Thursday’s 23 July announcement of a R1.6 billion boost to the Eastern Cape Department of Health has come not a moment to soon, as pressure on a dwindling pool of nurses has left some ward staff at Settlers Hospital in Makhanda fearful and exhausted.
THE DEPARTMENT OF HEALTH HAS PROVIDED A DETAILED RESPONSE TO QUESTIONS SENT BY GROCOTT’S MAIL. THIS IS INCLUDED IN FULL AT THE END OF THIS ARTICLE
Grocott’s Mail has spoken to staff at Settlers Hospital who are almost incapacitated by fear; but also to some who are pragmatic or simply stoic.
“I’m so afraid that I am taking this disease home with me,” said one health worker, exhausted and in tears after filling in shifts for colleagues booked off after testing positive or quarantining.
“We don’t have PPE and management doesn’t tell us which patients have Covid and which don’t,” the health worker said. “Worst of all, they make us come to work even after we have tested positive.”
The quarantine guideline for returning to work after testing positive for Covid has been reduced from 14 days to 10. And according to current protocols, retesting is not carried out at the end of quarantine because a person is considered to be no longer infectious following their quarantine. However, fear of the disease means many want the reassurance of a confirmed negative test.
Grocott’s Mail understands that personal protective equipment (PPE) is controlled through the hospital’s pharmacy and issued on a requirement basis. Management have said they have sufficient stock. The kind of PPE staff receive depends on the degree of contact they have with confirmed positive Covid cases. But many staff are so shaken by the rising number of deaths they are witnessing that they believe they need the near full coverage provided by cover-alls – the so-called moon suits.
“Patients who are Covid and who aren’t are being mixed because of waiting for a test result,” said another health worker. “People even die before their test results are back. That means nurses have had contact with them without knowing that they are positive.”
“People here are dying from this disease and now I’m taking this disease home with me,” said another health worker, in tears.
Another expressed alarm at the re-opening of the former Netcare section.
“Who is going to work in that ward?” they asked. “Already the hospital is short of staff.”
Very tough – but to be expected
A senior health worker acknowledged the fear of colleagues and said, “Yes, nurses are getting sick; yes we are being booked off; yes some patients are dying. But we have protective equipment and although it is a very tough situation, there is nothing untoward or that we should not expect in a pandemic.”
These and other fears came to the fore when nursing staff, cleaners and porters at Settlers demonstrated in front of the hospital’s casualty section on Monday 20 July. Also high among their concerns is a shortage of nursing staff.
Last weekend, as the growing number of Covid-19 cases put additional pressure on the hospital, a section of the 32-bed former private Netcare ward was prepared and opened for patients.
Staff say beds were prepared there to take the overflow caused by a sharp spike in confirmed and suspected Covid cases at the hospital; however, the Department of Health has not confirmed that the ward has or will be officially opened as a Covid treatment facility.
Netcare/Nalithemba last week confirmed that the former private facilities at both Port Alfred and Settlers hospitals were now fully in the hands of the Department of Health. Chairperson of the Ndlambe Joint Operations Committee (JOC) Alroy Taai confirmed that a 10-bed unit at the Port Alfred Hospital was fully operational as a Covid ward. The JOC is a multi-government and NGO forum for managing situations requiring combined action, currently the Covid-19 pandemic.
At Settlers, equipment is a concern. There are reports that life-saving equipment such as ventilators and vital signs monitors are in short supply and/or non operational. * The Department’s response to questions about this is included at the end of this article.
Rising numbers of staff being booked off after testing positive for Covid-19, or on precautionary quarantine means others are having to work extra shifts.
Along with being tired and overworked, some ward staff are simply terrified, as the pandemic hits home.
The Democratic Nursing Organisation of South Africa (Denosa) representative among a group of nurses, porters and cleaners who gathered in front of the Settlers casualty entrance on Monday declined to speak to Grocott’s Mail; however the union’s Provincial Secretary Khaya Sodidi later confirmed they were demanding answers from management about PPE, nursing staff shortages and Covid protocols.
Sodidi said staff at Settlers were concerned about:
- Lack of operational equipment;
- PPE – “There is, but it is not enough. They don’t want just aprons, facemasks and goggles, they want moon suits when they are working with Covid patients”;
- The growing number of staff who are becoming infected: they blame this on inadequate PPE and also say they are expected to continue working despite having tested positive.
