Like many of her colleagues, Nurse Sian Smart-Seymour had fears in the early days following Jamaica’s confirmation of the first coronavirus disease 2019 (COVID-19) case in March last year.
“I would think everybody was fearful. There was fear of the unknown because this was a new virus. When it came about, we weren’t sure how it spread …but once I found out it was a virus, I treated it like any other virus,” she said.
Smart-Seymour, a charge nurse with responsibility for assigning her colleagues, was among several health professionals associated with the intensive care unit (ICU) at the University Hospital of the West Indies (UHWI) who spoke with The Sunday Gleaner about their COVID-19 experiences.
They are just a subset of the thousands of front-line workers from different specialities who make up Jamaica’s first line of defence against the dreaded virus.
Among them would be the near 15,000 public sector health workers, which include community health aides, nurses, doctors and paramedics.
At the UHWI, the leading health institution in the fight against the respiratory disease, a special ward has been set up for COVID-19 patients, while the ICU has also been divided into two – ‘A’ for COVID patients, and ‘B’ for other patients.
CASE SURGE CAUSED BURNOUT
One of the most challenging times, Nurse Smart-Seymour recalled, was during the surge of coronavirus cases in the latter part of the year, triggered by disregard for social-distancing measures and the general election campaign.
“The number of staff was the same as when the count was low and staff had to be in the actual unit for an extended period. Usually, depending on the number of patients in the ICU, you would spend maybe up to two hours at maximum. However, at that time when you had more patients, we had to be spending up to four hours in the unit wearing PPE (personal protective equipment),” she stated.
“There was burnout at that time. There was more use of PPE. There were persons who actually called in. The staff was stretched at that point,” the nurse added, noting that personnel who were initially rotated after four weeks were now working for up to eight weeks before getting a break.
The crisis spilled over publicly, as media obtained a letter addressed to the Jamaica Medical Doctors Association, from the internal medicine resident body, which lamented the pressure on workers owing to the increase in COVID-19 cases and shortage of key resources.
“These working conditions have become more burdensome and unrealistic and have set up our colleagues for burnout, increased risk of succumbing to the virus, and, unfortunately, literal collapse,” the group said.
“It has been rough. I have been on my knees begging the doctors and the nurses,” admitted Kevin Allen, the hospital’s chief executive officer, in an interview with The Gleaner last August, the same month Jamaica recorded its highest COVID-19 hospitalisations (35) up to then.
“You don’t have enough persons in the teams, so you will have three persons manning 30 beds, 35 beds…It is the mercy of God that is carrying us through.”
Soon after, the Pan American Health Organization confirmed that Jamaica was experiencing an “epidemic wave”, as cases jumped from 715 confirmed (113 active) and 10 deaths on July 1, to 2,728 (1,788 active) and 38 deaths on September 1.
By November 1, confirmed coronavirus cases rose to 9,292 (4,320 active) and 236 deaths.
A TYPICAL DAY
The typical day for Nurse Smart-Seymour included changing from ‘street clothing’, donning PPE, to taking handover notes from the departing team in the electronic ICU (clean area) from where all patients are monitored, since there are time restrictions inside the unit with the patients.
“When you’re going to go in, you ensure that at least one staff is in that clean area to monitor while you are on the inside because being on the side, if you’re attending to one or two patients, you’re not able to see all the patients at that time,” the nurse said.
“You basically do everything for the patient as you would do with a regular patient who comes into the hospital that is sick. There are some things that are limited because of the spread…like suctioning the patient.”
Christine Williams, director of nursing in ICU, revealed that the unit is 25 nurses short, made more acute since the staff has to be split to serve COVID-19 and non-COVID-19 ICU patients.
“Nurses, they do have co-morbidities, too. So you have to be careful when you are allocating. Who do you put on COVID duties? Now, we think we have got it a little better, so the nurses who do go over there (ICU A), they watch each other’s backs,” said the near four-decade veteran at the UHWI.
MOST DIFFICULT PART
The case of a mother and daughter has stood out, both for the deadly consequences of the coronavirus and the jubilation that springs when a life has been preserved.
“You know, we thought the poor mother would have pulled through. We lost her. And then the daughter who she got it from came in. But she managed to pull through,” Nurse Williams shared, adding that there was a “big celebration” for that recovery.
Anaesthesiologist, Dr Vanessa Minott, joined UHWI’s ICU department during the August surge and early on determined that communication with the family who are blocked from seeing their loved ones is the most difficult part of the process.
“We can’t communicate in person for multiple reasons. One reason could be the patients’ relatives themselves may be in isolation because they also have COVID, so we have to communicate over the phone. Also difficult is when the patients are not doing well and we have to give bad news on the phone, which we prefer to do in person,” shared Dr Minott.
Another challenge, she said, is after-COVID care.
“I think the public may think that post-COVID you’re good to go, but that’s not the case, especially for ICU patients. Sometimes COVID has damaged their lungs so much that they still struggle after COVID, so they go to our other unit and some have passed,” she said.
Deaths that occur after a patient no longer returns a positive test but whose demise is connected to the effects of the disease are usually referred to as COVID-related.
Her daily routine, Minott said, includes a briefing from the team coming off shift, followed by a constant process of monitoring and assessment, including changing the patient management if necessary.
“We do blood tests that we follow up on. We do various point-of-care tests, the main one being the arterial blood gas. That’s one of the single most important that we do for ventilated patients because that’s how we assess that their lungs are oxygenated enough,” the doctor noted.
UHWI COVID-19 budget close to $1 billion
Chief Medical Officer at University Hospital of the West Indies (UHWI), Dr Carl Bruce, who said the COVID-19 budget is close to $1 billion, admitted to the difficulties workers faced who had to come in close contact with patients battling a disease with limited information.
“It’s resources that we have to spend because we have to save lives. We can have debates, we can have disagreements but when your family member gets COVID and it’s severe, then we need institutions that are going to stand up and take care of those patients,” Bruce told The Sunday Gleaner.
The neurosurgeon believes the hospital’s investment in an infection prevention and control department in 2019, driven by the concerns over past emergencies like Ebola, has paid dividends in preparing practitioners for the March moment, when Jamaica recorded its first novel coronavirus case, and since.
That, in addition to a public health system, though criticised for being outdated in parts, that allows for reaching citizens at the community level, has served the country well in responding to the pandemic, he believes.
What the doctors and nurses agree on, however, is that Jamaica now needs significant financial inflows to boost human capital availability to staff health institutions to reduce burdens.
“We have to try to build capacity in our ICUs islandwide – both for human resources and for equipment. ICU is expensive. It’s extremely expensive to run an ICU but we have to do it,” argued Dr Kelvin Matalor, the UHWI’s head of ICU and Anaesthesiology.