'We’re approaching the point where we'll be overrun': On the frontline of Covid-19 battle

As SA braces for the peak of Covid-19, exhausted health-care workers tell how the battle against the virus is taking its toll. There are life-and-death decisions to be made, protective equipment to be found and deep fear of taking the virus to families.

12 July 2020 - 00:00 By Sunday Times reporters
The casualty section at Chris Hani Baragwanath Hospital in Soweto is the first stop for patients suffering from the Covid-19 virus. The huge hospital, like many others, has struggled to find enough protective equipment for doctors, nurses and other health-care workers.
The casualty section at Chris Hani Baragwanath Hospital in Soweto is the first stop for patients suffering from the Covid-19 virus. The huge hospital, like many others, has struggled to find enough protective equipment for doctors, nurses and other health-care workers.
Image: Antonio Muchave

STICKING TO LEVEL 5 WHILE THE REST OF SA DROPS IT'S GUARD

Fifteen minutes after Dr Boitumelo Makaulule swabbed a patient for the Covid-19 virus on Wednesday, she watched him die. Covid can kill that quickly.

Makaulule works in a state hospital in Johannesburg. It has only five beds in its intensive care unit and until three weeks ago referred all Covid cases to Charlotte Maxeke Hospital.

The mental strain is intense, she said, and staff are called on to perform miracles.

The man who died had been admitted at casualty. "His family left after he arrived in our ward. I could see he was distressed. We gave him oxygen and some antibiotics. And 15 minutes later he was gone."

Because of a shortage of protective equipment, the doctor bought her own jumpsuit "because I don't want to risk being exposed and exposing my family".

At home her family is sticking to level 5 precautions. They don't go out unless they have to, and have no visitors.

Makaulule said people were not taking the outbreak seriously. "Government keeps saying we have it under control and we don't. My message to everyone is, keep practising social distancing, wash your hands, wear your masks and only leave your house if you have to." 

- Paul Ash

Dr Boitumelo Makaulule
Dr Boitumelo Makaulule
Image: Supplied
Professor Feroza Motara, the head of the emergency unit at Charlotte Maxeke Academic Hospital.
Professor Feroza Motara, the head of the emergency unit at Charlotte Maxeke Academic Hospital.
Image: Supplied

SUDDEN DETERIORATION, OFTEN FATAL IS PUZZLING

Patient fatalities used to be rare at the internal medicine department at Victoria Hospital in Wynberg, Cape Town.

But since it was converted into a Covid-19 unit two months ago, things have changed. "Just on Thursday this week we've had four deaths before 1pm," said manager Dr Nasief Van Der Schyff.

He had the most heartbreaking experience this week after he called the wife of one of his Covid-19 patients to report "good progress".

"I phoned the wife very upbeat, telling her that we may be discharging him soon. I said to her, 'Your husband is a fighter and things are looking good.' But the next morning I had to break the news to her that he didn't pull through."

Van der Schyff, who is himself a survivor of Covid-19, said one of the most puzzling aspects of the disease is the sudden deterioration of patients, which often results in death.  

- Sipokazi Fokazi

Victoria Hospital manager Dr Nasief Van Der Schyff.
Victoria Hospital manager Dr Nasief Van Der Schyff.
Image: Supplied
Social worker Patricia Njozela.
Social worker Patricia Njozela.
Image: Supplied

DOING 'GOD'S WORK' IN PANDEMIC AT AGE 92

For 92-year-old Durban GP Dr Perisamy Govender, the words "there will be plenty of time to rest when I am dead" are what he lives by as he soldiers on during Covid-19 despite the risks to his life because of his age.

"Right now I have God's work to do. When you are not there when the people need you the most, why must they support you in good times? My age has nothing to do with this."

Govender said he has encountered about 20 suspected cases of Covid-19, all of which have come back negative. Three of his patients tested positive at work and he is managing them from a distance.

He said that what the medical profession is going through now can only be compared to the Asian flu of the '70s. That was "very trying. We had no cellphones so we would have school children coming to us saying 'Everybody in my family has the flu,' " he said. 

- Lwandile Bhengu

Paramedic Leon Fourie.
Paramedic Leon Fourie.
Image: Supplied
Tracey Morris, nursing manager in the Covid-19 ward at Groote Schuur Hospital in Cape Town.
Tracey Morris, nursing manager in the Covid-19 ward at Groote Schuur Hospital in Cape Town.
Image: Supplied

RATIONING ICU ACCESS, EVEN IN PRIVATE HOSPITALS

"One day we'll look back at this year and see it as a landmark year," Life St George's Hospital pulmonologist Dr David Stickells says of his job in the Covid-19 hotspot of Nelson Mandela Bay.

