#Whatitslike: Heading up Charlotte Maxeke’s Emergency Department in the time of COVID-19
From 1 May 2020, it became mandatory for every person in the country to wear a mask in public. For hospital staff like doctors and nurses, however, wearing masks and personal protective equipment (PPE) has always been the norm even before the first COVID-19 case was confirmed in South Africa.
Medical staff have been donning and doffing – the practice of employees putting on and removing work-related protective gear, clothing, and uniforms – daily. Having to manage infection control in hospitals is after all nothing new.
They are not only treating COVID-19 cases, but are also attending to the ‘normal’ patients, who are placed in separate areas of the hospital, explains Professor Feroza Motara, head of the emergency department at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).
“You have to wear the full PPE to protect yourself – which includes the helmet. There is a lot of donning – to put on (the clothing) and doffing (to take off the protective clothing) in between seeing patients,” says Motara. “The full PPE is very hot and uncomfortable to wear when you wear it for long periods. It’s not heavy but it’s hot.”
Motara says she feels protected when she wears her PPE. “We have enough protective equipment. It will be a challenge if numbers go up significantly.”
Limited stock of personal protective equipment PPE, particularly N95 masks, has been a problem in many countries. At times in the United Kingdom doctors have resorted to wearing a surgical mask (not as protective as an N95). In the United States, many healthcare workers have admitted that their biggest concern is that they will not have enough personal protective equipment to take care of the number of patients that are coming in.
This week the Gauteng Department of Health in a statement said it has 11 004 334 items of PPE stock on hand. Based on the current patient load, the department said this is “adequate” and has procured more. This include body PPE (gowns), face PPE (masks), hand PPE (gloves), respiratory PPE and tools.
Similar fears on PPEs have been expressed in South Africa and it is widely accepted that healthcare workers are at a much higher risk of contracting COVID-19 than the general public. On Wednesday last week Minister of Health Dr Zweli Mkhize said that 511 healthcare workers in South Africa had by then tested positive for COVID-19. Of these 26 had been hospitalised and two had passed away at the time. At least one more healthcare worker has died since.
Gauteng Department of Health spokesperson Kwara Kekana says they are fortunate that most health workers who tested positive for COVID-19 in the province have not needed hospitalisation.
Less than five months later
The disease that we now know as COVID-19 was first reported less than five months ago in Wuhan, China. On 30 January, the World Health Organization declared the outbreak a Public Health Emergency of International Concern, and on 11 March a pandemic.
Motara remembers how she felt when the Minister of Health announced in February that Charlotte Maxeke would be a designated COVID-19 hospital. “(It was) scary, and we were anxious when hearing about it as we didn’t know much about the problem,” she says.
In February, Charlotte Maxeke treated its first COVID-19 patient. “The first patient who was COVID-19 positive was one of the original travellers from the Italian tour group. The patient was stable, and it was a bit scary as we knew so much less than we know now,” says Motara. “But the patient was managed as any other patient, was treated and discharged within a week.”
South Africa reported its first COVID-19 positive case on 5 March. According to a statement by Mkhize at the time, it was a “38-year-old male who travelled to Italy with his wife”. The two were part of a tour group of 10 people who visited Italy and arrived back on 1 March – the same tour group as the patient in CMJAH.
Motara says that these days the atmosphere at the hospital is more stressful. “Staff are concerned about potential infection and about taking it home to their families,” she says.
While she says that there was little psycho-social support in the beginning, there are now support groups and staff are offered therapy. Staff are also closely monitored for potential COVID-19 infection.
Much has also changed in how the hospital is run. Weekends used to be busy for her unit, Motara explains. [Before lockdown] there were more trauma related cases because of increased alcohol intake. “Presently we have added a load of COVID-19 related illnesses in addition to the normal patient load.”
She says the lockdown and the alcohol ban now means that there are “almost no trauma cases, no accidents from drunken driving, no violent fights with knives and guns”.
Kekana points out that facilities in the province have now set up triage areas outside for screening, and those presenting with flu-like symptoms are then handled accordingly based on assessment.
Inside the hospital care is also taken to keep COVID-19 patients apart from other patients. “The medical emergency unit sees all patients but patients are now screened for COVID-19 as they enter the unit and are then separated into different areas for COVID-19 and non-COVID-19.(There is) no effect on non-COVID-19 patients as they are still seen in a separate area,” Motara explains.
“Practice has changed – now there is much more awareness of infection risk, we’re taking additional protective measures – masks, gloves, aprons, visors,” she says. “When entering area where the COVID-19 patients are, one has to take all the precautions.”
By 13 May a cumulative total of 303 COVID-19 positive patients were admitted to hospitals in Gauteng. According to a statement of the provincial health department, a cumulative number of 231 patients were discharged and 24 succumbed to COVID-19.
There are currently 48 patients being treated for COVID-19 in Gauteng hospitals.
“(It is) a bit daunting and anxious but hopefully our preparation has enabled us to deal with what’s coming,” says Motara when asked about the expected surge in COVID-19 cases. “We have put protocols in place and chains for command regarding who gets intubated and when. These are based on evidence from overseas areas that had high numbers of patients.”
“The greatest reward”
Motara started working as a doctor in 1991. “I graduated from Wits University, worked as an intern at the then Johannesburg General Hospital just after it had opened up for non-white staff to be employed there,” she says.
Thirteen years later in 2004 she became the head of the emergency department at Charlotte Maxeke.
She grew up in Mbombela (Nelspruit).
Motara says she became a doctor because she has always had a passion for helping others. “(I’m) trying to do good for more than myself. I feel I can make a difference in people’s lives and communities,” she says.
“Helping a gogo who is ill or a child lying at death’s door is the greatest reward for what I do.”
But with COVID-19 comes new risks.
“My family are concerned about my risk and exposure and I’m concerned about potentially exposing them if I get infected,” she says.
Motara sees her two children daily but cannot see her mother or extended family. “(I) need to protect my elderly mum from any risk – but we talk over the phone or social media. My children are old enough to understand,” she says, “so they know the risks. Although they are coping well, they are worried about me.”
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