Front-line med­ical work­ers who have been bat­tling the COVID-19 pan­dem­ic over the last six months have be­come just as vul­ner­a­ble as pa­tients to this virus as the coun­try con­tin­ues to record an alarm­ing in­crease in the num­ber of pos­i­tive cas­es.

The coun­try record­ed its 13th COVID death and 66 new cas­es yes­ter­day, bring­ing the num­ber to 752 ac­tive cas­es in T&T.

Ac­cord­ing to re­ports reach­ing Guardian Me­dia, there are sev­er­al doc­tors in quar­an­tine and as many as 53 nurs­es iso­lat­ed af­ter pos­si­ble ex­po­sure to pos­i­tive COVID-19 pa­tients.

Ac­knowl­edg­ing con­cerns yes­ter­day as he re­port­ed health care pro­fes­sion­als are com­plain­ing of be­ing burnt out, Health Min­is­ter Ter­rence Deyals­ingh said the Gov­ern­ment has tak­en steps to re­lieve these work­ers who were on ro­ta­tion for the past cou­ple months.

He said three months ago, a de­ci­sion was tak­en to train ad­di­tion­al nurs­es to be placed in the In­ten­sive Care Units, and dur­ing the past two weeks, ap­prox­i­mate­ly 25 doc­tors and 50 nurs­es were added to the cur­rent ros­ter.

Deyals­ingh said they are in a good place as far as ICU nurs­es are con­cerned.

“We have brought on in the past two weeks about 25 doc­tors… 50 nurs­es. But it is not on­ly med­ical staff. We are al­so bring­ing out sup­port staff.”

These sup­port staffs in­clude dri­vers to trans­port sam­ples and ad­min as­sis­tants to do data­base en­try.

“So we are ex­pand­ing and hir­ing peo­ple across the spec­trum of ser­vices that we need….clin­i­cal, para-clin­i­cal and ad­min sup­port so that is be­ing done to strength­en every part of the sys­tem. From TPHL, the CMHO’s of­fice, Min­istry of Health. We are do­ing that to pre­vent ma­jor staff burn out.”

Deyals­ingh, speak­ing at yes­ter­day’s COVID-19 vir­tu­al press brief­ing said the hu­man ca­pac­i­ty to man the health sys­tem was fi­nite.

“We can add as many beds as we want…but we need doc­tors…we need nurs­es…we need dri­vers…we need ad­min as­sis­tants and some of our health care work­ers are al­ready com­plain­ing about burn out.”

Doc­tors' con­cerns

Im­me­di­ate past pres­i­dent of the Med­ical Board of T&T Dr Var­ma Deyals­ingh said doc­tors un­der quar­an­tine in­clud­ed per­son­nel from the pub­lic and pri­vate health sec­tors.

Deyals­ingh said the num­bers of quar­an­tined doc­tors and nurs­es were un­con­firmed, but his state­ment re­flect­ed in­for­ma­tion reach­ing the Board.

Asked if com­plaints re­gard­ing the short­age of PPE had reached the Board, he said, "It is a fright­en­ing sit­u­a­tion where we will now have mem­bers of staff not be­ing able to give the kind of care that is nec­es­sary if they do not have the pro­tec­tive gear, so def­i­nite­ly it is some­thing that front-line work­ers are con­cerned about as you do not know which pa­tient has it."

Deyals­ingh said nurs­es were burned out and doc­tors re­quired to work 24 hours on call.

He said ques­tions were now be­ing raised re­gard­ing the num­ber of ju­nior doc­tors that were be­ing brought on to as­sist that are not as qual­i­fied or ex­pe­ri­enced enough to in­ter­pret crit­i­cal is­sues.

Long hours

Mean­while, pres­i­dent of the T&T Reg­is­tered Nurs­es’ As­so­ci­a­tion (TTR­NA) Idi Stu­art, claimed that many nurs­es have been forced to work ex­treme­ly long hours be­cause of the crit­i­cal short­age of per­son­nel.

Some of these health care work­ers on the front line at pub­lic health in­sti­tu­tions have ap­par­ent­ly fall­en prey to the virus that has left the med­ical staff de­plet­ed across the coun­try.

