Graduating dental student Elmi Ibrahim reflects on why he is driven to serve

For young Elmi Ibrahim, the sprawling refugee camp in the Kenyan desert where he spent eight years of his childhood was his entire world. After his father was killed in the civil war in their home country of Somalia, his mother fled to Kenya with Ibrahim and his four siblings.

Dr Elmi Ibrahim

“As a child, it all seemed normal,” says the fourth-year dental student. “There was no school, and we could not leave the camp. It was all I knew. So my memory is of playing outside with a lot of other children every day. My mom sheltered us from the threats around us; the violence, the gangs, the disease outbreaks of malaria, hepatitis, cholera and HIV.”

At age 10, Ibrahim was plagued by an infected molar that kept him awake at night. His mother was skeptical of the self-appointed witch doctors who offered to cut the tooth out without pain medication using non-sterile instruments. She had seen too many crude procedures end badly. With no professional oral health care available at the camp, Ibrahim suffered for a full year before the family was able to migrate to the United States.

FIRST ENCOUNTERS

His memories of those first few days in the U.S. are vivid. They resettled in Burnsville, Minn., where a church sponsored their first several months in the country. A volunteer took them immediately to the University of Minnesota Dental Clinics where Ibrahim remembers feeling the pain dissipate instantly, for the first time, with Novocain.

“It was such a relief I cannot even describe it,” he said. “I lost the tooth, I knew no English, but it was my first dental visit and it was positive.” 

Ibrahim clearly remembers the volunteers who helped his family.

“They took us everywhere and taught us so much,” he said. “They taught us how to use the microwave, go grocery shopping, get to school and do laundry. The concept of volunteerism was new to me and I was amazed by this idea that kind people were helping us without getting paid. This has really stayed with me.”  

Ibrahim learned English quickly, excelled in school, completed a Bachelor of Science degree in medical laboratory sciences from the University of North Dakota and worked in a lab at the University of Minnesota for four years before applying to dental school.

ORAL HEALTH CARE IN THE SOMALI COMMUNITY

As a dental student and father, he carves out time to volunteer to improve the oral health of underserved communities, and in particular, the more than 100,000 Somali Americans living in the Twin Cities.

Recognizing the Somali community’s distrust of the American health care system, Ibrahim worked with Professor Nelson Rhodus, DMD, MPH, and fellow students to offer free oral cancer screenings at Mosques, apartment buildings and a Somali mall. He says the community was initially skeptical, but once they realized they were not selling anything, and that he and other Somali students spoke their language, they began to trust the screenings.

Ibrahim says he has learned that the prevalence of khat, a stimulant chewed predominantly by Somali men, and Hookah, smoked by many Somali youth, put them at greater risk for oral cancer. 

“The Somali community is very tight knit,” he says. “They get advice from each other, and the advice is not always sound. For example, if someone dies at a specific hospital, the whole community will avoid that hospital. I want to break that cycle of relying on resources and information that is not factual or scientifically proven.” 

Ibrahim credits Professor Nelson Rhodus for making the outreach possible and removing barriers at many levels.

“We look for cancer first, but we find a lot of periodontal disease, tooth pain, poorly-fitted and old prosthetic teeth,” said Ibrahim. “It is an excellent opportunity to educate and encourage better hygiene.”

Ibrahim served as president of the local Student National Dental Association, which promotes oral health equity among people of color. The organization’s membership grew ten-fold under his two-years as president as he empowered fellow students to develop outreach programs into their own communities.

A FUTURE OF SERVICE

Ibrahim will begin a general practice residency at Hennepin County Medical Center after graduating this spring, where he hopes to gain experience treating medically complex patients. He plans to one day open a practice with his sister, where they will see any patient who walks in the door.

Now, when he recalls his years in the Kakuma refugee camp in Kenya, he often thinks about his own two children, ages 4 years and 6 months, and how different their lives will be.

“I want them to realize how fortunate they are to be born here,” says Ibrahim. “Life isn’t only about looking out for yourself and your family. You always have to ask yourself how you are giving back.”

Ibrahim traveled to Guatemala early in 2020 with faculty and other fourth-year students from the School of Dentistry to gain a greater understanding of how to effectively partner with community organizations to advance their health goals.

