Kampala, 28 October 2020: - There is a beehive of activity at the construction site of Achwa Hydro-Power Plant (AHPP) in Pader district, Northern Uganda, about 100 Kms from Gulu City. People and machines pace up and down with a determination of beating a set deadline – kind of a race against time.

That was the scene at this site until the first week of August 2020 when one of the workers tested positive for COVID-19 during a random check. Work came to halt. Site management and health workers worked frantically to trace and isolate all people who had come into contact with this particular worker.

Subsequent contact tracing and testing identified and confirmed 15 more people with COVID-19 among the workers. Worry, fear and anxiety set in. Immediate testing of all 575 employees and workers was ordered leading to confirmation of yet another 287 infected workers.

This was now a crisis not only at the construction site but for the entire Acholi sub-region. To begin with, the number of infected people was too big to be admitted and managed at Gulu Regional Referral Hospital (GRRH). At the time, only regional referral hospitals were mandated by the Ministry of Health (MoH) to admit and treat COVID-19 patients. The dilemma was that GRRH had capacity for only 173 COVID-19 patients!

Luckily, the World Health Organization (WHO) and MoH guidelines provide for setting-up of a Non-Traditional Isolation Facility (NTIF) to manage non-severe cases once COVID-19 admissions exceed 60% of the available bed space at the referral hospital treatment center. With this guidance and in just a few days, Achwa Hydro-Power Plant construction site turned into and COVID-19 NTIF.

“When we got cases at the camp, the first organization to come to our rescue was WHO. We were not comfortable with having our workers treated at GRRH because of logistical issues. There was therefore relief when we were told by WHO that our camp could be used as a NTIF for our infected workers. I applaud WHO for this unique technical guidance,” says Mr Jazim S. Hassan, the PAC spa HSE Lead at AHPP, the company constructing the dam.

Sustained WHO support and presence at the site enabled GRRH and Pader District Health Team to isolate and manage the 205 COVID-19 infected people right at their place of work. WHO oriented health workers at the site in triaging patients and identification of those at risk of deterioration; management of non-severe cases; Infection Prevention and Control; risk-communication and disease surveillance.

Some housing units were re-purposed into isolation and treatment facilities and site administrators and health workers were given a quick yet thorough orientation in the clinical management of COVID-19 patients. A referral system for severe cases to GRRH and Mulago National Referral Hospital was also put in place and it came in handy when some people deteriorated and needed advanced management.

In liaison with AHPP project management, Pader District Health Team, Lancet Laboratories and the national COVID-19 mobile laboratory facility, periodic testing for the site workers was instituted. Testing was done at 5-days intervals and upon development of symptoms among the contacts. The testing interval was set at shorter periods compared to the national recommendation of testing at day 0 and 14 for contacts. The aim was to ensure early identification of new infections and timely isolation to quickly halt transmission.

“With WHO in the region, you can’t go wrong! We were already stranded with the increasing numbers of cases in Pader and when the AHPP crisis came in, we got overwhelmed. WHO came in at the right time and we highly appreciate the assistance though more is still needed,” says Dr Alex Layoo the District Health Officer for Pader district.

Setting up of the NTIF, regular testing and early case identification and timely clinical management were not only critical in helping to contain the cluster of infections but also helped the project management team to bring the situation under control and facilitate the early resumption of work.

Ssalongo Ssenkubuge a worker at the AHPP reminiscences the early days of the crisis: “We got terrified when the camp doctor announced that 15 of us were positive for COVID-19. We were then isolated and treated accordingly. The WHO staff supported us to the best of their ability which helped to calm us down. We later got discharged and we are back to work without any worry.”

Presently, 280 workers have recovered from COVID-19 and resumed work. There has been no death at the site. Of the 280 people, 198 (70.7%) were treated at the NTIF while 50 (17.9%) were transferred to GRRH and 32 (11.4%) cases to Mulago National Referral Hospital. No health worker infections occurred at the site.

“On behalf of PAC spa, I extend my heartfelt appreciation to the World Health Organization and the Ministry of Health for the generous assistance demonstrated at Achwa HPP during the COVID-19 outbreak. Although we had many cases, the emergency is coming to an end. More thanks to the professionalism demonstrated by all parties involved and we remain hopeful for a complete resolution,” says Mr Paolo Brachini, the Country Director PAC spa, Achwa HPP.

The WHO support and work at AHPP would not have been possible without the financial support of Irish Aid, DANIDA, DFID and GAVI who have been steadfast partners throughout the COVID-19 pandemic. “These partners provide the impetus, the fuel and energy needed for our COVID-19 technical work. On behalf of WHO and the people of Uganda that we serve, I heartily thank them for making it possible for us to contribute at Achwa HPP and in other districts of Uganda, say Dr Yonas Tegegn Woldermariam, the WHO Country Representative.

For now, the hustle and bustle at AHPP construction site have resumed with one lifelong lesson for all: COVID-19 is with us; it affects everyone, and it can bring all aspects of life to a fast and complete halt.