Working in a Covid ward: ‘We haven’t seen death at this rate’
Daily Maverick's Shiraaz Mohamed was granted rare permission to spend a few hours in a Covid ward at Klerksdorp’s Tshepong Hospital at the beginning of the third wave of Covid-19 to see how the hospital is coping.
On arrival at Klerksdorp’s Tshepong Hospital, I am met by two security personnel and introduced to Dr Oumanyana Mahloko, a senior doctor at the hospital’s Internal Medicine Department, who was to be my guide for the next few hours. We set off for Ward 3. There is a locked security gate at the entrance to the Covid ICU ward. Inside, a sign reads, “No entry beyond this point unless dressed in PPE”.
We wait in the changing room where staff put on their personal protective equipment (PPE). A nurse walks in carrying coveralls, one for each of us. I am already dressed in PPE and watch as the others don theirs.
Down the passage, two nurses work quietly at their station. To my right, a doctor covered from head to toe in PPE attends to a patient lying on a bed, attached to a ventilator. Like so many in these wards, his life depends on the ventilator.
“There’s almost a stigma associated with the Covid unit,” says Dr Debi Moagi, the doctor in charge.
“It’s like there’s them and there’s us. And because everyone else is so afraid of this disease, they hardly interact with us. We are also afraid of the disease, no doubt, but because we are here every day we sort of accepted that, ‘Okay, this is what we need to do,’ and when we see those patients who recovered, it brings some fulfillment and some joy, that at least we are making a difference.”
On Thursday, there were 92 Covid patients at Tshepong Hospital. There are 102 beds in the Covid isolation ward, 21 of them empty. The Covid high care ward has 10 beds with seven unoccupied and the Covid ICU has 13 beds with five empty. The figures change constantly.
“You think it would be easier for us to access things, because you struggle to get scans, you struggle to get auxiliary services, you struggle to get physios and also for other people to come in and provide the necessary care. I understand they are scared, they are also human beings,” Moagi says.
In the ICU ward, some of the patients wear oxygen masks, others are attached to ventilators. Apart from the overalls and masks, doctors and nurses here also wear face shields, gloves and shoe covers.
The ward is absolutely spotless.
Moagi, whose normal shifts are 8am to 4pm with “on call” shifts from 4pm to 8am the following day, is exhausted.
“As I stand here, I am feeling physically tired, emotionally as well, because this pandemic is really hard on one. We haven’t seen death at this rate,” she says.
At the beginning of July, North West had recorded 2,347 of South Africa’s 62,000 deaths.
“You do get told as you are training that, yes, some patients will die. But it’s a bit abnormal to see them dying at this rate. You get to a point where you feel like maybe you’re a practitioner for the dead instead of the living, because people are just dying so much, even young fit, healthy people,” Moagi says.
“Patients that you wouldn’t even expect would die, they come in, you’re speaking to them, you turn your back and… they’re gone.”
Dr Cyan Brown, a Senior Atlantic fellow at Tekano health equity, said, “The pandemic has amplified the emotional toll that all healthcare workers experience. We have an entire generation of healthcare workers who are experiencing PTSD and many facing burnout. Unless this issue is addressed with care we will see more cracks appear in our healthcare system and more people unable to cope.
“Talking about the emotional toll has been pushed to the side whilst healthcare workers are in survival mode during this pandemic.”
The doctors and nurses in the Covid ward have a camaraderie and depend on each other for support, says Moagi.
“Sometimes you leave this place and you want to cry. It’s okay. I cry. I let it all out. There are people you can talk to; we have our consultants here in the department, we can talk to them, even the sisters. We just sit down, we debrief, we say, ‘Okay, what just happened now? How are we feeling?’, because we know that in this ward, we definitely only have each other to rely on so we have to support each other.”
Nurse Onthatile Mmusi concurs: “We really, really struggle emotionally, I don’t want to lie. We try to support each other and we motivate each other.”
The hospital has a psychology department with psychologists who were mainly employed for Covid. Mahloko says that when needed, the doctors’ and nurses’ managers inform the psychologist, who sees them the same day. “We always try to prioritise our staff members.”
After I had been in the ward for three hours, it was clear the staff were getting anxious. Had I overstayed my welcome? No, their concern was my risk of exposure to the coronavirus.
This is their day, long hours of potential exposure to the coronavirus, day in and day out. They risk not only getting infected but also taking the virus home to their families.
“So it’s a bit challenging,” says Moagi. “The emotional support is not there, as much as it should. Because one just assumes, yes, you’re a doctor, you’re used to seeing people die, but not like this, this is a bit unusual, it is a bit abnormal.”
“Other people not working with Covid, they don’t really know what it is, what it feels like to be in this ward with the patients on a daily basis. They just know, yes, numbers are going up, deaths are going up and that’s as much as it is to them… it’s just numbers and statistics, but not real-life experience.”
Mmusi says the third wave of Covid-19 is more aggressive than the previous two waves, with patients presenting late with their oxygen levels already down.
“It affects us emotionally. Sometimes we cry, we cry literally in front of the patient that died,” she adds.
“We’re not yet at the peak, we are still expecting the worst,” says Mahloko.
“The beds are full, but we haven’t reached a place where there is a patient who’s looking for a date and the patient has to lie on the floor, or the patient needs oxygen and we have got no oxygen to offer the patient.
“The wards are full but we are not yet there, we are still expecting the worst to come. Looking at Gauteng as it is now, I think the worst is coming.”
Mahloko says that the hospital management had made preparations to get additional beds and staff.
Speaking from her bed, patient Marie Lerole tells of her recovery: “Now I don’t have any fear of dying. I am no longer scared. It is much better than before, because when I came in, I was unable to see where I was… the way I was sick.” DM
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