Nada Fadul, MD

Nada Fadul, MD, associate professor in the UNMC Division of Infectious Diseases, is working with the Coalition of Sudanese Organizations Against COVID-19, a group of Sudanese-American physicians and organizations, to help mitigate the devastating effects of COVID-19 in Sudan.

Dr. Fadul recently has taken part in efforts to train medical and health care personnel in Sudan. The virtual training has covered everything from proper use of PPE to pregnancy care during the pandemic, as well as efforts to provide PPE and other medical supplies.

Currently, she is co-leading a program with a colleague at Emory University in collaboration with other international faculty to leverage existing resources in the community, mostly of health care profession students.

"Medical schools were closed, so these students were sitting idle at home," Dr. Fadul said. "A lot of them wanted to do something, but they didn't know what to do or how to do it safely."

The project, called the Community Medical Response Team, is a home management program led by medical and health profession students.

"With our expertise managing COVID-19 here, we were able to put together a protocol of how to conduct home management remotely," Dr. Fadul said. The protocol, adapted from similar clinics at Columbia University and the University of Texas-San Antonio, has the students run a virtual clinic, with access to an escalation team of doctors, so if the students encounter any challenging case, they can consult attending physicians. The protocol includes the latest updates from the Sudan Federal Ministry of Health and World Health Organization's home management guidelines.

Dr. Fadul and her colleagues trained the Sudanese students on a home-management program for people with COVID-19, including how to help them navigate the health care system and how to overcome barriers that they might encounter in the community. She is working with the UNMC Infectious Disease ECHO Hub with the assistance of the ECHO program manager, Nuha Mirghani, MBBS, who also is from Sudan, to implement this training using the ECHO model. The UNMC Office of Global Engagement also has been supportive of this effort.

"It's been a big challenge to put all of this together remotely, but we're now at the stage of implementing this at the neighborhood level," she said.

The program has been endorsed by Sudan's Federal Ministry of Health, but challenges remain.

For one, Sudan had been under dictatorship for 30 years, Dr. Fadul said. When the regime ended in August 2019, the country was left defunded and its health care system broken.

"We had a very strong public health care system before, where we had primary health care centers that were government funded, so health care was pretty much free," Dr. Fadul said. "But in the past 30 years, that changed, and there was an emergence of private health care centers and hospitals, so the poor and needy didn't have access to health care."

The economic crisis in the country also created a barrier for students who would have liked to help during the pandemic, "but can't because of power outages, cellular data problems, or they simply can't afford to buy data to sit in a Zoom meeting for two hours," Dr. Fadul said.

Another challenge is the stigma of COVID-19 in Sudan.

"There are conspiracy theories that surround the disease in the country, because the remnants of the old regime are still out there in the community, spreading rumors and false information," she said. "Part of our training is teaching how to overcome these barriers and address the stigma.

"We've had family members who had clear symptoms of COVID-19, and they tested for malaria, typhoid -- all kinds of other diseases before they agreed to get tested for COVID-19."

In addition, the states' health policies vary, and there are not clear policies on mask usage.

"The prevention methods are not really being enforced in the country," Dr. Fadul said. "But that makes these programs even more important.

"I've told these students, if you've made an impact on one person, and you were able to help manage that patient at home and prevent him from going out and spreading the disease, in the matter of a month, you've prevented 400 patients from getting COVID-19.

"It's a beautiful thing, that these students are so motivated to make a difference in their community," she said.