Ap­plaud­ing nurs­es for ho­n­our­ing their oath to serve the pub­lic de­spite the risks, Stu­art ad­mit­ted the Cou­va and Cau­ra Hos­pi­tals set up by the Min­istry of Health to specif­i­cal­ly deal with COVID-19 cas­es "are ex­treme­ly short-staffed."

"The Gov­ern­ment re­as­signed three nurs­es from the Port-of-Spain Gen­er­al Hos­pi­tal (POS­GH) and three In­ten­sive Care Unit (ICU) nurs­es from the South West Re­gion­al Health Au­thor­i­ty (SWRHA) for a pe­ri­od of six months to re­al­ly run the unit up at Cou­va," Stu­art ex­plained.

Stu­art said these six nurs­es are "now ex­treme­ly burnt out be­cause all leave for health­care work­ers have been can­celled since the start of the year. With the short-staffing of nurs­ing per­son­nel across all the Re­gion­al Health Au­thor­i­ties, there has al­ways been a dif­fi­cul­ty in ac­cess­ing nurs­es, and COVID-19 has on­ly ex­ac­er­bat­ed this sit­u­a­tion.”

Stu­art claimed the trained ICU nurs­es were be­ing sup­ple­ment­ed by new­ly grad­u­at­ed nurs­es who do not have the req­ui­site train­ing or ex­pe­ri­ence that is cur­rent­ly need­ed.

"It is not ide­al as you would want se­nior nurs­ing per­son­nel to be able to go in­to a high-risk unit like that, and then fur­ther­more to treat with crit­i­cal care pa­tients."

De­scrib­ing the cur­rent sit­u­a­tion as a recipe for dis­as­ter, he ex­plained that safe staffing lev­els re­quired ad­e­quate nurs­ing per­son­nel along with the req­ui­site skills and com­pe­tent staff.

He said the min­istry had at­tempt­ed to in­tro­duce cor­rec­tive mea­sures af­ter it was ev­i­dent that the North Cen­tral Re­gion­al Health Au­thor­i­ty (NCRHA) had been un­able to sup­ply the nec­es­sary staff and had turned to ex­ter­nal sources in oth­er RHAs and to Cu­ba.

"When you have to ros­ter 12-hour shifts sev­en days a week, there is no way that six prop­er­ly trained nurs­es can han­dle that with­out feel­ing the ef­fects of a burnout."

He said the ICU man­dates the ra­tio of one nurse per pa­tient, hence the qual­i­ty of care to pa­tients would be im­pact­ed neg­a­tive­ly as “they can­not do that cur­rent­ly up at Cou­va."

That is a risk for the crit­i­cal­ly ill pa­tient, Stu­art said. "The pos­si­bil­i­ty for per­sons who could have been suc­cess­ful­ly treat­ed or could have pulled through dur­ing their ill­ness, may not pull through be­cause they don’t have that one-to-one nurs­ing due to the short­age."

Stu­art said the ju­nior nurs­es now be­ing brought in would have been away from clin­i­cal prac­tice as they grad­u­at­ed sev­er­al years ago.

He said, how­ev­er, the nurs­es want to work be­cause they see the im­pact this virus is hav­ing on the pop­u­la­tion.

"But the rate of spread of this par­tic­u­lar virus is a cause for con­cern and by the sheer num­bers of per­sons get­ting in­fect­ed, it will re­sult in a high­er num­ber of per­sons dy­ing if we don’t have the req­ui­site med­ical in­ter­ven­tion," Stu­art said.

The nurs­es, he said, would on­ly be fear­ful if they are not af­ford­ed the cor­rect Per­son­al Pro­tec­tive Equip­ment (PPE) "and when they see the em­ploy­er is not tak­ing the nec­es­sary time to sani­tise ar­eas or not do­ing it in a time­ly fash­ion."

Stu­art added, "In the gen­er­al set­ting, we are be­ing told by nurs­es that they are not be­ing pro­vid­ed with enough PPE and that is where one mask for the day comes about."