But for now, he is trying to manage patient care along with keeping things at home stable.

"It can place a strain on your relationship because you see yourself as the danger to your family. As a provider and a protector, it's a hard place to find yourself in."

He said Nelson Mandela Bay has truly entered the active phase, with ICU beds and ventilators having to be rationed.

"Working in a private practice, we are used to having everything that we need for our patients . Now we have to ration equipment, we make triage decisions when the patients come in.

"We just allocated the last bed to the last patient today [Friday]," he said. 

—Alex Patrick

Durban orthopaedic and spinal surgeon Rinesh Chetty.
Durban orthopaedic and spinal surgeon Rinesh Chetty.
Image: Supplied
Grey Hospital's Dr Sazi Nzama.
Grey Hospital's Dr Sazi Nzama.
Image: Supplied

HAVE WE DONE ENOUGH TO SAVE LIVES?

Whenever a patient dies, professor Feroza Motara, the head of the emergency unit at Charlotte Maxeke Academic Hospital in Johannesburg, wonders whether they have done enough to save that person's life. That makes staff try harder, but there's a limit to what they can do.

More and more, she is seeing people come to the hospital when they are "almost too sick".

"Some of the non-Covid-19 patients we admit are very sick and when you ask why they waited too long, they say they were scared of contracting the virus," she said.

"Stress levels have gone up among most health professionals, who now have to take care of patients and also worry about their sick family members."

Motara said staff shortages were a challenge even before Covid-19, and are worse now because of staff who have become infected. 

—Belinda Pheto

CONSTANT MENTAL FOCUS LEADING TO EXHAUSTION 

Durban orthopaedic and spinal surgeon Rinesh Chetty describes his days as an "exhaustive daily grind".

While his private patients' case load has eased, he has been assisting the JMH hospital group in its Covid-19 response.

A member of the South African military medical reserve force, he trains his staff to protect themselves, video-calls relatives who cannot visit loved ones and works between three hospitals, even if it means not being able kiss his children good night.

"The feeling is not overworked. It is a type of indescribable exhaustion. The constant mental focus to stay safe and avoid risky movements can cause a physiological and psychological exhaustion that takes a while to get used to," he says.

His biggest challenge is training staff to keep themselves safe and focused on providing an effective service without increasing the risk to themselves, their families and the community.

His family is his constant worry. "I know I am their biggest threat, I have done what I can to minimise their risk . I do sometimes take a risk and steal a hug and maybe kiss if I can catch them after I decontaminate." 

—Nivashni Nair

Life St George's Hospital pulmonologist Dr David Stickells.
Life St George's Hospital pulmonologist Dr David Stickells.
Image: Supplied

'A SPIT IN THE FACE' WHEN PEOPLE WON'T MASK-UP

Dr Sazi Nzama, who works in the paediatric intensive care unit at Grey's Hospital in Pietermaritzburg, KwaZulu-Natal, said the toughest part is seeing people refusing to take precautions.

"Watching this virus unfold, hearing or reading about its most recent kill and then going outside and seeing people without masks on their faces - honestly, that's a spit in the face! Because fast-forward two weeks and those same people are in the hospital, gasping for their lives. Nobody will accept blame for their callousness but rather call the health system incompetent when their loved ones die."

Coping is tough. "A simple stroll on the beach to unwind can leave you dead in two to three weeks."

—Nivashni Nair

Watching this virus unfold, hearing or reading about its most recent kill and then going outside and seeing people without masks on their faces - honestly, that's a spit in the face

YOU SEE THE ANXIETY... IN ESSENCE THEY DIE ALONE

Tracey Morris, nursing manager in the Covid-19 ward at Groote Schuur Hospital in Cape Town, says the most difficult thing for staff is handling patients' loneliness.

"You see the anxiety of not having family support in their eyes. That just makes many of us very sad. We have become the only family they know… so in essence they die alone," she said.

Morris is convinced her unit would be handling more deaths without its high-flow nasal oxygen machines. This week, she and her colleagues discharged five patients who had been treated with the machines.

Health-care workers booking off sick have put nursing teams under tremendous pressure, she said. 

—Sipokazi Fokazi

Durban GP Dr Perisamy Govender.
Durban GP Dr Perisamy Govender.
Image: Supplied

STRUGGLING TO GET BEDS FOR PATIENTS

Paramedic Leon Fourie sometimes has to wait hours outside a hospital with a patient because of the lack of beds.

"Hospitals are full, and if we have seriously critical patients we struggle to find hospitals to accept our patients."

