The small island country of Kiribati, home to 120,000 people, is currently facing COVID-19 community transmission for the first time since the pandemic began. During the worst of the current surge in cases from end-January until mid-February 2022, the country was seeing hundreds of cases a day – largely driven by the highly transmissible Omicron variant of concern.
The World Health Organization (WHO) has been supporting Kiribati’s Ministry of Health and Medical Services in their efforts to protect their population and save lives, building on years of joint work to boost the country’s preparedness for health emergencies, including the current pandemic. As part of this support, WHO has been providing technical assistance on clinical management, infection prevention and control, risk communication, and laboratory strengthening.
But what do we mean by ‘technical assistance’? To explain, we spoke with Dr Karen Hammad, a career nurse and academic with expertise – including a PhD – in emergency nursing and disaster response. Dr Hammad is currently the clinical management and care pathway lead in WHO’s Division of Pacific Technical Support (DPS), and has been deployed to support Kiribati’s COVID-19 response, with assistance from the European Union.
Can you explain what healthcare pathways and clinical management mean?
COVID-19 health care pathways are established at local, regional and national levels to support delivery of safe, high-quality health care for patients with suspected or confirmed COVID-19. It includes guidance for the public around when to seek testing, when to seek medical care or where to go for optimal care. For health workers, it provides guidance on the flow of patients through a health facility and how best to care for patients while limiting transmission within health facilities.
How have you been providing technical assistance to Kiribati and other countries on clinical management?
I've been working with Pacific Ministries of Health and with Pacific health workers to strengthen their readiness to manage a COVID-19 outbreak since mid-2021. I have supported simulation exercises, clinical management training, and I helped to develop and adapt tools for health workers to guide the development of health care pathways in Pacific countries and areas. When countries like Kiribati experience COVID-19 cases and community transmission, I help to provide Ministries of Health and healthcare workers with the latest evidence and advice around clinical care.
What does your normal day look like since you’ve been deployed to Kiribati in February?
In the morning, we have an emergency operations meeting led by the Ministry of Health and Medical Services to plan the response strategy and make critical decisions.
After that, the days vary. For example, while I have been here I have delivered clinical management training to healthcare workers at hospitals and clinics, and I have travelled to different health facilities across the country to observe and assess existing COVID-19 clinical areas or help repurpose other areas for COVID-19 clinical management.
While in Kiribati, we repurposed a hospital ward specifically for COVID-19 cases requiring hospital admission and repurposed a school of nursing into a facility to accommodate stable COVID-19 cases that don’t require hospital admission, but who need to be monitored because of underlying risk factors. To develop health care pathways, I have spoken with key stakeholders to identify the flow of patients through the hospital or across the country and then developed visual representations of that pathway to help inform health workers.
Dr Karen Hammad (leftmost), WHO Western Pacific Region – Division of Pacific Technical Support Clinical Management Lead, participates in an emergency operations meeting in Kiribati.
What have been the challenges that you’ve experienced in Kiribati since you’ve been deployed?
One of the biggest challenges in any Pacific country is the limited human resources available. When I arrived in Kiribati, many of the healthcare workers had recently been infected with COVID-19. Part of my job has been to help improve understanding of COVID-19, how to safely manage it and protect healthcare workers and patients. It has also involved advising healthcare workers on the ways they can protect themselves (and in doing so, also their families) through wearing appropriate personal protective equipment (PPE), getting vaccinated and implementing effective health care pathways and hospital screening. Also, we advise on using the COVID-19 response to strengthen the health system and provide much needed resources that can be used for COVID-19 such as pulse oximeters and oxygen concentrators that are also useful for general patient management.
Kiribati is made up of a lot of islands and some of those islands are remote and difficult to reach. Some of the islands are several days by boat from the hospital, so they're going to have to manage COVID-19 patients locally. We're in the process of working with the Ministry of Health and Medical Services to develop healthcare pathways for these outer islands, to ensure the people living there get support they need. The Ministry of Health and Medical Services, with support from partners like the European Union, WHO, UNICEF and the Pacific Community (SPC), has been providing equipment and supplies that they need to manage COVID-19 such as PPE, oxygen concentrators and testing supplies.
Health workers with Dr Hammad (third from left) in a local clinic in South Tarawa in Kiribati.
On a more personal note, what inspired you to do this kind of work?
I didn't really want to be a nurse, and then I did my first shift in the emergency department and discovered my love for emergency nursing that carried me through most of my career. When working in the emergency department, I became interested in disaster response and health emergencies. This led me to academia and doing my PhD as a way to help inform what we know about nurses and disaster response around the world. I left academia in 2019 to pursue a role with WHO in Geneva where I worked in health security. Since then I have continued to work for WHO on the COVID-19 response in the Copenhagen office and deploying to Montenegro and Albania and then living and working in Papua New Guinea. Since July, I have been working for the Fiji office.
My favourite part of the job is deploying and having the opportunity to meet health workers in the field who are working on the COVID-19 response. Coming from a place like Australia where we largely take our easy access to resources for granted, I have great admiration for the healthcare workers in Pacific island countries who are working hard with limited resources. Although I am introduced as Dr Karen, I take pride in telling people I am a nurse. Working for WHO was a dream that I never thought would happen and I feel very lucky to be doing something I love every day.
Dr Hammad with health workers after a training on clinical management and healthcare pathways.
From your perspective, what else should we keep in mind as Kiribati continues its preparedness and response to COVID-19?
I think the thing with COVID-19 is many countries did a lot to increase their preparedness back in 2020. However, for a lot of the Pacific islands, it's been two years without COVID and so, in that time, some people may have developed a sense that they were completely safe from the virus. However, we know that the virus will eventually reach every country. In DPS, we have been working to help strengthen preparedness of Pacific Island countries for COVID-19 outbreaks. Now also in Kiribati, while cases are declining, it’s easy to be complacent, particularly when the majority of cases have had mild to moderate disease severity. However, this is the perfect opportunity to further strengthen readiness for any future outbreaks or the introduction of another variant of concern. Particularly as countries around the world start opening up borders, it is critical that health systems are ready and have sustainable capacity to care for people with COVID-19 but also importantly, to still be able to care for non-COVID patients.
Furthermore, all countries must at some stage consider a transition from acute pandemic response to sustained management of COVID-19. Although this will greatly depend on how the virus evolves, and a combination of vaccination, public health and social measures and other factors including the behaviour of individuals. Kiribati and other Pacific island countries need to consider what is a tolerable level of risk for their population, and calibrate local measures accordingly.
Remaining vigilant and continuing to prepare and respond in a sustainable way, is the key to keeping our Pacific communities as safe and as healthy as possible.
WHO’s technical support to Pacific island countries and areas as they prepare for, and respond to, COVID-19 is made possible thanks to funding from the European Union.