COVID-19: Interview with a Cape Town doctor on the frontlines
When she gets home in the afternoon, physician Dr Arifa Parker disposes of her work clothes in the washing machine. She then has a thorough shower before greeting her three-year-old twin toddlers, Yusra and Haniya, with a hug.
Since January Parker has served at the coalface of South Africa’s fight against COVID-19. One of three infectious diseases specialists at Cape Town’s Tygerberg Hospital, she treats patients positive for the coronavirus in specially set up wards; supporting Intensive Care Unit staff, and screenings in a tent set-up on the premises. Meanwhile, she is also gathering information and formulating protocols for how to best tackle this new pandemic.
This week, 39-year-old Parker opened up to Spotlight about being a doctor and a mother in the eye of the COVID-19 storm. Speaking via a Zoom interview, her sentences are laced with laughter, despite the gravity of the task ahead of her.
“I’m very careful,” she says. “I know what the risks are and when I see my patients, I make sure that I wear adequate PPE – personal protective equipment. And that is what I tell the junior staff as well. No one should be seeing patients without adequate protection. We do have enough stock for now, if we use it wisely; and more has been ordered,” Parker says.
“So that makes me feel better going home to my kids. The hospital is frantically working on shower facilities for staff, so we could take a shower and change into normal clothes before going home. For now, I jump into the shower and wash my clothes before giving my little ones a hug. So that is a bit odd, because they usually would jump into my arms immediately when I get home.”
Fortunately Parker’s husband Ghaliel, who works in IT, is taking care of their young children during lockdown. “He’s been amazingly, amazingly supportive,” she says. “He’s been working from home via Zoom, with the kids in the background.”
HIV and TB
Parker’s early training is in HIV and tuberculosis (TB). After completing a medicine degree at Stellenbosch University, she did her internship at GF Jooste Hospital in Manenberg on the Cape Flats, under renowned mentor Professor Graeme Meintjes. This was in 2005, a year after antiretroviral (ARV) drugs were first starting to be rolled out by the state in South Africa, after a lengthy struggle by civil society for access to treatment.
“At the time it was quite overwhelming because ARVs were not freely available and a lot of young people were dying,” recalls Parker. “Manenberg was my first choice, because it was a hospital in an impoverished community. I wanted to help people. So I ended up doing my community service the following year in Khayelitsha as well,” Parker tells Spotlight.
“You know, as interns we used to have to fill in the death certificates. So you would have the deceased patient in front of you; and you’d look at the ID photo and it would show someone so different to the completely ravaged patient. And that’s why I ended up doing internal medicine and infectious diseases, because I wanted to understand a bit more about how the body works and how one would be able to treat these patients better. And fortunately with the ARV rollout, HIV patients are now doing so much better. And you know, it’s actually quite rewarding to work in the field of HIV medicine. But we still have a lot of work to do; we still have to roll out more ARVs and prevent lots of infections. We still have lots of challenges. TB and everything else.”
Parker pauses, as her phone rings. She excuses herself to answer it. Then, turning back to the interview, she adds: “And now there’s COVID-19 thrown into the mix, too.”
On January 11, Chinese state media reported the first known COVID-19 related death. Since then Parker has “lived and breathed” coronavirus.
“So COVID didn’t exist to us before January,” she says. “We heard about it mid-January; and then we started having to prepare for cases, having to put procedures and systems in place. So as infectious diseases specialists, we’ve had to educate ourselves, rapidly. We’ve had a steep learning curve and part of that has been adapting to create standard operating procedures for our hospital.
“Also we don’t know – internationally – what the effect of COVID will be on our HIV-positive patients. There were very few patients in China who had HIV. You know, there are lots of questions.”
At night, Parker sits in bed next to her husband working and reading; sometimes she works in their kitchen over a cup of tea. They take turns to cook; butter chicken, lamb curry, pasta and salads. The kids go to bed at 7pm; and at 9pm she goes back to the drawing board.
Days blurred into one
“Since January, my days have all blurred into one,” she says. “Most days I can’t remember what day it is. I start quite early. I haven’t been sleeping much since the start of COVID, I mean this morning I woke up at 4:30am. As you know, COVID is a new infection, with new data coming out all the time. So the first thing I do is look at my phone, I get lots and lots of messages; so I read the new things and send it on. My work day at the hospital starts at 8am. At 9am we have what we call a COVID ops meeting, where all our hospital’s heads meet – you know, radiology, surgery, anaesthetics, ICU, and so on.”
She gets home at around 5pm – well, it depends. “For example,” she says, “last Friday at 4pm, 200 people suddenly rocked up at the hospital’s testing centre at one time. I mean, you can’t just leave junior staff alone. So a few of us senior staff; the paediatric infectious diseases specialist, our head of clinical medicine, and another internal medicine consultant, stayed behind and helped out and assisted in doing the tests.”
While Parker cannot comment on patient figures, she says at present Tygerberg has two general wards full, and is ready to activate more. She is quick to deflect praise, crediting her team and colleagues.
“It’s not just an infectious diseases response,” she says. “We are only three, too few people. It’s been a hospital response from all departments. I feel so privileged to be working with such amazing people at my hospital. If work needs to be done, everybody pitches in. All sorts of hierarchy have flown out the window. For example, we had the head of nephrology (renal medicine) come down and doing swabs on patients. The plastic surgery registrar does shifts; we’ve had radiology specialists coming down to assist with screenings. The anaesthetic department has been very helpful. Intubation of the ill patients is obviously a very high risk procedure, because you would be in direct contact with the patients’ airway. And they happily put together a call roster of who will assist us should we need to do such procedures, because they are the best trained do to the intubations.”
