community to promote the event, but they also cleaned up after the Saraka dance which ended at 7 am on Saturday. They did so in less than two hours. It is also important to note that SNMA provided the glucose testing strips and lancets, while Bryden & Minors provided copies of promotional materials. This is what love of community is all about.”

- Article by: Central Health - Grenada

Is Your Parent Really Ok?

By: Central Health - Grenada

Eventually you - the child grows up and begins to carve out a life.  You may have a job, fighting to make ends meet or perhaps things are going well for you and your significant other. You check in with your parent(s) with visits or phone calls and within those windows, everything seems fine. 

YOU:                  “Hey Mommy.  Just calling to check in on you.  How was your day?”

MOTHER:         “Oh baby, I went to town today, to get some things for the house and pick up some medication.  I saw a lady that gave me a help out, and I also stopped in at NIS to check on things. I’m alright. Got everything done. How are you Sunshine?

{The conversation continues with general chit chat.}

What the child may not know about the day, are the finite details.  Four buses refused to stop for her, as the grey hair bellowed in the wind, because “Tante, you will slow us down.” Then she continues waiting until she gets a spot within the second row of the bus, as it is the easiest to get into.  While standing in line to pay for groceries her walking stick falls and she cannot bend down to pick it up. She is saved by the kindness of a middle-aged person who takes pity. This senior citizen has shoulder and leg pain and it is a real struggle to lift those heavy bags of groceries onto the bus. It was the truth, she did go to the pharmacy to get medication, but did not end up purchasing it because she had to make a choice between food or medicine and chose food. Typically, the first defense is, she can ask for help.  Maybe she did once and felt embarrassed.  After been ‘in charge’ all your life, handling everything and then to turn around and HAVE TO ASK for assistance can be daunting.

Caring for a parent(s) is a delicate balance.  Not everyone had a great childhood.  In some instances, when the child ‘breaks free’ they do not look back as they move away from the verbal narcissistic, controlling, physically abusive, sexually tormenting, and/or emotionally deprived home.  When this child did return home, hoping for the relationship they always wanted, got burned time and time again and has given up trying.  Others had wonderful childhoods. The home was fully functional, full of love, peace, and present caregivers.  Visits to the home after independence for this child, are filled with smiles, laughter, hugs, shared stories about growing up and plenty kisses.  Based on these variables, no one can dictate to others what they ought to do. However, this Health Perspective is to encourage those with living parents to examine their parents' living condition, economic wellbeing, health care and emotional/mental soundness – as you are able. Or maybe you already are assisting, and the burn out does not allow you to see the new needs.

Here are five tips to consider:

1.      Assess

Invest a full day periodically with your loved one, especially errand days, and observe how they are moving around. Treat it as a Bonding Day.  Be present and help as necessary.  Be mindful, some parents may suddenly change plans, so you won’t be able to ‘see’ them at moments of weakness, nonetheless keep insisting. Also evaluate the cleanliness of the home.  In your estimation, can the parent continue keeping the outside and inside of the house tidy on their own – or do they now need help. Pop up visits work best for that, otherwise the parent may overexert themselves to clean before your arrival. Another point to consider is the parent expressing concern about living alone.  Will an aid at night make them comfortable, can children take shifts spending the night or can siblings rotate taking the loved one in for a year each – as a suggestion.  As Elder Abuse is a real thing, do inquire/observe if the parent seems uncomfortable with that family member who is currently living with them.

2.      Ask

Some persons are 100% reliant on their pension plans.  For many it is not enough to meet monthly expenses.  Write out all of the medical expenses, groceries, utility, medication and so forth that are required a month.  Then compare that total with their pension income.  Similarly ask the person, what can you do that would help them out a bit.

3.       Have a family meeting with siblings

Once it has been determined the new needs of your parent, have a meeting apart from the parent to discuss what you have learned with siblings or family members who can pitch in.  The parent does not need to privy to arguments or frank conversations about who can do what and for how long. Assistance can range from scheduled visits, one person committing to paying for medication, another utility, another food.  Or perhaps everyone agrees to provide a set amount every month, so the parent is no longer secretly stressed.

After everything has been ironed out, have another meeting, this time with parent present and share what everyone will be doing moving forward. Share this innovation in a manner that will be received as, “It is being done as general love, care, concern and a willingness to just be helpful.” Ignore their efforts to refuse assistance as you would have already assessed and discussed the situation.

4.      Reassess Monthly

Check in with those who made commitments and ensure that they can continue or if a reshuffling of responsibilities is needed.  This is an important point to consider because sometimes life happens and people’s responsibilities or obligations change.  If an obligation can not longer be met, that information must be discussed apart from the parent, with the core group, to come up with how it can be met.  If the parent is told, they may feel obligated to ‘cover’ for the person and others may be oblivious to break down in commitment.

These are just suggestions, with the hopes it can begin an important conversation as it relates to senior care.  The goal is simply to ensure that your parent is indeed ‘ok.’

Photo: Lifehacker.com

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