Addressing COVID-19 Stigmatisation in Nigeria

My question to Nigerians, would you rather be stigmatised of COVID-19 and remain alive or hide away with the disease and go six-feet? Get a test if you suspect loss of smell or taste, your life is more important to any form of stigmatisation!

We are currently at a point in our lives as a nation and a people were the fight against COVID-19 is becoming difficult by the day. This trend may become much tougher in the coming days if not nip in the bud. Despite the government awareness of the COVID-19 stigmatisation, there seems to be no solution insight as the only message from the government is ‘take responsibility,’ but how?  Inasmuch as there is nothing wrong in telling people to take responsibility, it is obvious this mantra of self-responsibility is less effective or at best it is seen as another lexicon associated with the current COVID-19 era.

But what is stigmatisation as regard to health? It is an act where a group of people or individuals are labelled owing to a particular disease. In every instance of a new disease outbreak such as the COVID-19 pandemic, it is often common that vulnerable people, health workers, families or race get stereotyped, treated with disdain or ostracise from the community. These forms of treatment could easily drive people into depression, and in extreme cases suicidal ideation. At the onset of a new disease especially highly contagious diseases, stigmatisation is always the next-door neighbour. But the downside of early stigmatisation in a disease outbreak is that people may lose their lives due to fear of stigmatisation, and as the awareness becomes intensified, those who were the propeller of stigmatisation may likely fall in line. The question to be put forward to the citizenry is, how many will be fortunate to fall in line and will those who shied away from treatment due to stigmatisation be alive to tell the story?  

The risk of social stigmatisation is too high a burden especially for a disease were the symptoms only begin to appear after five to seven days from exposure to an infected person. When people fail to step forward due to the possibility of social stigmatisation, this places everyone at risk including individuals fuelling stigmatisation and those adhering to laid down rules. In addressing the bane of COVID-19 stigmatisation here are a few of my recommendations: 

Continuous Education: stigmatisation only persist when people are poorly educated or wrongly informed about the true nature of a disease. To address this, the government need to put the behavioural pattern of Nigerians into context in terms of learning and adherence to instructions. A perfect example is the era of HIV advocacy; now is the time to adopt the National Agency for the Control of AIDS (NACA) strategy in the early days of HIV in Nigeria. 

A Change in Patient Extraction Strategy: due to the sensitivity of the time, the use of marked vehicle such as ambulance should be discouraged and only used when extracting patients with severe conditions. Also, if patients could walk a few distance from their residence to a neutral place for pick-up this will equally help. When people are certain that their identity will be concealed, a lot more people will readily cooperate. Rather than broad daylight extraction, COVID-19 positive patients could be extracted at night as well. The end product here is treatment and by extension limiting the rate of COVID-19 spread.     

The Benefit of Early Reporting: once individuals suspect loss of smell, taste or general body weakness and persistent malaria-like symptoms, they should be encouraged to call the NCDC. The benefit of early reporting will reduce the number of contact tracing and by extension the authorities won’t have to question every single individual around. The benefit of this to the infected individual seeking anonymity is less word out into the community. It is therefore imperative people are aware of this benefit.

Video-supported Care: if individuals – asymptomatic patients do have the right conducive and requisite recovery environment such individuals should be given the opportunity to homecare. This can then be supervised through video tele-care and telecommunication should be partnered for the provision of free data to the COVID-19 patient over the period of treatment and recovery phase. 

Use of Words: no doubt the use of certain words or language can fuel stigmatisation and dehumanising in many ways. Rather than use ‘isolation centres’ how about ‘recovery centres.’ Also, NCDC should adopt a new way of reporting, for instance, confirmed cases could be replaced with ‘COVID-19 conducted tests;’ suspected cases to people with likely COVID-19 infection, discharged to recovered. The careful choice of words and usage will certainly reduce the level of discrimination. 

Engage Popular and Known Faces: to drive home the message of COVID-19 reality, popular artiste, comedians, actors or social media influencers should be engaged for a video-shoot in the respective recovery centres across the nation. The populace will readily buy into such individual personalities compared to the normal journalist in the mainstream media. Of course, these individuals should be provided and protected with appropriate personal protective equipment (PPEs).

A community of COVID-19 Survivors: the vaccine for the SARS-CoV-2 is nowhere in sight and if at all there is one in the next 9-months, Nigeria may likely not be on the list of top-twenty. Therefore, if we take seriously the magnitude of what we have at hand, then we need to encourage COVID-19 survivors’ community to help drive the reality of the disease across board. We are as strong as our weakest link in the fight against COVID-19.

Clarity of Purpose and Sincerity: there is a stigma as regard to insincerity of the government generally perceived by the people. This form of stigmatisation mumbled with less clarity of purpose as regard the exist plan for the COVID-19 pandemic, portrays the government on a deceitful light to the people. One of such clarity is, are we waiting secretly for a vaccine? Are we equally banking on herds-immunity quietly by allowing majority of Nigerians get infected owing to the age demography, knowing fully well many will recover without knowing they had the virus? The government should be seen as communicating clearly and truthfully, brushing such concerns aside will further lead to the stigmatisation of the government by the people.     

At this rate of unknown causes of death in the country, activating one’s survival instinct to pull through 2020 is more crucial than many other things in life for the now!

Dr PI Imoesi, BSc, MSc, Ph.D.
Molecular Neuroscientist and Research Fellow, 
Institute of Medical Science,
University of Aberdeen.
Scotland, United Kingdom.

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