It pained Ibrahim to learn last year that only recently have professional oral health care services been brought to the more than 160,000 residents of Kakuma. 

“I had hoped, all this time, that things had improved with health care there,” he said. “I have been gone for 20 years and am learning that only recently are dentists going to the camp. I would like to be one of them someday.”

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Somalia confirms 49 new COVID-19 cases, total rises to 286

MOGADISHU, April 21 (Xinhua) -- Somalia's Ministry of Health on Tuesday confirmed 49 new cases of novel coronavirus, raising the national tally to 286.

Fawziya Abikar, the health minister, said six people succumbed to the deadly virus, bringing the total number of fatalities to 14.

"Six people died of the virus. This is the highest number of deaths in one day," Abikar said in a statement issued on Tuesday evening.

She said two more people have recovered from COVID-19, raising the total number of recoveries to six.

The latest cases came after the government and the United Nations have expressed concerns about the sharp surge in the number of confirmed cases in Somalia due to limited capacity to contain the spread of the virus because of the fragile healthcare system.

The majority of the cases, including the first fatality, have no travel history, signifying local transmission of COVID-19. The World Health Organization (WHO) said further transmission of the virus can be expected.

The Horn of African nation has instituted measures to contain the spread of COVID-19 including closing schools, banning large gatherings and suspending international and domestic passenger flights.

A curfew took effect on April 15 in Mogadishu to help enhance measures against COVID-19 amid fears that the disease could spread fast given the country's fragile health system. 

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Kenya to begin mass producing ventilators

The Kenya Association of Manufacturers (KAM) made public the prototype of the locally developed ventilator in Nairobi on Tuesday.

The PumuaIshi 2.0 is designed to be a complete intensive care unit respirator.

Job Mathenge explains how the PumuaIshi 2.0 ventilator works to Industrialisation Cabinet Secretary Betty Maina and CAS Lawrence Karanja on April 21, 2020. PHOTO | SILA KIPLAGAT | NATION MEDIA GROUP

It is portable, robust, compact, economical and easy to use, KAM said.

“The primary focus of the PumuaIshi 2.0 is to provide intermittent positive-pressure ventilation (IPPV),” said Ashit Shah, an expert on ventilators made using Israeli technology.

This is the process of manually or mechanically ventilating a patient exhibiting a brief stop of respiration as well as one who has difficult or laboured breathing.

He added that the ventilator can easily be used by untrained people and can operate continuously for up to four hours without power.

KAM automotive sector chairman Niraj Hirani said 100 pieces would be made daily and 500 every week when mass production begins. Industrialization Cabinet Secretary Betty Maina said the breakthrough is a result of the challenge to local manufacturers to help in the war against the deadly virus.

Kenyatta University, Dedan Kimathi University of Technology and the Kenya Industrial Research and Development Institute are also in the process of mass-producing such gadgets.

“These innovations need to be encouraged even after the pandemic. Kenyan manufacturers should compete in the regional and global markets,” Ms. Maina said.

“It shows that local manufacturers can make and deliver critical medical equipment and when required to.”

KAM chief executive Phyllis Wakiaga said the PumuaIshi 2.0 would undergo tests and refinements in the next five days and consequently go into mass production in two to four weeks. She said the cost of producing the ventilator would be a quarter the amount needed to import a similar gadget.

“We took the challenge from the government for the good of the country and its businesses,” Ms. Wakiaga added.

“The pandemic has presented an opportunity for local manufacturers to show what they can do.”

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United States Bolsters Somalia COVID-19 Response with Donation of 350 Hospital Beds

The United States Embassy Mogadishu, through the United States Agency for International Development (USAID), will donate 350 hospital beds and 500 bedsheets to support the Somali Government in preventing and controlling the spread of COVID-19. The Ministry of Health was present at a handover ceremony in De Martino Hospital where medical staff graciously received the beds.

Somalia health officials 

These beds and accessories will be used in the ICU units of De Martino hospital and in isolation centers in Mogadishu and be distributed to newly established isolation centers in the regions helping medical personnel to provide life-saving care to their patients.

