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On the Covid-19 frontline

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By Callisto Sekeleza:

MTUNDUWATHA—We work in shifts of four hours

At Kamuzu Central Hospital (KCH), 27-year-old Patricia Mtunduwatha, Nurse Midwife Technician, has generally known the Eye Ward domiciled in the Ethel Mutharika complex, as her workstation; likewise her team member 37-year-old Daniel Nasimba, who works as Audiology Technician in the ENT (ear, nose, throat) section of the hospital.

The two have known lesser workload than they fathomed would be at the Covid-19 treatment centre, situated just outside KCH, opposite the mortuary.

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“In the eye ward we have ‘general’ patients who might not need intensive care. Occasionally we have some patients needing intensive care. However, work has been different at the Covid-19 treatment centre because the whole facility is an intensive care unit,” Mtunduwatha said.

Her involvement at the treatment centre has improved her work experience in her three-year career. She was member of a team comprised of 14 people; two doctors, five nurses, one infection prevention officer, two hospital attendants, health surveillance assistant, one ground worker and two guards.

“In the Covid-19 Isolation Centre, we work in shifts of four hours with 12 hour breaks in between until we complete this cycle in seven days. This is different from the shifts we have in the general ward whereby we may come in the morning and retire for home at the sunset. In short we use night and day shift,” she narrated.

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However, for Nasimba, who has been in the health sector since 2010, this is his first time to work in a big isolation centre, having treated patients in chicken pox and cholera epidemics.

“This is the largest isolation centre I have worked in as the others were not as big this one,” he said.

Daniel says the Covid-19 treatment centre is big, not just because of number of admissions but rather the aggressive transmission cycle associated with the disease.

“In the other isolation centres I have worked in, like the chicken pox, all one needed was not to touch the sick; so you need gloves and aprons. In the Covid-19 isolation, we are afraid even at one metre away because it is highly infectious,” he said.

First day mood in the treatment centre

During their first days in the Covid-19 treatment centre the two members, just like others in the team, were paranoid, knowing the high infection rate of the novel Coronavirus.

“I had the fear but also had passion to fight the pandemic. I felt eager to see what Covid-19 was doing to patients; see the symptoms and all that we had learnt from other people,” Mtunduwatha said.

Her counterpart, Nasimba, added that when one is outside, they do not get much information but when they get into the centre, they are even surprised that the work is immense and they have to adjust. He is a nurse but, in the team, he worked as Infection Prevention (IP) Officer.

“When I went to the treatment centre, I thought I would find just a few people and not very sick. I didn’t expect I would find very sick people that would need total patient care that we had to even bath and feed them. It was a totally different thing,” he said.

Nasimba thought he would probably find around 10 patients. This was never to be. He met 19 patients in the centre. He led the team of 14 that was also divided into sub teams that worked in 4-hour-work and 12-hour-rest cycle, until they came out after their 7-day shift.

“I was the IP officer and also team leader. My task was to ensure that everything was organised, supplies were there and I communicated with the management team outside. Everyone in the team had specific tasks and they also communicated with their respective heads outside the centre,” he said.

Every day in the health care is a learning day. Nasimba found work to be hectic in the first two days but by third day, the team had gotten used to the work.

“Every four hours I had to monitor how staff was following the protocols, help them with putting on and putting off the Personnel Protective Equipment (PPE) and all infection prevention measures,” he explained.

Originally built to serve as KCH’s skin department, the treatment centre has two rooms with five beds, one room with four beds, another room with two beds and three rooms each with one bed.

What is nursing like in the isolation centre?

Mtunduwatha said work in Covid-19 treatment centre is continuous nursing care. They work on a ‘continuous’ seven-day shift and retire when another team comes.

“We focus on managing the distress and ensuring that there is good oxygen concentration in the patients supplied by the oxygen concentrators or cylinders. Most of them are on machines and we ensure that oxygen therapy is progressing properly,” she explained.

She said they also do drug administration and general nursing care.

“Most of the patients are bed ridden. Some need to be fed; normal feeding or using nasal gastric tubes. Others need to be bathed and be turned in the beds,” she said.

She said within the seven days, there is daily disinfection of the facilities done by the health surveillance assistants. The beds where someone has died or been discharged and even the utensils in the facility are all disinfected.

Before a new patient comes in, the team at the treatment centre receives a call from the KCH Covid-19 Response Team, explaining about the patient like age, gender, level of sickness and prevailing comorbidities so that they can be able to prepare adequately for the sick.

According to Nasimba, although the whole centre is for intensive care, there are various degrees of illnesses as some cannot walk, others cannot breath without support while there are other they can ably chat with as they are not full time on oxygen.

The good and the bad

According to Mtunduwatha, much as work in the Covid-19 centre might be distressing to the health workers as well, there are still good moments which are motivating for them.

She said seeing someone who had been diagnosed with the virus and admitted into the centre, treating them and again seeing them being discharged was a very good moment.

“Although we have a positive mind, it’s very difficult to say whether the patient will survive or not. However, it feels good to see someone discharged. Someone might look good today and tomorrow it’s another story,” she said.

To be continued next week…

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