FULL RESPONSE FROM THE DEPARTMENT OF HEALTH AT THE END OF THIS ARTICLE
R1.6bn boost for Health in the Eastern Cape
MEC for Finance in the Eastern Cape Mlungisi Mvoko on Thursday 23 July delivered the Province’s Adjustment Budget. This follows the Minister of Finance’s 24 June special adjustment budget that included a R20 billion reprioritisation for provinces with R15bn to Health for Covid-19 intervention, with an additional R11 billion and R9 billion being reprioritised for water and sanitation through conditional grants.
PROVINCIAL ADJUSTMENT FOR COVID-19 AS PER MEC MVOKO, 23 JULY 2020: HEALTH AND FRONTLINE SERVICES – R1.681bn (of R2.6bn)
• R840 million for Field Hospitals/ Infrastructure/ Operating Costs – “this included the maintenance of quarantined and isolation sites done by the Department of Public Works”;
• R461m for PPE and Consumables – “this should be enough to sustain the health officials for the duration of the Covid period”;
• R175 million for 5 400 Community Health Workers;
• R173 million for ventilators for 240 intensive care unit (ICU) beds;
• R17 million for 171 enrolled nurses and nursing assistants for 12 months in additional to the 822 allocated in the emergency funding ; and
• R12 million for Cuban Medical Brigade personnel.
RESPONSE BY THE EASTERN CAPE DEPARTMENT OF HEALTH TO QUERIES FROM GROCOTT’S MAIL
Grocott’s Mail sent questions about Settlers Hospital to the Department of Health about resources and capacity at the facility. We received this extensive and detailed response and, in the public interest, have dedicated these pages to publishing it in full. We asked about emergency and high care equipment; bed capacity and standard operating procedure for Covid cases; staffing, and staff health and welfare. In bold is each query and below follows each response.
EMERGENCY CARE AND HIGH CARE EQUIPMENT
We heard reports that emergency and high-care equipment isn’t operational because it isn’t maintained.
Equipment is maintained on request by the end user [staff member]. The request is logged along with a motivation are signed by the End User Unit Manager /Head of Section. It is approved by the Cost Centre Manager and submitted to Supply Chain Management Unit (SCMU) which processes it.
What high-care and emergency equipment does the hospital have that is fully operational?
- Two (2) in Casualty
- Three (3) combined in Anaesthetist machines in Theatre
- One for installation
Operational Vital signs monitors
- Eight (8)
Operational Laryngoscope sets
- Twenty Four (24)
- Seven (7)
Mask/Nasal Cannulas for administration of oxygen
- Seventy Six (76) nasal masks
- 126 Cylinders are available
What plans are in place to make sure that the hospital is equipped with operational equipment?
- Basic equipment is available
- Every mid-year the hospital submits equipment needs to supply chain management units. The end user forwards requests to SCM. This is then forwarded to the District office for procurement purposes.
- Head office supplies Settlers with medical equipment for their needs.
BEDS AND STANDARD OPERATING PROCEDURE
How many areas (and which) are set aside for PUIs (persons under investigation) and confirmed Covid cases?
- Casualty: Isolation room X1
- OPD: Isolation Room X1
- Maternity: Isolation Room X2 (1-bed rooms)
- Medical Wards:
x 2 (10-bed)
x 1 (6-bed)
x 2 (1-bed)
x 2 (3-bed)
x 2 (5-bed)
- Paediatric ward:
x 1 (1-bed room_
x 6 (1-bed cubicles)
What is the admission protocol for these patients?
- All clients are screened in hospital and are attended according to their needs after being triaged.
- Sick patients are admitted as PUIs in isolation units after being swabbed, while awaiting results.
- Positive Covid -19 sick patients are admitted in the hospital isolation wards
What is the testing and isolation protocol?
- All patients presenting with signs and symptoms related to Covid-19 are swabbed to rule out Covid-19. The patient will then be isolated while waiting for results, meanwhile is treated based on the symptoms.
- If the result comes back negative, that patient will be taken to the general ward and continue with his/her treatment until recovery. They will be discharged home when the doctor is satisfied with their condition, in consultation with the patient.
- If the results comes back positive, the patient will be transferred to one of the wards that are for Covid-19 positive patients and be discharged according to guidelines and the condition of the patient.
How is it made clear to staff which patients are under investigation?
- Principles on admission and handing over of patient from one unit to another, to admitting nurse in the unit during admission.