The United States is proud to assist the Somali Government during this critical time,” said the U.S. Ambassador to Somalia Donald Y. Yamamoto. “Well-equipped isolation centers where patients are well cared for and are safely and comfortably separated, will help limit the spread of COVID-19 throughout the country.

“This generous investment makes it possible to save lives, and better prepares us to control the infectious nature of COVID-19,” said Minister of Health Fawziya Abikar Nur. “To beat this outbreak, everyone needs to continue to peacefully follow health guidelines, observe social distancing, and maintain good hygiene practices.”

The U.S. Government is leading the world’s humanitarian and health assistance response to the COVID-19 pandemic even while we battle the virus at home. When an outbreak strikes, it threatens to undermine a nation’s progress towards self-reliance and stability. USAID’s global public health investments ensure continuity of development goals while providing countries with critical assistance to combat COVID-19.

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Nigerian woman, 68, gives birth to twins. All three are doing well.

The Lagos State University Teaching Hospital has announced the successful delivery of twins by a 68-year old woman.

The chairman of the hospital’s Medical Advisory Council, Prof Wasiu Adeyemo, made the announcement in a statement on Sunday.

Parents proudly holding their newly born babies

It said the woman gave birth through an “elective cesarean section at 37 weeks gestation.”

The babies and mother are doing well, it added.

He said the woman was delivered of the babies on April 14 via caesarean section.

According to Adeyemo the woman, became pregnant for the first time courtesy of In Vitro Fertilization (IVF).

He said: “LUTH has successfully delivered a sixty-eight (68) year old primigravida (pregnant for the first time) with twin (a male and a female) gestation (pregnancy) following an IVF conception. She was delivered through an elective caesarean section at 37 weeks gestation on Tuesday, April 14, 2020.”

According Cable, Adeyemo noted that  “the IVF and embryo were done at a separate location but later referred to LUTH during the early stage of the pregnancy where it was consequently managed until delivery.

“The development was the first of its kind in LUTH, Nigeria and Africa, adding that both the mother and babies are in a good state.

“The IVF and embryo transfer were done at an outside facility. She was thereafter referred to LUTH at early gestation and managed till term. This is the first in LUTH, Nigerian and Africa! Mother and babies are well.”

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Somalia: main COVID-19 treatment centers have only beds. No oxygen, no ventilators.

The most critical piece of lifesaving equipment of the coronavirus pandemic is in desperately short supply in Africa: According to the World Health Organization, there are fewer than 2,000 ventilators across 41 countries that reported to it.

De Martini Hospital, Mogadishu, Somalia

Somalia’s health ministry still doesn’t have a single one. Similarly, Somaliland also doesn’t have a single one. The Central African Republic has three. South Sudan, four. Liberia, five. Nigeria, with a population of two-thirds that of the United States, has fewer than 100.

Officials say those numbers will change as ventilator donations trickle in. But even in countries with the machines on hand, few doctors have undergone intensive training to use them, and anesthesiologists, required in most cases to intubate patients or supervise that process, are scarce.

The inadequate equipment and training mean that Africa’s most vulnerable countries stand little chance of saving the lives of their most severe COVID-19 cases as the number of patients begins to spike. As of Friday, there were more than 19,000 confirmed coronavirus cases and 1,000 deaths across the continent.

We are now failing. Let me use that word deliberately,” said Mahad Hassan, one of Somalia’s few epidemiologists and a member of the government’s coronavirus task force. “At our main treatment center, almost nothing is there. Last time I visited, beds, only beds. No oxygen, no ventilators.

Somalia has just four intensive care unit beds, according to Abdirizak Yusuf, 35, who is in charge of the health ministry’s response. As of Friday, the country had confirmed 116 cases.

The government has tried to procure protective equipment and ventilators quickly, but everywhere they turn, they come up against countries that want to keep what they can for themselves. Ventilators are also expensive, costing at least $25,000 each.

A few ventilators and 200 ICU beds are on the way, Yusuf said, and should be in Somalia within two weeks. Jack Ma, a Chinese billionaire and owner of the e-commerce giant Alibaba, has donated 500 ventilators that will be divvied up among African countries.

