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Battlefield Frontline Healthcare – a nurse in private...

Maverick Citizen

MAVERICK CITIZEN

Battlefield Frontline Healthcare – a nurse in private hospital speaks out

Cape Town - 20200601 - South African Minister of Health, Dr Zweli Mkhize, visits the Covid -19 field hospital in the Cape Town International Convention Centre. His visit was part of a nationwide tour to assess the state of readiness of Provinces to cope with the expected rise in Covid-19 infections. The previous hard lockdown regulations were intended to slow down the spread of the disease sufficintly to buy time so that health infrastructure could be put in place. This field hospital is the largest of those in Cape Town.  It has 862 beds and all the necessary accompanying infrastructure and medical equipment. Managing Nurse Yolanda Hofmeester checks that everything is in place. The facility uses a paperless system for patients' records.( Photo: Jeffrey Abrahams/Gallo Images)

At South Africa’s private hospitals, frontline healthcare workers are feeling vulnerable and unheard as Covid-19 sweeps across the country. Recently, a nurse at Mediclinic Legae, located in Mabopane, 40km north-west of Tshwane, contacted Maverick Citizen to voice concerns.

The nurse, who is in her mid-30s, wanted to remain anonymous to protect her employment. She has worked at the hospital for nearly 10 years.

The nurse in question works 12-hour shifts (from 7am until 7pm) at one of the hospital’s medical wards, one of three wards dedicated to Covid-19 care. The other two are a high-care ward and an ICU (Intensive Care Unit) ward.

Her main concern was that at her ward, patients waiting for Covid-19 test results were kept alongside Covid-19 positive patients – and that these patients sometimes even used the same bathroom. This poses an infection risk to non-Covid-positive patients.

“The patients wait hours and hours for their Covid test results,” she said. “They’re supposed to wait eight hours, but now because of the backlog at Ampath – which has a lab in the hospital – it can take up to 24 hours. These people are called PUIs – patients under investigation – and they are kept in a ward with Covid-positive patients. Of course we practise social distancing; beds are two metres apart, with curtains between patients, but often they’re using the same bathroom. When someone’s test result arrives and they’re negative, only then the patient is moved from the ward. But of course there is an infection risk.”

Second, she said staff at the hospital were overwhelmed and overworked as the Covid influx continues to rise. “Patients are not receiving the quality of care they deserve because of the overload. I’m at the medical ward, it has 38 beds. We’re completely overwhelmed. Normally we’re three nurses on duty, now we’re just two, meaning I have to look after 18 beds instead of 12. We are admitting six to seven Covid patients a day. Some don’t have their results yet, but you can see with your own eyes that they have it.” 

Third, she claimed that nurses at the hospital are not attired in appropriate PPE (Personal Protective Equipment). “We are attired in ordinary nursing scrubs with a N95 mask, rubber gloves and an apron – with bare arms. Dressed like this, we have to help Covid-positive patients to the toilets. We see on TV nurses at other hospitals wearing proper PPE, which is why we started asking questions. At our Mediclinic, only the doctors have proper PPE.”

She added that two of the hospital’s nurses and one administration staff member tested positive for Covid-19 in the past week.

Danver Roman, provincial secretary of DENOSA in the Western Cape (Democratic Nursing Organisation of South Africa), agreed that healthcare staff should not assist Covid-positive patients with bare arms. “The gown must close up over the arms, the sleeves must reach up to their wrists,” he said. In South Africa, PPE requirements are stipulated by the NICD (the National Institute For Communicable Diseases), he added.

Maverick Citizen submitted these concerns to Mediclinic on July 8. The following day, Mediclinic Southern Africa’s chief clinical officer, Dr Stefan Smuts, responded, insisting that Covid-positive and negative patients are kept separately at the Mediclinic Legae, and that they do not share a bathroom.

This week, the nurse contacted Maverick Citizen again, saying that there had been changes at the hospital following Maverick Citizen’s questions to the hospital group’s management. She said that this week staff at her ward were issued with better PPE – notably gowns that cover their arms – and that patients under investigation have been moved to a different ward. “Thank you very much, your calls have made some changes,” she said.

“Patients that have been confirmed as Covid-positive are accommodated in a dedicated portion of the ward,” he said. “A dedicated portion of the unit is also reserved for patients under investigation (PUI) but these patients have direct access to separate bathroom facilities and do not share these with the positive patients accommodated in a different area of the unit.”

However, when told about Smuts refuting her claim, the nurse said that the hospital’s management was “lying”.

Meanwhile, Smuts admitted that the group is experiencing staffing challenges: “Mediclinic applies Integrated Staffing Models (ISM) to assess the correct level of staffing for any particular unit. While this has been applied within Mediclinic Legae, the hospital has experienced challenges with available staff due to illness and lack of available agency staff to support where numbers may be impacted on specific days. Mediclinic has identified this as an area of need, and is applying solutions such as short term contracts as well as upskilling staff in order to ensure that we are able to maintain the level of care for our patients.”

While the nurse told Maverick Citizen that she approached the media as her manager did not respond to her concerns, Smuts said: “Management has engaged with staff in various platforms to address their concerns, as we understand that it is important to ensure staff are working in a positive working environment. In addition, management is present within the wards several times a day to ensure they are available for staff to engage on any matters of importance.”

Smuts added that nurses at the hospital were issued with appropriate PPE: “It is important to note that the type of PPE that staff require will differ depending on treatment area or the type of procedure that is being performed.”

This week, the nurse contacted Maverick Citizen again, saying that there had been changes at the hospital following Maverick Citizen’s questions to the hospital group’s management. She said that this week staff at her ward were issued with better PPE – notably gowns that cover their arms – and that patients under investigation have been moved to a different ward. “Thank you very much, your calls have made some changes,” she said.

Furthermore, Roman alleged that at The Netcare Group – the Christiaan Barnard Netcare hospital in Cape Town, in particular – managers are compelling nursing staff to sign declarations that they contracted Covid 19 in their communities, and not at work.

“At the Christiaan Barnard hospital staff are being made to sign contracts that they picked up Covid-19 at home and not at work,” he said. “But are you more likely to pick up the virus while caring for patients who have it, or in your community? I mean, this is difficult to prove.”

In response, Netcare “strongly refuted” the allegation. “No Netcare facility would ever expect, let alone force its staff members to sign a document to this effect,” said Craig Murphy, director coastal of Netcare hospital division. “That would not only be illegal but a breach in the trust relationship between Netcare as the employer and our employees. The statement is not only patently incorrect but we regard it as highly irresponsible, particularly at this time.”

In response to Netcare’s denial, Roman said: “Yes the hospital has denied this, but why would nurses lie to me? Unfortunately many people don’t know their rights.”

In a media statement dated July 2, DENOSA lamented a continuing shortage of PPE for health workers in South Africa, which is leading to rising infections.  

In the statement the organisation said: “Given the sharp rise in Covid-19 infections in the country and the rising number of healthcare workers who are infected, DENOSA would like to forewarn the country of the next wave of crisis – a shortage of healthcare workers due to a rising infection rate among healthcare workers who are now in quarantine and some are in self-isolation, and needing care themselves.” DM/MC

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