By Irene Abalo Otto
With the Covid-19 infections rising in the country, doctors and nurses on the frontlines are feeling the pinch.Some have lost their lives in the line of duty, and others are soldiering on amid the changing face of the pandemic.In the early days of the pandemic, healthcare givers would even afford to sing while discharging recovered patients but the situation is now changing. The joy has now been replaced with fatigue and endless nerve-racking hours in Covid-19 wards, struggling to save lives. Some are advised not to remove their Personal Protective Equipment (PPEs) to answer nature’s call for fear of contracting the virus. Since March 21, Ms Namuli (not her real name) has witnessed the changing trends in coronavirus admissions, discharge or death at Mulago National Referral Hospital.From patient zero on March 22, when Uganda reported the first case of the disease, to the current 120 at the facility, she has been there as a senior nurse.Coronavirus care is mostly in the hands of nurses who stay longer with the patients throughout the sickness until they are able to either walk home or transition to eternal life. “Because they are 100 per cent dependent on oxygen, you have to be there, by their side to help them change position or feed them. There are those who will want to visit the toilet. Others want to be cleaned if they cannot take a bath because they are on oxygen. You have all these people demanding your attention,” Ms Namuli narrates.She says the five to six nurses on duty have no option but to try to pay attention to the more than 60 patients in the High Dependence Unit (HDU) while at the same time taking extra care to avoid catching the virus.“If you leave their (bed) side or delay, someone can die. Whatever you do for them, you have to do it from the bed because if you remove the oxygen, it becomes dangerous. By the time you come out, you are all soaked in sweat and dehydrated. Sometimes when you feel dizzy, you just request to come out and take some rest or fresh air. These PPEs are hot,” she adds.On average, one nurse takes care of about eight to 10 patients while on duty. These are patients who need close monitoring and care because they are on oxygen support to stay alive and the doctors can’t be there all the time.Patients are put on oxygen support because their lungs are damaged and need higher concentration of oxygen. Those with severe disease typically require supplemental oxygen and should be monitored closely for worsening respiratory status because some patients may progress to acute respiratory distress syndrome (ARDS).Health experts say Covid-19 patients with comorbidities can easily progress to acute respiratory distress syndrome. This calls for medical oxygen to reduce fatality rates. So far, 245 people have succumbed to the deadly virus in Uganda.Mulago hospital currently has 120 Covid-19 admissions. Of these, seven are in the Intensive Care Unit (ICU), 68 in HDU and 45 are in the recovery wards awaiting the final results. Advertisement
Dr Rose Mary Byanyima, the deputy director of Mulago Hospital, told Daily Monitor yesterday that most of the cases are referrals from health facilities within Kampala, including Case Clinic, Nakesero Hospital, Kampala Hospital, among others.Despite these response measures, healthcare systems are still overwhelmed since those who need specialised care can only get it at a few health facilities in the country.Some of the private health facilities have no more than five ICUs and this puts pressure on government hospitals.One of the security guards who has been guarding the entrance to the isolation wards says the situation was scary at the beginning but as more patients came in, it became a routine to watch new admissions and deaths. These patients, wherever they come from, end up under the care of overworked nurses, who have to spend between eight and nine hours a day or night with them covered in PPEs.“If you are working day, you can enter at 8am and come out at about 3pm or 4pm. For those nine hours, you don’t visit the toilet. You help yourself in your clothes with the PPE because if you try to remove and use the toilet, you can get infected,” Ms Namuli tells Daily Monitor.According to her, there is no resting while in a Covid-19 ward. The pain that some patients go through and the discomfort of the oxygen pipe, makes some cry, calling for help and yet if a nurse is working on a patient, he or she has to first conclude with that patient before attending to another one.A doctor or two usually come for review or do ward rounds for a few minutes and leave. Some patients use buckets to ease themselves because they cannot help themselves to the washrooms and you must be there to ensure they are okay.Before the number of Covid-19 patients increased, Ms Namuli was comfortable with the “buddy system” where two nurses enter for less than one hour, treat a patient together and come out. Most of the patients were asymptomatic and could be heard chatting with each other and cracking jokes with the nurses. “We became friends with the patients. Even now, when we call them by name during the reviews, they are so happy that we rescued them. We were free with them during the ward rounds and while serving them food,” Ms Bernadette Namugema, one of the nurses treating Covid-19 patients at Mulago, told Daily Monitor in May. But the situation has since changed when the country saw a spike in community infections with the phased lifting of lockdowns in June and July. Uganda is in phase four of the pandemic, where contacts of infections can no longer be traced.“Buddy system is still there but there is an inadequacy of staff. The buddy system cannot be effective now. Just look at me, who started working in March and I have not rested to date. I feel the fatigue but I have no choice but to carry on,” Ms Namuli explains.By the time a nurse’s shift ends and another group enters, the nurse is tired and hungry.Daily Monitor could not establish how the mental and psychosocial well-being of these medical workers are being catered for to help them cope with the daily stress in the Covid-19 wards. “We are few and we can’t keep changing and the PPEs are few. We don’t need to have space in between. When you space, a person dies. They take like three weeks, one month, one and a half months before they are discharged. Those with comorbidities take longer to recover and leave hospital,” Ms Namuli further narrates. Whereas the medical workers have recently had improved equipment procured by the Ministry of Health and donors for efficiency in treating Covid-19 patients, there is need for more specific equipment, especially in the ICU and HDU.Without giving details of how many glucometers and puloximeter they need, the nurse says what they have is inadequate.A pulse oximeter is a tiny device that usually slides over your fingertip or clips on your ear lobe and uses infrared light refraction to measure how well oxygen is binding to your red blood cells.A glucometer is used to check blood sugar levels. These work by analysing a small amount of blood, usually from a fingertip. A lancet lightly pricks your skin to obtain the blood for measurement of sugar levels.According to Dr Byanyima, treating Covid-19 is expensive because different patients come with different conditions that require special care and attention to recover.“Taking care of a Covid-19 patient is very expensive and by the time you go to ICU, that means your life is 50/50,” she told Daily Monitor.Mulago hospital currently has capacity for eight ICU beds, with a plan to add seven more fully installed with infusion pumps and monitors, 120 beds for HDU with a plan to add 58 more.As of December 28, Ministry of Health statistics showed that Uganda had 33,360 confirmed cases (only Ugandans), 433 active cases and 10,905 cumulative recoveries.iaotto@ug.nationmedia.com
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