Covid-19

CORONAVIRUS

Against all odds: A Cape Town doctor speaks from the frontlines

Against all odds: A Cape Town doctor speaks from the frontlines
Before lockdown: Dr Arifa Parker, husband Yusra and her children Ghaliel and Haniya. (Photo: Supplied)

Since January Dr Arifa Parker has worked at the coalface of South Africa’s fight against Covid-19. Biénne Huisman spoke to her about what life is like in the eye of the storm. 

When she gets home in the afternoon, physician Dr Arifa Parker dumps her work clothes in the washing machine. She then showers thoroughly before greeting her three-year-old twin toddlers, Yusra and Haniya, with a hug.

Since January, Parker has been at the coalface of South Africa’s fight against Covid-19. One of only three infectious diseases specialists at Cape Town’s Tygerberg Hospital, she treats patients who have tested positive for the coronavirus in specially set up wards, supports intensive care unit staff, and performs screenings in a tent on the premises. At the same time, she gathers information and formulates protocols on how to best tackle the pandemic.

This week, 39-year-old Parker opened up to Spotlight about being a doctor and a mother in the eye of the Covid-19 storm. Speaking via a Zoom interview, her sentences are laced with laughter, despite the gravity of the task ahead of her.

“I’m very careful,” she says. “I know what the risks are and when I see my patients, I make sure that I wear adequate PPE – personal protective equipment. And that is what I tell the junior staff as well. No one should be seeing patients without adequate protection. We do have enough stock for now, if we use it wisely, and more has been ordered,” Parker says.

“So that makes me feel better going home to my kids. The hospital is frantically working on shower facilities for staff, so we could take a shower and change into normal clothes before going home. For now, I jump into the shower and wash my clothes before giving my little ones a hug. So that is a bit odd, because they usually would jump into my arms immediately when I get home.”

Fortunately, Parker’s husband Ghaliel, who works in IT, is there to take care of their children during lockdown. “He’s been amazingly, amazingly supportive,” she says. “He’s been working from home via Zoom, with the kids in the background.”

HIV and TB

Parker’s early training is in HIV and tuberculosis (TB). After completing her medical degree at Stellenbosch University, she did her internship at GF Jooste Hospital in Manenberg on the Cape Flats, under renowned mentor Professor Graeme Meintjes. This was in 2005, a year after antiretroviral (ARV) drugs were first starting to be rolled out in South Africa following a lengthy struggle by civil society for access to treatment.

“At the time it was quite overwhelming because ARVs were not freely available and a lot of young people were dying,” recalls Parker. “Manenberg was my first choice, because it was a hospital in an impoverished community. I wanted to help people. So I ended up doing my community service the following year in Khayelitsha as well,” Parker tells Spotlight.

“You know, as interns we used to have to fill in the death certificates. So you would have the deceased patient in front of you, and you’d look at the ID photo and it would show someone so different to the completely ravaged patient. And that’s why I ended up doing internal medicine and infectious diseases, because I wanted to understand a bit more about how the body works and how one would be able to treat these patients better. And fortunately with the ARV rollout, HIV patients are now doing so much better. And you know, it’s actually quite rewarding to work in the field of HIV medicine. But we still have a lot of work to do – we still have to roll out more ARVs and prevent lots of infections. We still have lots of challenges. TB and everything else.”

Parker pauses as her phone rings. She excuses herself to answer it. Then, turning back to the interview, she adds: “And now there’s Covid-19 thrown into the mix, too.”

On 11 January, Chinese state media reported the first known death from Covid-19. Since then Parker has “lived and breathed” this novel coronavirus.  

“So Covid-19 didn’t exist to us before January,” she says. “We heard about it mid-January and then we started having to prepare for cases, having to put procedures and systems in place. So as infectious diseases specialists, we’ve had to educate ourselves, rapidly. We’ve had a steep learning curve and part of that has been adapting to create standard operating procedures for our hospital.

