Posted on by basilBLOGinc · 7 Comments

Some Good News

I have been distracting myself since the second wave. Our hospital has quietened down as far as Covid-19 cases go, and we started doing limited planned surgeries. After my last post which detailed the overwhelming and horrific difficulties we faced during the second wave, a friend of mine suggested my next post should be about some good news.

So I thought of telling you about a touching visit by a medical student to her grandfather. He had been admitted with Covid pneumonia and is now recovering at home. I also thought I would write about how we have resumed planned surgeries, and how it feels different to when we resumed after the first wave. In the background I have been working on a document detailing how Covid-19 has affected me as an orthopaedic surgeon. I think the latter post would not be good news.

But there is good news for this post: I received my Johnson and Johnson vaccine on Friday. It was injected into my left arm by a community clinic nurse at Prince Mshiyeni Memorial Hospital, a provincial general hospital in the south of Durban, KwaZulu-Natal.

There is so much to say about the vaccinations for Covid-19. The scientific endeavour and ultimate production and licensing is nothing short of miraculous. The first time use of mRNA vaccines in the Pfizer and Moderna vials is science exploring the envelope . The Pfizer story is worth reading. It details a humble event. Albert Bourla is a Jew born in Thessaloniki, northern Greece, who steered Pfizer as CEO to be the first to release and use a vaccine for Covid-19. The story of who was the first person to be vaccinated in Greece is where much respect goes to Mr Bourla. Mrs Despina, 95 years old and also of Thessaloniki, is a Jewish-Greek holocaust survivor. She received her vaccine in early January 2021.

The Astra-Zeneca and Johnson & Johnson vaccines both use the older technology of inactive adenovirus with the DNA of the Corona virus incorporated. Unfortunately the Astra-Zeneca vaccine gave less protection for the new variants of the Corona virus, including the variant which caused South Africa to explode in the recent second wave. The adenovirus DNA vaccines are more robust than the modern mRNA vaccines, whose cold chain storage at -70 degrees Celsius is difficult in a developing country. South Africa had already taken delivery of one million doses of the Astra-Zeneca vaccine as the studies unfolded about it not being as protective as we had hoped for. It was an disheartening blow to the nation’s health care workersw who were relying on a vaccine to give them real protection.

Before the dust had settled on the unused Astra-Zeneca vials ( which were sold to other African countries) South Africa took delivery of 80 000 doses of the Johnson and Johnson Vaccine. This is a single dose vaccine as opposed to the others which rely on two doses, given at an interval of a few weeks to a few months. Over the last week the Department of Health co-ordinated the distribution of the Johnson and Johnson vaccine under the umbrella of a trial for health care workers called Sisonke. Sisonke in Zulu means “together”. It is a Phase 3 (b) clinical trial which is pragmatic and set in the real world. Perhaps a little more real in Africa.

The Department of Health distributed the 80 000 doses between 14 state hospitals and used these initial doses to protect frontline health care workers. Their EVDS (Electronic Vaccination Data System) website allowed me to register as a health care worker. My hospital then stratified staff into risk levels, and then I was able to register on the Sisonke website to be part of the trial. Besides entering personal details this also involved digitally signing an informed consent. After this I received a voucher number and a booking to get my vaccine on Friday 26 February 2021 at Prince Mshiyeni Memorial Hospital. It was not all as simple as it sounds. 

The logistics of the vaccine delivery process has been difficult globally. South Africa has discovered the limitations of the public-private health care system. Some provinces allocated appointment times. When I received my invitation it was open ended: from 8 am until 4 pm. My heart sank as I thought of my visit two years ago to the Department of Home Affairs to apply for renewal of my passport. For that I arrived at 5 am to be close to the front of the queue. It could not be that bad, so I arrived at Prince Mshiyeni Memorial Hospital, 10km away from Netcare Kingsway Hospital, just after 7 am. I was relieved and reassured to see our nursing manager at the entrance welcoming and directing me. I was number 184 in the queue. Two hours later I received my injection. Then I had to wait the obligatory 15 minutes to ensure I did not suffer an adverse reaction.

I walked out feeling empowered. I had survived a mild dose of Covid-19 at the end of last year,  and now with the vaccine I was protected. As data comes in I will in turn protect others. But until a significant proportion of our population is vaccinated I will continue applying the appropriate precautions. We should all continue to wear masks, wash hands and maintain social distance. In the hospital and my office the minimum requirement remains a mask, visor, plastic apron and gloves. 

We still have a long way to go with this pandemic, but the vaccine is the most significant step in our battle to gain control of this novel corona virus.

I am grateful to the scientists who developed the vaccine and the South African government for choosing to protect us. Special thanks to the manager of Netcare Kingsway Hospital, Mrs Demetriou for her efforts to get her staff vaccinated.  Health care workers have seen a different reality to the rest of the population.

