As hospitals gasp for breath at the height of each wave of the pandemic, the nurses working with Covid patients never let go of hope and healing, even when they are battered themselves. The virus has become more advanced — but so have these professionals dealing with it.
BY PAULA SLIER AND SASHA STAR
THE TRAUMA UNIT OF SOUTH AFRICA’S reputed Chris Hani Baragwanath Hospital is usually abuzz with urgent activity. Gurneys rush back and forth with bleeding patients as medical staff shout instructions over beeping machines.
Overwhelming is a mild way to describe it.
“The trauma cases that healthcare workers are exposed to in South Africa are overboard, mostly due to issues in our communities. Countries overseas often send their own healthcare workers here to gain exposure and experience in regards to trauma,” says Dr Marietjie Theron who trains nurses at Empilweni Education, a private nursing college in Johannesburg.
New Year’s Eve is typically the busiest night of the year at the hospital, with a steady stream of patients from vehicle accidents and violent disputes caused by drunken activity. But as 2020 shifted into 2021, the trauma unit was empty for the first time in its eight-decade history. Instead of dealing with broken bones and stab wounds, nurses at Africa’s largest hospital were treating patients who could not get enough oxygen into their lungs because of the deadly Covid-19 virus.
In the time that has passed since, South Africa has encountered two more waves of Covid-19. The virus has become more advanced — but so have the healthcare professionals dealing with it.
“It was very scary when I first heard of Covid, because I didn’t know what to expect. I didn’t know what to do. Nobody had any knowledge. Everything that was done was through trial and error,” recalls Sister Lucia Sikhakane who heads the Covid ward at Netcare St. Augustine’s Hospital in Durban in the KwaZulu-Natal province of South Africa.
“Seeing people dying, left, right, and center, you didn’t know what to expect the next day. When you went home, you questioned everything that you did… When this [Covid] first started I thought that it was never going to end, but now I think I can see the light at the end of the tunnel.”
The early days of the pandemic saw many healthcare workers around the world putting their own lives on the line as they tried to save those of their patients.
Full personal protective equipment (PPE) including masks, gloves, and gowns were a basic necessity, but not one that was always available.
“There was a lack of PPE in the beginning,” says Fawole Israel, a general nurse practitioner in Nigeria’s Oyo State. “We were using ordinary face masks, not N95 masks, and sometimes we had to wear the same ones for a week. At times you had to use your own personal money to buy gloves to work.”
The lack of PPE for medical personnel prompted Israel to take matters into his own hands.
“I wrote to a couple of international nursing organizations to help nurses in Nigeria with PPE. They sent face shields, gloves and N95 masks,” he says.
In addition to a shortage of protective equipment, the West African country is also reportedly experiencing a shortage of nursing staff. According to Israel, more than 15,000 nurses have taken their skills abroad over the past two years due to a lack of resources and support.
Covid-19 has certainly sparked a shift in the public perception of those working on the frontline. A global movement saw citizens opening their doors and windows and applauding their country’s healthcare workers each evening.
“When patients say, ‘thank you, God bless you for taking care of me so well’, that alone is a very special moment for me. It goes a long way to motivate me as an individual and as a nurse to always give my best,” says Tracy Koranteng who works as a staff nurse in a hospital in the Ghanaian capital of Accra.
Alison Cohen has also discovered a renewed love for her work during the pandemic. As a community nurse in Cape Town, she makes daily visits to patients suffering from Covid.
“I’ve had the most amazing experiences. You share so much with your patients and you feel so appreciated as well. One can sort of almost feel taken for granted in nursing. But in this situation, so many of the doctors wouldn’t see the patients so I was that link between them.”
In Cohen’s opinion, the role of a nurse during Covid goes far beyond checking oxygen levels and noting down a patient’s temperature. “People are incredibly anxious in isolation and that doesn’t help the immune system to fight anything. A lot of what I do involves reassuring patients. There are also an incredible number of people that have no support at all, so for them it means a lot to have someone pop in every day to say hello and ask if there’s anything I can do. And sometimes it’s just a simple thing like needing a battery for their torch.”
The effects of the most recent variant, Omicron, have been far milder than its predecessors. Omicron does not attack the lungs as aggressively as Delta did, and far fewer deaths have been recorded. Yet, the virus as a whole is debilitating and in many situations, nurses were having to care for their fellow healthcare workers.
“It was so sad seeing your colleagues sick and depending on you to look after them. And it was devastating having them pass
on in front of you,” shares Sikhakane. “As a manager, even though I was hurting inside, I had to put on my big hat and be strong for my staff. Although I did have breaking points, I am like the mother of the house, so I had to give them the assurance that I’m always there, no matter what happens, we’re in this together.”
