OPINION | Letter from a doctor: Rats, dirty laundry and finding hope in Eastern Cape hospital

Two weeks ago already, things were really bad here at Livingstone Hospital in Port Elizabeth.

They weren't collecting the waste, no one was cleaning and the nurses were also striking because they felt the working conditions were not safe. Even the kitchen wasn't working.

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We had to port patients. We had to mop the floors. It was very, very bad. The smell was even worse.

One freezing night, I took a 70-year old lady into the ward. I was pushing her in a wheelchair. It was absolutely freezing. There were no sheets. They just have these disposable paper things that they wrap around the surgical sets in theatre. She got on a bed and this poor old woman gave me such a pitiful look. It was so cold and there wasn't even a sheet to cover her. There was just a piece of paper on the bed.

Later I heard that a local priest expressed concern about recent newspaper headlines to one of the doctors, and then donated 100 blankets. So we have been giving out blankets to the patients, and it has been fantastic on-call. Some people come all the way from Graaff-Reinet or Cradock in just a T-shirt.

People are constantly panicked
 
But now the laundry has started working again. Before, one of the consultants was taking laundry home in bags in his car and washing them at his house. We felt that was not okay, because the drapes were contaminated with blood and pus and whatever else. I know they had started taking it to a private laundromat just so that there could be drapes for theatre for urgent cases. I have to admit that since then things have become a lot better at Livingstone.

The main issue across the board is that people have enough knowledge about Covid-19 but they don't have enough insight to understand what constitutes high-risk exposure and low-risk exposure.

This means people are just constantly panicked. They'll say: "I was in contact with so and so."

But when you speak to them, you find out they were both wearing a mask and it was for less than 30 seconds.

And then they'll say: "No, but I was exposed," which you cannot deny. They'll go to staff health, and staff health – because of the protocol – will have to book them off work.
 
The other problem is that the laboratory was taking strain due to backlogs. The tests were taking so long to come out, that even people with a low-risk exposure were waiting days for results. But they can't come to work while awaiting results because they are a potential infection risk.

For example today, in a ward where there are more than 45 patients, only one nurse is on duty. It's impossible for one person to manage that workload. That's how people get burnout.

That's what happened at Dora Nginza, the regional hospital in Zwide as well. A colleague told me she was on-call with her intern, and there were medical officers for obstetrics and gynae and interns. And because so many people were booked off either because they were positive or because of exposure to people who were positive, they were recovering all patients in theatre because there was no staff in recovery for theatre.

They were washing the floors. They were pushing patients to the ward. They were washing all the instruments between each case. And there were no nurses on duty in the labour ward.

It's physically impossible for those doctors to also manage the labour ward. There were just no midwives to do the work.

Frustrating

What has also worsened the situation, is that 35 staff members at Humansdorp Hospital have tested positive for Covid-19. That is more than half of the people who work there. Nurses, doctors, physios, everyone. So now, Humansdorp has been closed completely.

Then, the same thing happened at the maternity unit at Uitenhage. That means Dora Nginza is seeing many more patients than they normally would see, PLUS they don't have midwives on duty.

I'm really hoping things are going to get better as people get infected, recover and come back to work because it means they can't get exposed again. That's kind of where we are now at Livingstone, with people slowly returning to work. Dora Nginza is about two weeks behind us.

But I don't know if there's anything in particular people can do to help. It's frustrating for everyone involved. When the porters come on duty, they demand full PPE [personal protective equipment]. They want to wear surgical gowns. They want to wear N95 masks. They want shoe covers. They won't take patients to wards unless they have shoe covers, which is a bit ridiculous.

If I take a Covid-19 positive patient to the ward, which I've done multiple times, I wear gloves, an apron and a surgical mask. I don't wear a N95 mask because the N95s are really scarce. You get one N95 mask a week, if you're lucky.

I know a lot of people have been told by their unions: "You must not work unless you have adequate PPE," which is interpreted as full PPE.

But they don't understand that certain interactions are low risk, like pushing someone in a wheelchair, where you don't talk to them, you don't touch their body. You're literally just pushing them to the ward. That is a low-risk interaction.

I just think they don't understand. So to them everything has the same level of risk. And therefore needs the same amount of PPE. And if they don't have it, they are not going to work.

If they have even the slightest interaction with someone who is positive, they are off work, and the whole system can collapse. You have to respect that desire to protect the workers, even if it is misguided and makes everything very difficult.

This week in theatre a patient caused a lot of havoc. The patient tested positive after three tests – they tested negative twice and then tested positive the third time. The nurses were very upset.

They don't want to hear phrases like "false negative" or "test sensitivity". They want concrete reassurance, which is just not possible at this point.

It's part of this weird paternalistic relationship we have with the nurses where they say: "You (the doctors) are putting us (the nurses) in danger because you (the doctors) are insisting that we operate on the patients."
 
But we (the doctors) are telling you this person is under investigation so that you can take appropriate precautions; we are trying to protect you; we are trying to protect everyone in the situation as best as possible.

We say to them: "Please wear your visor; please wear your mask; please let's wipe everything down."

And if there's a problem or if a staff member tests positive, then it's: "What are we going to do now? How are we going to do this?"

It's like we (the doctors) have to solve the problem. But that's not our job. Our job is to treat patients. Admin and managerial staff are there for a reason. But so much problem-solving and soothing have to be done, extras above and beyond our clinical work.

We have also been seeing that nurses who don't follow the instructions of the union or who don't follow the pack when the others want to "sit-in" or delay things because they are unhappy about something, are being victimised.

One of the nurses volunteered to work in the Covid-19 ward because they didn't have anyone to work there and when she went back to OPD the next week, the other nurses shunned her. She's been eating lunch in her car ever since.

But I've taken the approach that I am trying to find small things I can actually change and improve, like giving out blankets. And it has made my experience better because I don't feel as guilty when I see patients shivering in their beds.

What I can't do anything about is the rats running around the passages.

I can't eradicate all the rats. I can't remove all the medical waste in the hospital. But I can keep my small area clean. And it's made me feel a lot more positive about the whole situation.

Finding small ways to make things better for patients has made me feel like I'm not always overwhelmed by hopelessness and that things are crumbling and there's nothing I can do.

- The author is a medical doctor in the Eastern Cape on the frontline of the fight against Covid-19.



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