In the meantime, Yusuf thinks coronavirus cases could be spiraling out of control. It was just last week that Somalia developed the capacity to domestically test samples for the virus.

I think there can be even a million cases that we’re missing in Somalia,” he said, speaking from the country’s one isolation center, out of breath from a day of frantic work. “My colleagues are even testing positive. Our ministry people are testing positive. Most of the people we are testing are testing positive.

Five COVID-19 patients have already died in Somalia, and Hassan said he is expecting “very, very painful weeks ahead.” All five needed intubation with a ventilator when the oxygen support that was available failed to improve their condition.

Somalia’s health care system is one of the poorest in the world. Yusuf estimates there is just one doctor for every 100,000 people. Those doctors are concentrated in the capital, Mogadishu, where the government runs its response out of a dilapidated hospital dating to the Italian colonial era. Beyond the city, the extremist group al-Shabab controls much of the country’s rural areas, making access nearly impossible.

“In those places, we can only reach them by phone to tell them how to prepare for COVID-19,” said Yusuf.

Even with ventilators, however, trained health workers are scarce.

Operating a ventilator requires intensive training and isn’t a one-person job. Most times, an anesthesiologist has to be involved. Most of Africa’s 54 countries have less than 1 per 100,000 people, according to the World Federation of Societies of Anaesthesiologists.

Such expertise, however, cannot be packed up and shipped over like a ventilator. Physicians used to board planes to help each other through crises, but now doctors trained to use ventilators are linking up with African counterparts on Zoom, Skype and WhatsApp. They sit six feet apart in hospital conference rooms, demonstrating techniques on human dummies with fake lungs.

Nurses in Sierra Leone have connected with doctors in Baltimore to record training sessions they hope to share with colleagues in Liberia, Ghana and Kenya.

“It is better than nothing,” said Seyoum Worku, one of two doctors in Liberia who is trained to use a ventilator and is leading six-hour crash courses with his colleagues.

When you look at our health workforce, we are not talking about people who have done research, gotten grants, et cetera,” said Hassan, the task force member in Somalia. “The total number who have done so is less than almost any other country. You wouldn’t even compare us to a small American state.

Right now, the lack of ventilators seems like a looming crisis in Somalia. The country is still trying to get its testing abilities off the ground.

Because Somalia developed testing capabilities so late, health workers fear that the country lost precious time in tracing the contacts of those who eventually tested positive. Before last week, samples had to be flown on infrequent charter flights to Nairobi in neighboring Kenya. It took weeks for some to get their results.

That has also created a lag in the Somali public’s understanding of the virus, said Marian Hassan Mohamud, who coordinates health workers for the International Rescue Committee, an international nonprofit that works across the country.

Most Somalis haven’t realized that this thing even exists,” she said. “People still have misconceptions that our climate is too hot for the virus, or that only foreigners are susceptible to it.

The delay in contact tracing means that many cases have surely moved beyond Mogadishu and Hargeisa, Somalia’s two biggest cities where nearly all the cases so far have been recorded, Mohamud said.

Depending on how quickly the health ministry can ramp up testing, the number of confirmed cases is expected to skyrocket in the coming week. By that point, patients should already be showing up at hospitals, many of whom will eventually need ventilators that just aren’t there.

“The best we will likely be able to do for most patients is isolate them,” said Mohamud. “Treatment? To be honest, there is no such thing yet.”

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Musthag Kahin: Meet the nursing apprentice on the NHS front line

Musthag Kahin is one of thousands of nursing apprentices now working full-time in the NHS battling coronavirus.

Musthag Kahin

Yesterday, I received an email from a clinical lead asking for volunteers for a new ward that will treat Covid-19 patients who can’t self-isolate. I emailed back straight away and put myself forward, says Musthag Kahin. 

As soon as the end of April, Kahin could be working on that ward full-time –  despite the fact that she is not a fully qualified nurse.

She is one of thousands of nursing apprentices who have had their courses paused so they can be released to the NHS front line to tackle the coronavirus pandemic. 

Kahin would normally work 30 hours at a hospital placement, and then spend seven and half hours a week at university. For the next four months at least, her university time has been paused, her apprenticeship training is halted, and she is working full-time at the hospital. It’s a big change for her and her peers: and it’s a direct result of the global pandemic that has taken thousands of lives, including those of many health staff.