He said nurs­es are now be­ing giv­en "one dis­pos­able mask and every time it gets soiled or wet it los­es its abil­i­ty to pro­tect the nurse and pa­tient. If you keep on that mask through­out the day, you can now in­fect oth­er per­sons and col­leagues with­in the unit."

While PPE was usu­al­ly kept on all the wards, Stu­art said all stock has been re­moved to a cen­tral dis­tri­b­u­tion point and have to be re­quest­ed by nurs­es.

"Most nurs­es have now re­sort­ed to buy­ing their own PPE at phar­ma­cies to make sure they have stock on hand be­cause not every time you go, you will get. When they do get it, they have to main­tain it for the day.

"This is to­tal­ly un­ac­cept­able and that is how the virus is spread­ing. In­ter­na­tion­al­ly, we have seen this is how a num­ber of health care work­ers be­came in­fect­ed when they re­strict PPE and they had to im­pro­vise. We are see­ing that slow­ly but steadi­ly hap­pen­ing in our hos­pi­tals."

In some in­sti­tu­tions, Stu­art said there was al­so re­strict­ed ac­cess to gowns and gloves.

In ad­di­tion to not work­ing with PPEs, Stu­art said nurs­es are de­vel­op­ing Uri­nary Tract In­fec­tions, low­er back and leg pains and chron­ic ve­nous in­suf­fi­cien­cy from stand­ing long hours and be­ing un­able to take re­quired breaks.

Re­fer­ring to the Cuban nurs­es who ar­rived in T&T in March to as­sist lo­cal nurs­ing per­son­nel–which Deyals­ingh claimed were spe­cial­ist ICU per­son­nel–Stu­art said, "It is clear­ly ev­i­dent that they were not spe­cial­ist ICU nurs­es re­sult­ing in nurs­ing man­age­ment re­quest­ing our lo­cal nurs­es to train them as they were not as ex­pe­ri­enced as first por­trayed."

He said lo­cal nurs­es have re­fused to train the Cubans who are re­ceiv­ing high­er salaries than them.

Stu­art ques­tioned why Cuban nurs­es who were brought pri­or to 2016 and re­mained in T&T af­ter their ini­tial con­tracts had end­ed were not utilised since they have the med­ical ex­pe­ri­ence.

Ques­tioned about the im­pact a pa­tient’s death would have on the at­tend­ing per­son­nel, Stu­art said, "There is noth­ing more trau­ma­tis­ing, frus­trat­ing or de­press­ing for nurs­es who just do not have the re­sources and man­pow­er to give that pa­tient the lev­el of care they need and that pa­tient dies for an is­sue that they could have sur­vived."

PSA con­cerned

Pres­i­dent of the Pub­lic Ser­vices As­so­ci­a­tion Wat­son Duke, whose union rep­re­sents over 2,000 nurs­es and doc­tors, con­firmed that nurs­es and doc­tors are “burnt out.”

Duke ad­mit­ted that work­ers en­gaged in treat­ing pos­i­tive COVID pa­tients are over­worked due to lim­it­ed staffing avail­able.

Duke said “There is a se­ri­ous re­duc­tion in alert­ness and sen­si­tiv­i­ty where they are con­cerned. They feel the Gov­ern­ment has dropped the ball.

“They are burnt out due to the fact that they want to use the same group of peo­ple and to keep it so tight as if it is a se­cret so­ci­ety. Let the lim­it­ed few be suf­fi­cient to run a shift and al­low a per­son to have two clear days of rest,” he said.

Duke said he was aware of two nurs­es treat­ing dozens of COVID pa­tients in a 12-hour shift, stat­ing this ought not to hap­pen.

The cor­rect ra­tio should be one nurse to four or five pa­tients.

“In a sense, the nurs­es are not ag­gres­sive enough. But we have spo­ken against this 12-hour shift. It goes against the min­i­mum wages act which stip­u­lates that pro­fes­sion­al work­ers should not go be­yond ten hours of work per day or 40 hours per week. We are say­ing COVID health care work­ers should not be al­lowed to work more than eight hours a day.”