“Also we don’t know – internationally – what the effect of Covid will be on our HIV-positive patients. There were very few patients in China who had HIV. You know, there are lots of questions.” 

At night, Parker sits in bed next to her husband working and reading. Sometimes she works in their kitchen over a cup of tea. They take turns to cook – butter chicken, lamb curry, pasta and salads. The kids go to bed at 19:00 and at 21:00 she goes back to the drawing board.

Days blur into one

“Since January, my days have all blurred into one,” she says. “Most days I can’t remember what day it is. I start quite early. I haven’t been sleeping much since the start of Covid. I mean, this morning I woke up at 04:30. As you know, Covid is a new infection, with new data coming out all the time. So the first thing I do is look at my phone – I get lots and lots of messages, so I read the new things and send it on. My work day at the hospital starts at 08:00. At 09:00 we have what we call a Covid ops meeting, where all our hospital’s heads meet – radiology, surgery, anaesthetics, ICU, and so on.” 

She gets home at around 17:00 – if she’s lucky. “For example,” she says, “last Friday at 16:00, 200 people suddenly rocked up at the hospital’s testing centre at one time. You can’t just leave junior staff alone, so a few of us senior staff – the paediatric infectious diseases specialist, our head of clinical medicine, and another internal medicine consultant – stayed behind and assisted in doing the tests.”

While Parker cannot comment on patient figures, she says at present Tygerberg has two general wards full, and is ready to activate more. She is quick to deflect praise, crediting her team and colleagues.

“It’s not just an infectious disease response,” she says. “We are only three … too few people. It’s been a hospital response from all departments. I feel so privileged to be working with such amazing people at my hospital. If work needs to be done, everybody pitches in. All sorts of hierarchy have flown out the window. For example, we had the head of nephrology come down and do swabs on patients. 

“The plastic surgery registrar does shifts – we’ve had radiology specialists coming down to assist with screenings. The anaesthetic department has been very helpful. Intubation of the ill patients is obviously a very high risk procedure, because you would be in direct contact with the patients’ airway. And they happily put together a call roster of who will assist us should we need to do such procedures, because they are the best trained to do the intubations.”

Changing demographics

Parker points out that the demographics of the Covid-19 outbreak are changing. Initially, transmission was travel-related. Now, healthcare specialists are seeing the early stages of community transmission. Of great concern is increasing transmission to essential workers. 

She notes a spike in infections in Khayelitsha. According to provincial statistics released by Western Cape Premier Alan Winde on 28 April, there were at that time 205 confirmed Covid-19 positive people in Khayelitsha. 

“Last week, my direct boss, Neshaad Schrueder, and I went to Khayelitsha Hospital,” she says. “We were very concerned about the spike in Covid numbers and wanted to see how Tygerberg can support the hospital. I think they have an excellent team of staff. They’ve put amazing systems in place. They’ve also set up a tent for testing outside the hospital, and within the hospital they have identified separate spaces where they can isolate people from each other. So we were able to help with that,” she says.

“We’re also advising hospitals that we need to work together. So if they are seeing that they are overrun with patients, they shouldn’t hesitate to call us. Because it’s pointless having open beds in one hospital while another is full. Because we know Covid sort-of attacks areas. You’ll have fires of outbreaks – so one area might have more cases, especially at this point in the outbreak.”

On 29 April, Cape Town community newspaper TableTalk reported that two employees at Checkers Bayside – Sindoswa Msiwa of Khayelitsha and Sylvia Gaxela from Delft – succumbed to Covid-19. The newspaper quoted Msiwa’s brother, Luthando, as saying: “My sister worked on Sunday 12 April even though she wasn’t feeling well. She called me that evening saying she wasn’t well, and I took her to Khayelitsha Hospital where she tested positive. She was later transferred to Tygerberg Hospital, where she stayed in intensive care. She died on 12 April.”

Asked about Msiwa’s death at Tygerberg, Parker notes that she is not allowed to comment on individual cases due to patient confidentiality. “This is so sad,” she says. “My thoughts are with the family. It’s very sad, but it is inevitable that people will die. I see some of my colleagues are struggling with this, but there is nothing more they can do. As healthcare workers, we shouldn’t be too hard on ourselves.”