Joining the fight against coronavirus

“At the beginning, it was terrifying. We didn’t know what was going on, we didn’t know if it was airborne. We were not routinely testing anyone, not even us as the staff. We weren’t wearing masks all the time, only when we were dealing with patients,” Kahin says. 

But as time has gone on, guidance has changed and we have been provided with full PPE. I’ve become more confident in dealing with coronavirus and looking after people affected by it.

Speaking to Tes from the acute mental health ward that she had been working on as part of her apprenticeship, she says life on the ward has changed significantly in the past few months.  

We don’t normally wear uniforms, but now, as we come into close contact with everyone, we are wearing the proper equipment. We had new rooms allocated for PPE and equipment, and we are using plastic utensils which can be thrown away. Anything that has to be reused – for example, the blood pressure cuffs – has to be clearly labelled if it has been used on a patient with suspected Covid-19 or Covid-19, she says.

A lack of PPE, Kahin says, hasn’t been an issue on her ward. Staff there have always had the equipment they needed. She feels safe and confident that she will be fully protected if she transfers to the Covid-19 ward in a few weeks' time. There, she would be dealing with mental health patients who are unable to self-isolate at home because they are too vulnerable to be left alone, need medication injected in their blood streams and regular check-ups.

Like the patients she sees every day on the acute ward, they will be dealing with a range of mental health illnesses: from severe depression and schizophrenia to bipolar disorder and self-neglect. These conditions, Kahin says, make them more vulnerable than most. And she’s witnessed first-hand the effect that self-isolation, even within a hospital, can have.

Isolation and mental health

“Many have had to self-isolate and stay in their rooms, which is really tough for people with mental illness, especially when there’s not much to distract them like a TV. We check in on them, bring them newspapers and encourage them to make use of the free wi-fi but it’s really hard.”

It’s hard on her, too – but, despite everything, Kahin says she’s really grateful to be going into work. Her parents, like many who have children working in the NHS, are concerned.

“They tell me I shouldn’t be working, but I say, 'I have to work – I haven’t got a choice.' We are in unprecedented times and looking after patients and caring for them takes priority,” she says. 

Kahin’s father is 75 and her mother 65. Her father lost three of his friends to the virus last week. Kahin is doing everything in her power to minimise risk and keep them both safe.

I work quite long days, and travel 50 miles a day to get to the hospital, so by the time I am home by 10pm they are normally in bed. I put my scrubs in an air-tight bag, and then another bag, and wash them as soon as I get home, she says.

“When my dad is in the living room or kitchen, no one else goes in. He has his own bathroom too. I am in contact with them constantly, that hasn’t changed, I just can't be physically close to them. I see a lot of people who are losing their relatives, so I’m doing all I can to make sure they stay at home and they stay safe.”

'Staying at home is for the greater good'

Kahin stresses the importance of everyone staying at home, and says that still the message needs to be clearer.

“I know people might criticise the people who were on Westminster Bridge last night [standing close to each other in a large group] but from the beginning, people haven't been taking it seriously. Even our prime minister, he shook people’s hands and said we needed to take it on the chin. It didn't seem serious. 

“It is hard for people, especially when there’s so much conspiracy going around. It’s stuff that makes you think, really? But others are more susceptible to it. There’s other problems, too, with messaging. You know for some people English is not their first language, so the sources of information could be different,” she says.

I never thought it would get to the scale it has. The numbers of people dying every day – we are all at risk. But it’s not until it happens to someone close to you or a family member that it hits you differently.

"Please stay at home. It is difficult, but it is for the greater good.”

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10 African Countries Have No Ventilators, Somalia is among them

Basic supplies like oxygen and soap are needed first to slow the spread of the coronavirus.

Habtamu Kehali provides training for doctors on how to use mechanical ventilators for coronavirus patients at the American Medical Center in Addis Ababa, Ethiopia.Credit...Michael Tewelde/Agence France-Presse — Getty Images

DAKAR, Senegal — South Sudan, a nation of 11 million, has more vice presidents (five) than ventilators (four). The Central African Republic has three ventilators for its five million people. In Liberia, which is similar in size, there are six working machines — and one of them sits behind the gates of the United States Embassy.