Thanks to Sister Nompumelelo Molefe
Posted on by basilBLOGinc · 2 Comments

Sometimes I Think

Sometimes I think and nothing happens. That seems to happen a lot during this period of the second wave of Covid-19 that has hit my hospital. Netcare Kingsway Hospital is a community private hospital and has been overwhelmed in caring for patients with Covid-19.

Sometimes I think and something happens. That’s when a story takes shape and I wonder how I will tie it together to make it work.

Sometimes I think about the pandemic. I focus on the problems we face and work out solutions. I reflect on all we have done. I reflect on what we have learnt. Although we were all tired after the first wave, at least for the second wave we had systems in place. Systems to protect staff with PPE, systems to control the flow of patients and systems to deals with patients waiting outside and waiting for an ICU bed.

Sometimes I think that it is affecting everyone. It is affecting every nation. Uniting some and dividing others.

Sometimes I think that it is not only about the nurses and doctors and first responders. It is about the cleaners and security staff, about the porters and the kitchen staff. About the switchboard operator and the admission clerks. They are the ones that make up the scaffolding from which the nurses and doctors flesh out their caring and compassion. Without them risking close contact with sick patients health care workers could not do what they have had to do. 

Sometimes I think about the undertakers I see moving around the hospital. Death certificates in hand if they are lucky, otherwise their unfazed search for the source of that important document. I have seen families cry as a body has been transferred to the undertaker’s van. It was eerie to see a full length leg prosthesis pushed like a spare part above one body.

Sometimes I think about all of these people. I just have not written about them. Now I will write about them.

It may look like it’s only sometimes that I think about them. But today I walked out of my office holding a tray doughnuts. A patient brought them yesterday to celebrate his birthday with us. I didn’t save his life. I am just an orthopedic surgeon. I only fix bones as my clever anesthesiologist insists. I was grateful my patient thought of us but I never got round to having the doughnut.

Sometimes I think clearly. This time I took the doughnuts to the security guard that directs people in crisis to the back of the hospital for them to be triaged. He remains calm and polite and cares as much as any nurse or doctor. I know that because I see him every day he comes on duty. I wave as I drive in and he salutes me.

Sometimes I wish I could do more for them. The doughnuts for the security guard were a start.

Moving mannequins at a Durban outdoor market
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So Now Your Hospital is Open…

The seven days that Netcare Kingsway Hospital was closed completely became a long week. 

There were moments of self-doubt. Finding calm in the moments that made up the closure of our community hospital was difficult.

I was paralyzed during the week my hospital was closed. I limited my news intake, and as I don’t use social media, I was spared the barrage of funny videos, false news and frustrated outbursts that we all experience under lockdown. My paralysis left me unable to read documents that were important to the functioning of a hospital, and further, the functioning of an orthopedic surgeon in a hospital. No hospital, no function: paralysis.

It was late Friday night that I heard that we were allowed to open.  The weekend would be taken up by dusting off everything and ensuring that all the things that are vital to a hospitals functioning were working. This meant checking things like oxygen, air, vacuum (for suction) and back-up generators were all working. 

Then we had to meet to train. We had to appoint new key players in new departments that make up the new normal of working in a hospital during the Covid-19 pandemic.

So after a week of mental paralysis how do you focus when you seem to be starting in the beginning again?

My mind races and there are many answers to the many questions. The answers that ground me are not technical. They are the emotions that will enrich us: empathy, gratitude and answering the question why for this period.

Firstly we  need to have empathy, as each one if us has been to dark places in the last month. No one knows exactly what path anyone else has tread, but caring for each other is important. We need to be kind-hearted, concerned and considerate.

Secondly, and equally important, we need to be grateful for everything we have and everything that has happened to us. We need to be grateful we had time to slow down and recalibrate. We are now all more grateful to have a place of work. More than that we are grateful that the public trust us to take care of them in our place of work.

Lastly, we need to answer the why of what has , is and will need to be done. We can easily answer the what and how, but why will reveal the foundation of our plans and protocols so that the team can incorporate them as part of their fibre. United in understanding we will achieve much more than just with protocols and procedures. 

An extended period of closure for any business can be devastating. For a hospital, closure speaks to a further loss. The feeling of failure settles easily on your shoulders if you don’t stand tall. Stand on your foundations of empathy and gratitude, and answer why it happened. 

Then what we do in the new normal will be greater than we would have done before.

Posted on by basilBLOGinc · 4 Comments

What Does “Closing Your Hospital” Mean?

Toward the end of last year I was reading an article on disruption from Singularity University. The writer challenged businesses to think how they would respond if their customer base was suddenly lost. The challenge seemed to be based on climate change extremes and technological advances. It was a good article,  and I thought about it.

My hospital, Netcare Kingsway, is set in the lush coastal bush of a tall dune on the South Coast of Kwa-Zulu Natal. I thought that even with a significant rise in sea level we would not be affected. The dune is at least seventy metres above current sea level. 

So what could else cause me to lose my patients? The answer is clear four months into the new year: the economic and political chaos that has followed the Covid-19 pandemic. 