Time to prepare

Can the pandemic still be contained in South Africa? “Obviously we’re worried,” says Parker. “I don’t think we can entirely eradicate Covid. But I think it’s imperative that we try to prevent cases. If we don’t, more people will die and our hospitals will be overrun. So it’s still very important that we test, test, test, and when we find cases, that we try to isolate. We are obviously very concerned about overcrowded areas, and that is why the country has rolled out community testing.”

While government is under fire from some quarters for its  lockdown regulations, Parker insists these measures are crucial. “My personal opinion is that the lockdown was an excellent decision, because it gave our hospital and other hospitals time to prepare, time to make sure that staff are educated on how to use PPE, time to create ward and intensive care space and create the documents that we are working on at the moment,” Parker says.

“I am so fortunate that we have had a chance to work on those. I just think of the poor healthcare workers in China and Italy who didn’t have a chance to prepare. They didn’t know what hit them. Fortunately, we have systems that are now in place that can hopefully help to relieve the burden on our healthcare force.”

She says healthcare workers are rethinking the way they practice medicine in the time of Covid-19. This includes less touching.

“We have to minimise risk while assessing and managing patients,” she says. “For example, something that would normally take five minutes, now takes ten minutes. You need to know exactly what you are going to do for the patient when you go into his or her ward. As physicians, we love to spend time with patients. We love to feel, touch, and thoroughly examine everything. But I think we need to sort of rethink the way we practice medicine in the time of Covid. Have an additional layer of awareness. We have to touch less and think: ‘If I touch this, is it going to contribute to my management of a patient. If I spend hours listening to every part of the lung, would it give me more information than the chest X-ray that we already did?’ I would not have said this in December, but now with Covid, obviously we have to change the way we practice medicine, which may be a bit controversial.”

Staying in touch – without touching

“Our patients have been amazing,” says Parker. “I’ve also learned new things about technology, communicating via cellphone, phoning the patients and taking their history like that, asking them if they are okay. I have renewed respect for social media – this is really helping to keep patients in touch with their families. Somebody mentioned that maybe patients shouldn’t have their phones with them because they can get contaminated. That’s the worst idea. This is the only way they can keep in touch with family and friends.”

Parker adds that the public and private health sectors are collaborating in the fight. “This has been another amazing thing. We call each other for advice, it’s just been such a different experience as to how medicine normally works. And I really hope that if there is an after-COVID, that we continue this sort of enthusiasm.”

Don’t complain – fix it

Parker grew up in Cravenby in Cape Town’s northern suburbs – near Tygerberg Hospital – and matriculated at Cravenby Secondary School. 

“We had amazing teachers, who shaped and opened our minds,” she says. “The motto of the school was ‘aim high’, so we did… we aimed high.”

One of five children, Parker’s youngest brother also studied medicine and is completing his internship at Kimberley Hospital. 

“My parents never forced us to do anything,” she says. “My mom’s brother is a doctor, but there’s no real family history in healthcare. My parents did encourage hard work, though.”

As for her cheerful disposition, she says: “I think negativity is a wasted emotion. I think if you find that there are issues, or that you find something negative or you’re not happy about something, it may be more constructive to come up with a solution to that problem. That’s just my approach. 

“If something is broken or seems to be broken, try to fix it instead of complaining about it.” DM/MC

*This article was produced by Spotlight – health journalism in the public interest. Sign up for our newsletter and stay informed.

 

 

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"Information pertaining to Covid-19, vaccines, how to control the spread of the virus and potential treatments is ever-changing. Under the South African Disaster Management Act Regulation 11(5)(c) it is prohibited to publish information through any medium with the intention to deceive people on government measures to address COVID-19. We are therefore disabling the comment section on this article in order to protect both the commenting member and ourselves from potential liability. Should you have additional information that you think we should know, please email [email protected]"

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