More than anything *Dina would love to scoop her four-year-old into her arms when he runs to greet her upon her return home after work.

But the nurse, who works at a Netcare private hospital in KwaZulu-Natal, has her heartbroken each time, telling him to stay back “and wait a few minutes for mommy”. Those minutes are for her to remove her shoes, keeping them outside her house. She undresses and leaves her clothes in a bucket to be soaked overnight. Then, she steps into the shower. Only afterwards, will she hold her child.

This is nursing in the time of Covid-19.

Her heightened personal precautions come off the back of a bruising month for the private healthcare group whose hospitals were at the centre of two outbreaks in the province at the end of March 2020.

Both St Augustine’s and Kingsway Hospitals reopened for new admissions this week after being closed on 2 April and 14 April 2020 respectively, following the death of five people from the virus and 48 people testing positive.

Among the hard lessons to be learnt has been the importance of keeping staff informed and providing them with sufficient personal protective equipment (PPE).

“In the beginning, they could have done things differently. We were given a three-ply mask and told to use it for seven days unless it got wet or soiled. After a while, they gave us N95 masks that got zapped [decontaminated], up to five times. Now we get a fresh mask at the start of every shift,” says Dina.

“In the beginning, dealing with the virus was new to everyone, so I think people weren’t taking the use of PPE that seriously,” she says.

For Dina, nursing is a vocation, and she says she’s less afraid than she was a month ago. There are Covid-19 patients in her hospital, but she says staff working in these isolated wards use separate entrances and have separate facilities.

“We are screened every day and our temperature is taken every day. Nurses also won’t lose income if they test positive and Netcare has a place you can self-isolate if you are infected. It’s important because you don’t want people to be scared to answer screening questions honestly because they’re scared they won’t be able to work and won’t have an income,” she says.

She still doesn’t want to be identified though, because she is afraid of being victimised or singled out by her employer.

It was just under a month ago that one of her colleagues at one of Netcare’s Johannesburg hospitals raised concerns with Spotlight over the group’s Covid-19 preparedness – also asking not to be identified.

Healthcare worker *Sindy was outraged with the treatment she and her colleagues were receiving. She described, like Dina, how they were issued with a single 3-ply surgical mask and told to place it in a brown paper bag with their name and the date of issue written on the bag. She sent Spotlight photographs of how the masks were being stored and forwarded email correspondence telling staff of the policy on masks.

“I thought maybe they were going to sterilise the mask, but these are single-use disposable masks. But they were not sterilised and I was shocked. Masks get wet and are quite disgusting after a few hours of wearing them. They can also become contaminated and even if it was not passing on the coronavirus, we could be passing on all kinds of other illnesses to each other and patients,” Sindy said.

WhatsApp group messages she shared outlined anxiety and resentment at what staff perceived to be Netcare skimping on basics like a new mask for each person at each new shift. There was also concern that adherence to safety protocol was patchy. Comments included: “They ignored my warnings that they are not following protocols even after they were approached by some of us.”

Sindy said she and her colleagues received training for using PPE correctly, but it is adherence to the training that worried her most.

“People pull the masks onto their heads or under their chins and go for lunch and a smoke break then put them back on. There’s not much physical distancing going on, and no one is enforcing the guidelines. I really am not comfortable working in a situation like this,” she said.

Nehawu (National Education, Health and Allied Workers Union) spokesperson Khaya Xaba said: “We met with the Minister of Health and agreed that no worker must be forced to work without PPE and they must not be punished for refusing to work,” he told Spotlight.

Xaba reiterated the union’s stance, which was outlined in their press statement released at the middle of April 2020 when the news of 19 staff members at Morningside Mediclinic (another private hospital group), testing positive had emerged days after the outbreak at Netcare’s St Augustine’s and Kingsway hospitals.

“The attitude and negligence of the managers in the private healthcare industry is making a mockery of [the chief health advisor’s] warning that we need to stop small flames to reduce the risk of raging fires,” the statement read. “This egregious conduct by private healthcare providers is in stark contrast with requirements and dictates of the Occupational Health and Safety Act, which clearly states that the employer has an obligation to provide and maintain a workplace that is safe and without risk to the health of workers. Nehawu maintains that failure to protect workers is tantamount to murder.” 

Netcare responds

Dr Anchen Laubscher, medical director of the Netcare Group, said they have never expected a staff member to work without appropriate PPE. “We reject any claim that staff are required to re-use single-use PPE in the strongest possible terms.”

She acknowledged though that they had to revise their directive on masks in early April 2020. Laubscher said: “Certain categories of staff were issued with a mask which could, and had to be, worn over five shifts and were safely stored in between shifts. In the event that masks got soiled, damaged or wet at any time, a new mask was issued to the staff member.”

Netcare said they have been preparing for Covid-19 since January 2020 with the establishment of a multi-disciplinary task team and have since introduced daily briefings via Skype. About 250 key personnel log on to “discuss key developments, learnings and matters of importance to all operations”, and this is disseminated to all staff and contractors.

Anyone entering a Netcare hospital is also risk assessed and screened for Covid-19 and the hospital has introduced separate zones for treating patients based on their Covid-19 risk, given that many Covid-19 patients are now known to be asymptomatic.

Laubscher added that Netcare has distributed reusable fabric masks to staff and they monitor staff for adherence to safety protocol via CCTV, spotters, colleagues and the hospital leadership. “PPE, hand washing and social distancing retraining has involved 21,000 staff members, doctors and other workers at our hospitals and has been done by clinical facilitators, infection prevention practitioners (IPPs) and occupational health and safety specialists,” Laubser said. 

“Part of the retraining requires that each individual has to practically demonstrate the correct use of PPE. A register is also kept of all persons trained and a certificate of competence is issued.” DM/MC

*Identities withheld

This article was produced by SPOTLIGHT – health journalism in the public interest.

SIGN UP for our newsletter.