Fourie, who works for Life Response 24/7, said he and his colleagues have also encountered patients who did not want to be taken to hospital for fear of contracting the virus.

"People are very scared and on the edge, and patients have very short tempers these days," he said.

"The public don't understand that we really try our best and that the lack of beds in hospitals is really not our fault." 

— Lwandile Bhengu

FUNERALS THAT BRING NO COMFORT OR CLOSURE 

Social worker Patricia Njozela finds funerals the most heartbreaking aspect of this disease. Families can't get closure - "it's not natural" - and the caskets are sprayed with disinfectant by an undertaker in full personal protective gear.

Njozela works at the Doctors Without Borders-built Thusong field hospital in Khayelitsha, Cape Town.

Her hardest moment, though, was visiting a family to discuss a recovering patient who was due to go home, only to find that the patient's daughter had died suddenly during the night, leaving the family without a caregiver.

She returned to the hospital to find the patient was "very restless", crying and calling for her daughter. 

—Paul Ash

LONELINESS OF PATIENTS CUT OFF FROM FAMILY 

The loneliness that patients feel being cut off from seeing their families broke her heart, said a nurse at Leratong Hospital in Krugersdorp.

“I sometimes let patients use my cellphone to call their family. There are the little things we can do for them to make it better, like charging their phones. But sometimes things get so hectic you forget to return it, but they wait patiently.”

The hardest is to call people with news of a death.

“It’s so sad because the last time they saw the patient would have been when he or she was admitted.

“Families are not always able to call the patients to check up on them, but sometimes … we can speak to families who ask us for updates.”

The nurse usually takes care of 10 to 12 patients at a time, but now she has to care for 24.

—Belinda Pheto

“All we want is for the hospital to shut for a day so we can get it cleaned properly.” 

TURNOVER LEAVES HOSPITAL 'IN NEED OF AA CLEAN-UP'

The quick turnover of patients means no proper sanitation can be done, said a nurse working at Frontier Hospital in Queenstown, in the Eastern Cape.

Even the surgical wards and eye clinic have been converted for infected patients. Nineteen nurses from her ward have been diagnosed with the virus.

“We were told that…102 colleagues — including a doctor—are ill with Covid-19,” she said. Two nurses are on ventilators.

“It doesn’t look good for them.”

A colleague from her ward has died.

“All we want is for the hospital to shut for a day so we can get it cleaned properly.” 

— Alex Patrick

FIVE DAYS, SAME MASK AS BARA RUNS SHORT 

Some weeks ago, staff at the Chris Hani Baragwanath Hospital had to wear the s am e protective masks for up to five days because stock was low, said a doctor at the Soweto hospital .

“More than 20 nurses and doctors have contracted the virus and the systems are not coping. At least one colleague has died, a matron ,” the doctor said.

“Such a sweet lady. It leaves traumatic scars and fears that everyone else will follow.

“Things are falling apart. Currently there is no ICU ward dedicated to Covid patients. It is still being prepared.”

—Sipho Masondo

WITH ONLY 120 BEDS, DOCTORS HAS TO PLAY GOD 

“I feel like I am playing God because I decide who gets a bed and has a fighting chance of living and who doesn’t and dies,” said a doctor at the Bheki Mlangeni Hospital in Jabulani, Soweto.

The doctor had just worked a 30-hour shift. The hospital’s 120 beds — 60 for Covid patients and the rest for patients displaying symptoms — were full .

“People spend up to 72 hours in casualty waiting for a bed,” said the doctor.

When a bed becomes available he has to decide which patient gets it.

“Some diet here [in casualty].” He said the infrastructure was overwhelmed.

“There are no oxygen points, no social distancing between patients and no ventilators .”

About 10 colleagues, out of 25, have the virus.

—Sipho Masondo

People spend up to 72 hours in casualty waiting for a bed

'WE WILL HAVE ANARCHY... HELL IS COMING'

Only one patient has come off a ventilator at the Nkosi Albert Luthuli Hospital, in Durban, according to an intensive care specialist there, and “once they reach that stage it becomes a game of chance”.

“We ’re approaching the point where we will be overrun,” she said.

“On top of the patient load,  e have 50 staff infections …who do we put in their place, and what happens when we get the next 50 infections?

“We’re not prepared for the peak. We are at capacity now and the peak is coming. We can’t make beds, doctors and ventilators appear out of thin air, and at this point I don’t know what the future looks like for us.

“We will have anarchy … it ’s clear to me now that we will be in the same situation that the Eastern Cape is in now. The hell is coming .”

As in all hospitals, there are shortages. Nurses are given masks to distribute to the other staff but hold onto these because there are so few.

“So now we have fights over masks .”

— Jeff Wicks


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