- The patients file contains their clinical history, triage information, assessment history by the doctor, observations done, tests done, care and management instructions including treatment, history of specimens taken and results when available for the nurse in the ward to admit the patient accordingly.
Will the former Netcare section be fully opened and set aside for suspected and confirmed Covid cases?
- Still under discussions and consultations.
Is there sufficient nursing staff to operate the facility?
STAFFING AND STAFF HEALTH AND WELFARE
We have heard that there is mixing of positive and non-positive cases in wards because of the slow rate of testing.
- There is a unit in every ward for patients awaiting results and a unit for patients with confirmed Covid positive results
We have heard that nurses aren’t told whether or not a patient was indeed positive.
- The nurse in the unit does the triage and screening of the patient.
- On shift change and on admission, the Unit nurses (OPD/ Casualty) report the admission to another nurse in the admitting ward telephonically. Included in this report are the patient’s diagnosis, stat (immediate) doses given, investigations done, immediate care needed for the patient, as well as the condition of the patient. This all allows the ward nurse to prepare the relevant place for admission of the patient.
- The patient is accompanied by nurse if ambulant (walking) and by a nurse and porter for those patients with diminished mobility i.e. using wheelchair or stretcher. The same above information is given and a patient is handed over to the nurse in the wards by the OPD/Casualty nurse. The ward nurse continues with nursing care management and starts a Care Plan (formal planning and record-keeping of patient care in the ward).
- Report about the patient is handed over by one nurse to another during every shift change (in between tea time, lunch, night and day duty).
- There is a nursing supervisor in each unit to manage, mentor and coach junior nurses.
Staff say they are required to come to work even though they have tested positive
- Staff who have tested positive are given 10 days quarantine from the date of receiving results for isolation purposes.
- If they are sick and warrant admission he/she will be admitted to hospital.
Staff say that management insists on face to face meetings in groups
- Hospital meetings are held for staff training and awareness on Covid-19
- Regular meetings have been stopped due to the Covid pandemic. The hospital only conducts Health and Safety meetings, as well as for Covid updates and the sharing of Covid guidelines. This is with the aim of equipping staff and also allowing an opportunity for staff to raise their concerns and experiences about the management of Covid patients and themselves.
- The Hall usually accommodates around 50 personnel, but during the current pandemic not more than 15 are allowed in the hall for training and Covid update meetings.
- The hall is well ventilated with large windows, and two doors.
- The hall is deep cleaned and sanitised every morning. The tables, chairs and surfaces are sanitised before and after every session.
- Employees have their own sanitiser in small spray bottles that is provided by the hospital.
- There is always a 500ml spray bottle during sessions to cater for those without personal their personal spray bottles, for frequent sanitising of hands and surfaces.
- Social distancing is always emphasised.
- Wearing of a mask is a must.
How many beds in total at Settlers, including the 32 in the former Netcare section?
- 178 beds.
How many staff are currently off sick/ Quarantine?
- Thirteen members are on quarantine
How many staff have tested positive for Covid 19?
- Thirty one (31) as per results received to-date from NHLS and from staff tested from private doctors
What PPEs are assigned for which staff?
- The PPE’s is assigned according to utilisation per category of the unit management in accordance with National Guidelines.
What counselling and emotional support is available for frontline staff at Settlers?
- The Hospital has a Clinical Manager to whom they are referred to for counselling and consultation, as well as Unit doctors.
- Tuesdays every week is a day put aside by the hospital to update employees and it is when they have an opportunity to share their experiences and concerns. Here too, action plans with time frames are developed.
- The staff members are given an opportunity to consult the doctor of their choice.
- There is an employee wellness programme for employees and staff.
- Staff apply for COIDA leave when they are Covid positive
- The Hospital’s Occupational Health and Safety committee monitors adherence to the Health and Safety Act.
- Individual assessment forms are filled in by each and every employee for the purpose of disclosing their comorbidities.
- The Supervisors are in the in the process of assessing individual assessment forms for proper placement at work that take into consideration their comorbidities. This is done once that information, alongwith supporting documents, is received from employees.
- There is training planned on Psychosocial Support for employees that will be conducted by the Clinical Manager as the Covid-19 Champion.
What plans are there to increase the nursing staff complement?
- The staff needs were identified and submitted to District level for consideration.
- There is pre-approved funding for staff for Settlers Hospital.
- There is a massive staff recruitment process in progress for fast employment and placement.