Duke drew ref­er­ence to a 1970s doc­u­ment signed be­tween the CPO and PSA that al­lows health care pro­fes­sion­als to have two con­sec­u­tive days off.

“We are clam­our­ing that nurs­es not be giv­en more than eight hours a day to work es­pe­cial­ly when they are deal­ing with COVID pa­tients."

He said over­worked health pro­fes­sion­als treat­ing COVID pa­tients can open them­selves to er­rors on the job.

“Any mis­take can re­sult in them con­tract­ing the dis­ease or con­tribute to the dis­ease spread­ing.”

He said if the min­istry fails to do its part, the next step would be “mas­sive re­sis­tance. We will have to per­haps refuse to con­tin­ue with those in­hu­mane and un­safe work­ing con­di­tions. But that will take some time.”

Duke felt front-line work­ers who deal with COVID-19 pos­i­tive pa­tients should not go home to their fam­i­lies but ac­com­mo­dat­ed else­where to avoid the virus from spread­ing.

An­oth­er is­sue in­volved nurs­es not be­ing test­ed for the virus, stat­ing that such work­ers should be swabbed pe­ri­od­i­cal­ly.

“I don’t know why. I guess they treat­ing this test as if it is very ex­pen­sive and like if it is gold. They don’t even have prop­er safe­ty gears and N95 masks.” Duke said some nurs­es are giv­en sur­gi­cal masks which are not as ef­fec­tive as the N95.

He said there was a lack of pro­tec­tive equip­ment, while some work­ers have been lob­by­ing for com­pen­sa­tion, fa­cil­i­ties and ameni­ties.

“The best stan­dards are not be­ing prac­tised due to lim­it­ed re­sources...Doc­tors are quite con­cerned about prop­er equip­ment and the avail­abil­i­ty of it.”

BOX

NCRHA Head re­futes claims

CEO of the North Cen­tral Re­gion­al Health Au­thor­i­ty Davlin Thomas has called on Stu­art to iden­ti­fy those peo­ple who may be ill and have con­tin­ued work­ing, so they can be re­moved, test­ed and quar­an­tined.

De­fend­ing his or­gan­i­sa­tion’s op­er­a­tions dur­ing the pan­dem­ic, the NCRHA’s CEO yes­ter­day re­fut­ed Stu­art’s claims that nurs­ing per­son­nel who might have been in­fect­ed with the virus, were be­ing forced to work

La­belling them as false, Thomas ex­plained the NCRHA had im­ple­ment­ed strict safe­ty mea­sures for both staff and pa­tients.

Deny­ing they “had any sit­u­a­tion at all where any­one who is ill is on the job site,” Thomas stressed, “To in­di­cate how se­ri­ous we are about pre­serv­ing the safe­ty of all per­sons…if some­one is iden­ti­fied as a pri­ma­ry or even sec­ondary con­tact of some­one who is in­fect­ed or whom we be­lieve had been ex­posed…even if they are not show­ing symp­toms, we move im­me­di­ate­ly to re­move them.

“Our is­sue is con­ti­nu­ity of the sec­tor. It is fool­hardy for us to have peo­ple who are not well and pos­si­bly in­fect­ed with the virus, work­ing among peo­ple who we want to con­tin­ue do­ing their jobs.”

Thomas re­vealed that there were per­sons cur­rent­ly in quar­an­tine who were not even show­ing symp­toms. He said this is part of the NCRHA’s strat­e­gy to en­sure the par­al­lel health sys­tem op­er­ates smooth­ly and ef­fi­cient­ly and ful­fils its’ man­date to save lives.

“We can’t do that nor is it pos­si­ble to project a fu­ture if we have peo­ple who are pos­si­ble COVID-19 pos­i­tive in­ter­act­ing with the pub­lic…we not even chanc­ing that,” he said.

The NCRHA is re­spon­si­ble for fa­cil­i­ties in­clud­ing the Er­ic Williams Med­ical Sci­ences (EWM­SC), the Cou­va Med­ical and Mul­ti-Train­ing Fa­cil­i­ty and the new­ly opened Ari­ma Gen­er­al Hos­pi­tal.