Parker points out that demographics of the COVID outbreak is changing. Initially, transmission was travel-related. Now healthcare specialists are seeing the early stages of community transmission. Of great concern is increasing transmission to essential workers.
She notes a spike in infections in Khayelitsha. According to provincial statistics released by Western Cape premier Alan Winde on April 28, there were then 205 confirmed COVID-19 positive people in Khayelitsha.
“Last week, my direct boss, Neshaad Schrueder, and I went to Khayelitsha Hospital,” she says. “We were very concerned about the spike in COVID numbers and wanted to see how Tygerberg can support the hospital. Yes, and I think they have an excellent team of staff. They’ve put amazing systems in place; they’ve also started a tent for testing outside the hospital, and within the hospital they’ve identified separate spaces where they can keep persons isolated from each other. So we were able to help with that,” she says.
“We’re also advising hospitals that we need to work together. So if they are seeing that they are overrun with patients, they shouldn’t hesitate to call us. Because it’s pointless, having open beds in one hospital while another is full. Because we know COVID sort-of attacks areas. You’ll have fires of outbreaks; so one area might have more cases, especially at this point in the outbreak.”
On April 29, Cape Town community newspaper TableTalk reported that two employees at Checkers Bayside – Sindoswa Msiwa of Khayelitsha and Sylvia Gaxela from Delft – succumbed to COVID-19. The newspaper quoted Msiwa’s brother, Luthando, as saying: “My sister worked on Sunday, April 12 even though she wasn’t feeling well. She called me that evening saying she wasn’t well, and I took her to Khayelitsha Hospital where she tested positive. She was later transferred to Tygerberg Hospital, where she stayed in intensive care. She died on April 12.”
Asked about Msiwa’s death at Tygerberg, Parker notes that she is not allowed to comment on individual patients due to patient confidentiality. “This is so sad,” she says. “My thoughts are with the family. It’s very sad, but it is inevitable that people will die. I see some of my colleagues are struggling with this; but there is nothing more they can do. As healthcare workers, we shouldn’t be too hard on ourselves.”
Time to prepare
Can the pandemic still be contained in South Africa? “Um, obviously we’re worried,” says Parker. “I don’t think we can entirely eradicate COVID. I think it will still be a problem, but I think it’s imperative that we try to prevent cases. If we don’t, more people will die and our hospitals will be overrun with cases. So, it’s still very important that we test, test, test, and when we find cases, that we try to isolate. We are obviously very concerned about overcrowded areas, and that is why the country has rolled out community testing.”
While government is under fire from some quarters for its lockdown regulations, Parker insists these measures are crucial. “My personal opinion is that the lockdown was an excellent decision, because it gave our hospital and other hospitals time to prepare, time to make sure that staff are educated on how to use PPE; time to create ward and intensive care space; to create the documents that we are working on at the moment,” Parker says.
“I am so fortunate that we have had a chance to work on those. I just think of the poor healthcare workers in China and Italy who didn’t have a chance to prepare; they didn’t know what hit them. Fortunately we have systems that are in place now that can hopefully help to relieve the burden on our healthcare force.”
She says healthcare workers are rethinking the way they practice medicine in the time of COVID-19. This includes less touch.
“We have to minimise risk while assessing and managing patients,” she says. “For example, something that would normally take five minutes, now takes ten minutes. You need to know exactly what you are going to do for the patient when you go into his or her ward. As physicians, we love to spend time with patients. We love to feel, touch, and to thoroughly examine everything. But I think we need to sort of rethink the way we practice medicine in the time of COVID. Having an additional layer of awareness. We have to touch less and think: ‘If I touch this, is it going to contribute to my management of a patient. If I spend hours listening to every part of the lung, would it give me more information than the chest X-Ray that we already did?’ I would not have said this in December, but now with COVID, obviously we have to change the way we practice medicine, which may be a bit controversial.”
How do they compensate for a lack in physical interaction?
“Our patients have been amazing,” says Parker. “I’ve also learned new things about technology, communicating via cellphone, you know, phoning the patients and taking their history like that, asking them if they are okay. I have renewed respect for social media, this is really helping to keep patients in touch with their families. So, you know, somebody mentioned that maybe we should have patients not have their phones with them because they can get contaminated. That’s the worst idea. This is the way they keep in touch with family and friends, despite the lack of interaction.”
Parker adds that the public and private health sectors are collaborating in the fight. “This has been another amazing thing. We call each other for advice, it’s just been such a different experience as to how medicine normally works. And I really hope that if there is an after-COVID, that we continue this sort of enthusiasm.”
“Try to fix it instead of complaining about it”
Parker grew up in Cape Town’s northern suburbs in Cravenby – which happens to be near Tygerberg Hospital – where she matriculated at Cravenby Secondary School. “We had amazing teachers, who shaped and opened our minds,” she says. “The motto of the school was ‘aim high’, so well, we aimed high.”
One of five children, Parker’s youngest brother studied medicine too, and is presently completing an internship at Kimberley Hospital. “Oh, my parents never forced us to do anything,” she says. “My mom’s brother is a doctor, but there’s no real family history of healthcare. My parents did encourage hard work.”
On her sunny disposition, she says: “I think negativity is a wasted emotion. I think if you find that there are issues or that you find something negative or you’re not happy about something, it may be more constructive to come up with a solution to that problem. That’s just my approach. If something is broken or seems to be broken, try to fix it instead of complaining about it.”
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