Sikhakane, herself, eventually tested positive after being exposed to the virus during four full waves.
“It was really scary. At the back of my mind, when I had the symptoms, I knew. But I was in denial,” she admits. “I think it was a good experience for me, though, because I could understand what the patients feel. I always used to ask myself why patients didn’t come in earlier. When I was sick at home and it was my turn, I understood what they were feeling – that feeling of ‘it can’t be me’.”
Denial remains a huge part of the virus, even two years on.
“If you were to ask 10 people in Nigeria about Covid-19, five will tell you that it’s a conspiracy theory. They believe it is a conspiracy by Western people to depopulate African countries or a government lie to siphon money,” claims Israel. “Just the other day I went to buy groceries and a friend asked why I was wearing a face mask as Covid-19 does not exist and I’m deceiving myself.”
The conspiracy theory angle becomes even more vehement when vaccines are brought into the equation.
“Some religious organizations preach against taking the Covid vaccine and people take the word of their religious leaders seriously,” Israel says.
This rings true in Kenya as well, according to Yvonne Kiogora, a senior clinical officer in Nairobi.
“Kenya is very tech-savvy with good coverage of the internet so people can access information from all over the world and
view all these conspiracy theories on social media platforms. They believe that the vaccine is dangerous and you’ll die in two years. Or that it will affect fertility because we are Africans.”
Although she has been vaxxed, Kiogora admits that she felt some hesitation before receiving the jab. “I also took some time before I got the vaccination because of some health issues. But I’m glad I took the vaccine. I feel safer being vaccinated.”
“I don’t think a lot of anti-vaxxers have seen a patient struggling to breathe,” notes Cohen. “And for some reason, [the anti-vaxxers] don’t seem to get as sick as they should. Perhaps that’s because we are all vaccinated and don’t pass it on to them…”
Covid vaccines are free in the majority of African countries, but the same cannot be said of the test to determine whether one has the virus in the first place. According to the Pietermaritzburg Economic Justice & Dignity Group, around half of South Africa’s population lives below the upper-bound poverty line of about $80 a month. The cost of one PCR test until recently used to be approximately $54, now lowered to $33.
“When the Delta was prevalent, researchers said that our numbers were probably five times higher than what was being recorded. For instance, one person gets it, they know that they’re positive, then their spouse gets it, and then the five children get it. They know they’ve got it but they aren’t going to go and test. So therefore those numbers are not put into the system,” Cohen explains.
The financial burden of a positive result is also a deterrent for many against getting swabbed. “People think, ‘do I want to stay at home for 10 days and not get paid?’ So if they’ve got a headache and a bit of a cough, it’s cheaper to buy some paracetamol and a bit of cough mixture, take it and carry on.”
Nurses, more than most people, understand the importance of “carrying on”; in fact it appears to be in the blueprint for joining the profession. Constant exposure to illnesses and a strong stomach for bodily fluids are just the tip of the iceberg.
“Nurses are used to working long hours. They work 12-hour
shifts and if there is no one to relieve them, especially in theater, they just continue to fill that space,” says Theron.
“Because of the long hours, they don’t spend much time at home or with their families, they can’t take their children to school or put them to bed if they’re doing night duty; all the things that
a normal parent does. People don’t always realize what a nurse forfeits to be at a bedside and care for patients while their own families don’t always have that privilege.”
For nurses working with Covid patients, this has been further intensified as they attempt to protect their loved ones from being infected.
“I have a very good relationship with my parents and would go visit them all the time, but I don’t see them as often as I used to because I fear for them. They have co-morbidities and I don’t want them to get infected. I don’t want to blame myself for making them sick,” laments Sikhakane.
“When I go to public places, I still have paranoia. It is PTSD [post-traumatic stress disorder],” says Israel who had the virus at the end of 2021. “When I wash my hands, I don’t just use soap; I add bleach. At work I’m constantly asking myself ‘whether I touched my eyes, did I touch that person, have I done something to infect myself’?”
“It’s not easy being a healthcare worker,” Koranteng contends. “We are exposed to a lot of things – even before Covid arrived. It is very demanding work. So we value the support and encouragement. And sometimes we just need patients to be a bit more patient, like their name,” she laughs.
Florence Nightingale is regarded as the founder of modern nursing. The Englishwoman attended to wounded and dying soldiers during the Crimean War and wrote what is considered as the quintessential guide to taking care of the sick. It is she who said, “[Nursing] is one of the finest of arts; I had almost said, the finest of fine arts.”
Medication may be adept at fighting viruses; but sometimes the best prescription is receiving care – from the heart.