Terrence Deyalsingh, Minister of Health

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.”

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.