Thomas said while there is no short­age of PPE, they had de­vised a sys­tem to ra­tion the cur­rent stock and en­sure it is not mis­used or abused.

He as­sured, “We have more than enough and for all who are pro­vid­ing care, they will re­ceive it.”

Thomas es­ti­mat­ed there were ap­prox­i­mate­ly 30 peo­ple in­clu­sive of doc­tors and nurs­es that were in quar­an­tine at this time.

He re­it­er­at­ed, “We are now do­ing rou­tine test­ing of staff be­cause we are not tak­ing that light­ly. We will en­sure we are not jeop­ar­diz­ing the sys­tem by hav­ing per­sons work­ing who are symp­to­matic or where con­tact trac­ing im­plies they might be car­ri­ers.”

Re­in­forc­ing Thomas’s state­ments re­gard­ing the safe­ty of both staff and pa­tients, NCRHA’s Cor­po­rate Com­mu­ni­ca­tions Man­ag­er Pe­ter Nep­tune said their health and safe­ty pro­to­cols were of the high­est stan­dards.

NWRHA re­sponds

Re­spond­ing to the is­sues raised by Duke and Stu­art, act­ing CEO of the North West Re­gion­al Health Au­thor­i­ty (NWRHA) Sal­isha Baksh in an email yes­ter­day stat­ed that its nurs­ing fra­ter­ni­ty has been work­ing stead­fast­ly dur­ing the pan­dem­ic.

“While at present the work­load of both nurs­es and med­ical doc­tors have in­creased due to the surge in cas­es, they are nonethe­less de­ter­mined, re­silient and ded­i­cat­ed to ser­vice and their pa­tients.”

How­ev­er, in the in­ter­est of man­ag­ing any burn out of cur­rent staff, Baksh said the NWRHA has in­sti­tut­ed mea­sures where­by work­ers are giv­en time-off when re­quest­ed and fea­si­ble, while flex­itime has been im­ple­ment­ed, in­clud­ing con­tin­ued staff sup­port has been pro­vid­ed via its em­ploy­ee as­sis­tance pro­gram, oc­cu­pa­tion­al health and hu­man re­sources.

“The NWRHA is in the process of em­ploy­ing ad­di­tion­al staff to as­sist in its over­all COVID-19 re­sponse.”Baksh in­sist­ed that all health­care work­ers wear the ap­pro­pri­ate/pre­scribed PPEs in ac­cor­dance with the WHO/min­istry’s IPC’s guide­lines while pro­vid­ing care and treat­ment to their pa­tients.

She said all front-line staff are pro­vid­ed with the ap­pro­pri­ate quan­ti­ties of PPEs in

ac­cor­dance with the min­istry’s pol­i­cy on the ra­tio­nal use of PPE.

ER­HA re­sponds

CEO, East­ern Re­gion­al Health Au­thor­i­ty (ER­HA), Ronald Tsoi-a-Fatt said, “Our staff is of the great­est im­por­tance to us and we have put sys­tems in place to man­age them very close­ly on the ground…mak­ing sure they are safe and not burnt out.”

Monies Al­lo­cat­ed To Fight The Pan­dem­ic

In Ju­ly - Deyals­ingh re­vealed he had gone to Cab­i­net months be­fore the start of the COVID episode in T&T with a Cab­i­net note re­quest­ing $150 mil­lion for the Trinidad re­sponse to COVID over the four RHA’s (Re­gion­al Health Au­thor­i­ties), the TRHA (To­ba­go Re­gion­al Health Au­thor­i­ty) is un­der a sep­a­rate cov­er, be­cause that’s a sep­a­rate re­port­ing func­tion re­ceived $50 mil­lion for their re­sponse.

With a com­bined to­tal for both is­lands at $200 mil­lion, Deyals­ingh es­ti­mat­ed that up to Ju­ly 25, the min­istry had spent around $50 mil­lion.

At the time, he pro­vid­ed a break-down as he said the NCRHA had been al­lo­cat­ed $129,950,000; while the ER­HA had been al­lo­cat­ed $33,113,990; and the NWRHA re­ceived $16,606,000; with the SWRHA re­ceiv­ing $5 mil­lion.