I have seen fewer patients during lockdown than the fingers on my surgeon hands. For one week in April, the Medical Centre (a building adjacent to the hospital housing over fifty doctors) in which I work was closed. It underwent a deep clean by professional cleaners brought in by our hospital management. This despite there not having been a patient or doctor or receptionist who works in the Medical Centre testing positive for Covid-19.

Since the deep clean a handful of doctors returned to consulting in the Medical Centre during the last week of lockdown. They were seeing a fraction of the number of patients they normally see. Seeing these patients during the pandemic is difficult with protocols in place to enforce social distancing, wearing of masks and visors as well as increased hand hygiene for all. With the adjoining hospital still closed we cannot use the laboratory or X-rays department to help us make diagnoses. Worse still, we cannot admit our patients for treatment, be it medical or surgical

The patients we have cared for feel that we, the doctors, have abandoned them. I have cared for over twenty three thousand individuals and families during  the two decades I have worked at Kingsway.

My last operation was on Easter Monday, over three weeks ago. Shortly after that the hospital was closed to contain a Covid-19 outbreak. My patient was a ninety-two-year-old lady who shattered her thigh bone. The theatre staff and I were in full PPE (personal protective equipment) to protect her and us from Covid-19. She was discharged from Kingsway last week. Her thigh bone was fixed and she did not get infected with the New Corona virus in hospital.

I am pleased lockdown has been lifted in phases. I am not sure if I will be able to send her flowers for her ninety-third birthday next week.

I believe that Netcare as a group has been proactive with policy and protocol before Covid-19 was declared a pandemic by the World Health Organisation. Kingsway Hospital management has upped their game: they spent on more PPE, created more negative pressure ventilation cubicles, paid staff even though they are not working, converted a day ward of twelve beds into a Covid changeroom for staff, allocated only one patient to a cubicle even in three or four bed wards. This management team ran the hospital efficiently before Covid-19. Now they are risk managers as well, dealing with unimaginable crisis after crisis that has become the hallmark of this pandemic.

We have ongoing cleaning of the hospital including with an Ultraviolet Robot since we were closed to new admissions. We have emptied the hospital of all patients and closed the Medical Centre again from the end of April and have repeated the deep clean. We have trained staff and doctors in Covid-19 protocols. We have taken a team that has always cared and been cautious, and have made them better. 

All of us are dealing with all the unknowns of the Covid-19 pandemic. For us at Kingsway Hospital an additional unknown is when our hospital will be re-opened. We have lost a great part of what defines us as doctors.

Kingsway Hospital’s front door is closed.
Posted on by basilBLOGinc · 21 Comments

Stay safe..

Dear Nurses

I am so proud of all of you.  You have applied yourself to everything that is new. You have patiently listened as we explain protocol after protocol, and then frustrated  you by changing it the next day. I am proud of how you showed care to my 99-year-old patient whose hair is perfectly coiffed and her makeup is ready for a BBC interview.

Like you I don’t know what day it is. I need to check a calendar to see if it’s a working day or a weekend. Not that it makes any difference to you, working shifts and three-day weekends every second weekend.

I try, and yet I fail to talk to you in the corridors and in the nurses’ stations and in your offices in management suite.  

I failed to act ten days ago when someone asked me to write something motivational for you. This is a time when failure is commonplace: the only solution is to acknowledge it, learn from it and move on. With this letter I hope to move on.

We are facing a global crisis in our little hospital that has always served our community to the best of our ability. It seems sometimes that nothing we do is enough for our patients, our hospital, the whole world. But we have not failed!

The sense of failure, the fear of not being in control, the quarantine, the concern for our families causes us all to feel anxiety.

Feeling anxious about things in today’s world is completely normal. Although I am no master, I’d like to share with you how I have learnt to deal with my anxiety over the years and what works for me now:

We need to deal with it. Learn from our failures. Consolidate and move in a new direction with calm and strength and compassion. I believe we all, and especially you, have this ability.

In our medical training and our experience at the workplace over the years we have all faced stressful moments: a patient’s death, a complication, a disagreement with a colleague. Think back to those times. Now empower yourself by reminding yourself that you dealt with those crises before, and you have the tools to deal with this crisis. You have achieved so much, and will continue to achieve.

Over the last decade I have been blessed to meet many wise and caring people who have helped me deal with fear and anxiety. The essence of their help for me can be distilled into three words: 

Remember to breathe (even if it is behind a suffocating mask).

Breathing is the essence of life, and we can control it. In the beginning just acknowledging your breath is enough. Start to feel the place where your in–breath gently fades into your out–breath. Feel your diaphragm move. If you want you can pause, and count to four at the end of each breath.

It is as simple as that. Now you have something you can control. In controlling that you can reduce your fear and anxiety. 

I salute you all. For once the world is recognising your calling.  They are appreciating your service for the greater good of humanity. They understand your sacrifice. 

Stay safe.

Ask for help if you need it.

Best wishes

Basil

Sunrise over the Indian Ocean …