In all, fewer than 2,000 working ventilators have to serve hundreds of millions of people in public hospitals across 41 African countries, the World Health Organization says, compared with more than 170,000 in the United States.

Estimated number of ventilators as of Apr. 17

Country	Ventilators	Persons per ventilator
Somalia	0	-
DR Congo	5	20,356,053
Mali	3	6,517,799
Madagascar	6	4,492,623
South Sudan	4	2,640,311
Central African Republic	3	1,996,952
Burkina Faso	11	1,894,127
Nigeria	169	1,266,440
Malawi	17	1,246,861
Niger	20	1,138,618
Burundi	12	988,818
Zimbabwe	16	909,145
Mozambique	34	885,241
Senegal	20	786,818
Uganda	55	786,418
Liberia	7	724,757
Sudan	80	569,519
Sierra Leone	13	509,610
Namibia	10	263,007
Kenya	259	206,672
Ethiopia	557	194,099
Ghana	200	146,701
Libya	350	19,687

Source: New York Times reporting; International Rescue Committee; Norwegian Refugee Council; The CIA World Factbook.

Ten countries in Africa have none at all.

Glaring disparities like these are just part of the reason people across Africa are steeling themselves for the coronavirus, fearful of outbreaks that could be catastrophic in countries with struggling health systems.

The gaps are so entrenched that many experts are worried about chronic shortages of much more basic supplies needed to slow the spread of the disease and treat the sick on the continent — things like masks, oxygen and, even more fundamentally, soap and water.

Clean running water and soap are in such short supply that only 15 percent of sub-Saharan Africans had access to basic hand-washing facilities in 2015, according to the United Nations. In Liberia, it is even worse — 97 percent of homes did not have clean water and soap in 2017, the U.N. says.

“The things that people need are simple things,” said Kalipso Chalkidou, the director of global health policy at the Center for Global Development, a research group. “Not high-tech things.”

Though limited testing means it is impossible to know the true scale of infections on the continent, several African countries report growing outbreaks. A snapshot of the situation on Friday showed that Guinea’s cases were doubling every six days; Ghana’s, every nine. South Africa had more than 2,600 cases; Cameroon, nearly 1,000.

Of course, there are big disparities among Africa’s 55 countries, too. Ventilators are much more plentiful in South Africa, which has a big economy and a relatively strong health infrastructure, than in Burkina Faso, one of the earliest West African countries to be hit by the coronavirus. At last count, it had 11 ventilators for 20 million people.

And not all African countries want it known how few ventilators they have. For some, this information could have “a lot of political implications,” including criticism of their management of health systems, according to Benjamin Djoudalbaye, head of health diplomacy and communication for the Africa Centers for Disease Control and Prevention.

The Africa C.D.C. has been trying to amass data on how many ventilators and intensive care units each country has, so it can model what needs will arise if there is an explosion of cases. But even collecting the data is not easily “attainable and extremely expensive,” Mr. Djoudalbaye said.

The World Health Organization said last week that there were fewer than 5,000 intensive care beds across 43 of Africa’s 55 countries — amounting to about five beds per million people, compared with about 4,000 beds per million in Europe. But the numbers in Africa are so unclear — the data is a scattershot representation of the continent — that there is no way of knowing for sure, Mr. Djoudalbaye says.

Across Africa, there have been efforts to get ventilators. Ecowas, the union of West African countries, is trying to get hold of them to distribute to its member states. On April 1, Nigeria’s finance ministry appealed to Elon Musk on Twitter — before deleting its message — admitting that Africa’s most populous nation needed support and asking for at least 100. Jack Ma, the Chinese billionaire, says he is donating 500 to the continent.

Liberia has ordered another 20, according to Eugene Nagbe, the minister of information. But global demand is so high, he said, that vendors are the ones calling the shots, and it is difficult to compete with more powerful nations.

Getting more ventilators to African countries is not enough, though. Trained medical personnel are also needed to run the machines, as well as a reliable electricity supply and piped oxygen. These are things taken for granted in most European and American hospitals, but are frequently absent in health facilities across the African continent.

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