The coronavirus pandemic has put immense pressure on healthcare systems all over the world and has challenged the mental health of frontline workers, who walk a fine line between life and death every single day.
T he novel coronavirus has taken the world by storm. Everything we know has been transformed entirely, and every day we step out of the house we now tread carefully and manoeuvre cautiously, trying to adapt to this ‘new normal’ where a handshake or a hug can carry more danger than one would have thought possible.
NURSES HUB: The nurses station is where each nurse will begin and end their shift every day. Every meeting, daily report and status update takes place at the nurses bay. Photo: Vetiwe Mamba.
The coronavirus 2019 (covid-19) was first identified in the town of Wuhan, China in December 2019 and quickly engulfed the rest of the world. The World Health Organisation (WHO) declared this virus a global pandemic in March – governments had to respond accordingly, and life as we knew it was a thing of the past.
The virus was swift and impartial in its conquest, forcing us to adjust quickly and normalise habits that would otherwise be foreign to us. The pandemic has shone a light on healthcare systems all across the world. Some systems have shown exemplary direction, while others have buckled under the pressure as seen in countries such as America, Mexico and India.
Within every healthcare system there is a team of people – human beings who are as afraid of the virus as we are, yet wake up every day to treat, look after and, in some instances, save the lives of those who are sick with covid-19.
A closer look at the essential worker
The term ‘frontline healthcare worker’ covers all types of health workers such as nurses, midwives, community health workers, doctors and pharmacists – all who provide care directly to their communities. Due to their close contact with infected individuals, healthcare workers are at high risk of infection, which could lead to further spread to patients, friends and family.
The mental well-being of healthcare workers has been the topic of discussion across all spheres of society. Their lived fear is something we, as onlookers, don’t wish to even imagine. Fear of catching the virus, witnessing countless deaths on a daily basis, treating critical patients but being afraid of them, are only a few of the stresses healthcare workers have had to grapple with and overcome every day, since the virus started spreading.
In the Kingdom of Eswatini, the prime minister invoked section 29 of the Disaster Management Act (2006) and declared a National Emergency on March 17, and thereafter the country entered a five-week partial lockdown. The lockdown was partial to ensure economic survival for the small nation. As of November 1, the Kingdom has recorded 5 925 covid-19 cases and 117 deaths.
A brief introduction
Nurses Vesta Makadzange (40) and Tadessu Kebede (48) took time to speak to Wits Vuvuzela about what their experience of the pandemic has been like at Manzini Clinic, named after the most populated region of the country and the epicentre of the virus since April this year.
Both women are veteran nurses, with over 20 years of nursing experience, yet neither of them was entirely prepared for the anxieties the pandemic would bring with it.
“When the virus started spreading overseas, everyone was scared – front liners included,” Makadzange remarked.
Makadzange started nursing in Zimbabwe, her home country, and moved to Eswatini with her husband over 10 years ago. Kebede is originally from Ethiopia and has been in Eswatini for 25 years.
Makadzange details her daily activities, which start with a daily report from the night-shift nurses at 07:00, followed by an outfit change into scrubs, including the required personal protective equipment (PPE). She will then greet patients, administer medication, perform sponge baths on bed-ridden patients and accompany others to the bathroom because they are too weak to go themselves, among other things.
A SMILE KEEPS THE BLUES AWAY: Sr. Vesta Makadzange, nurse supervisor for Manzini Clinic, dressed in her standard uniform – an outfit worn by senior nurses when they are not required to wear PPE. Photo: Vetiwe Mamba.
Towards the evening, she will write up a report for the night-shift nurses coming in, reporting on any changes, admissions or deaths that happened throughout the day, and by 19:00 she is checked out and on her way home. A typical day in the life, you would assume.
However, with covid-19 roaming the streets, the days have not been as predictable. On any given day, in between these seemingly mundane activities, nurses morph into super humans. Some days, they are resuscitating patients who have suddenly stopped breathing, while others spend hours trying to stabilise a patient despite fearing over-exposure (nurses are advised to see patients at 30-minute intervals, to reduce the possibility of catching covid-19). On other days, nurses helplessly watch chronic patients pass on, and some might lose six patients in a day and struggle to sleep for nights on end.
These ‘in-betweens’ are the moments and memories that remain with healthcare workers: these are the events that will mark their experience of covid-19 and be part of their lives forever.
Fear of covid-19 in Eswatini was high. Many felt the country was not prepared for it. Remarking on her initial thoughts on the pandemic, Kebede said she had feared that the clinic would lack the capability to handle the virus.
“We hadn’t been trained; we didn’t have enough outfits [PPE – personal protective equipment]. Everything was happening very fast and our response had to be fast too,” she said.
Fortunately, the clinic managed to pull resources together and ensure that its staff was sufficiently protected against infection. This was assisted by the clinic being private. However, for other healthcare workers in public hospitals across the country the process was not as swift.
Poor resources can affect the mental-health of healthcare workers
In April the Swaziland Democratic Nurses’ Union (SWADNU) held a protest and filed a lawsuit against the government for failing to provide adequate PPE for healthcare workers across Eswatini. The union felt that government was infringing on their rights as dictated in the Occupational Health and Safety Act (OHS). The act states that every employer has a duty to provide “adequate and appropriate personal protective appliances, equipment and clothing” to its employees who work under conditions that can affect their safety and health negatively.
The national newspaper, Times of Swaziland, reported that the ministers concerned said these allegations were baseless because the National Emergency Act waives the duties laid out in the OHS act.
THE LIFESAVER: An intensive care unit (ICU) nurse dressed in full PPE gear at the Manzini Clinic. Photo: Vetiwe Mamba.
Research done by the Human Sciences Research Council (HSRC) shows that inadequate PPE can cause anxiety and stress levels to peak among healthcare workers, which can breed other anxieties like catching the virus, or unknowingly spreading it to loved ones or even patients.
South Africa has dealt with similar difficulties in terms of PPE procurement. In the earlier stages of the pandemic the HSRC created a survey for healthcare workers to review their preparedness and expectations towards the then coming storm. More than 7 600 healthcare professionals participated in the survey.
Mental health statistics among healthcare workers
Under the theme of health and well-being, the results show that nearly half the nurse practitioners were extremely concerned for their personal health, while three in five reported being concerned about passing infection to family members. A quarter of nurse practitioners experienced severe psychological distress, and health professionals working in public hospitals were seen to be experiencing higher levels of psychological distress, compared to those working in the private sector.
Overall, the HSRC found that nurses had higher personal risk perception (a general perception one holds of the severity of/their vulnerability to a health threat), causing poor mental health and affecting the health workforce’s capabilities, staff performance and morale.
Clinical psychologist, Garret Barnwell, says psychological distress is often caused through structural issues: “Things like PPE, access to adequate diagnostics, treatments and staffing, clear protocols, good team communications, all help to create a facilitating environment for staff.”
Dove Medical Press, a publisher of scientific and medical journals, published an article on the implications of covid-19 for sub-Saharan Africa and found that the impact of covid-19 could be immense, due to weak healthcare systems.
As observed during the Ebola epidemic of 2014-2016, the psychological effects of an epidemic can be far-reaching and can lead to an increase in depression, anxiety and post-traumatic stress disorders. From their findings, writers Bazghina-werq Semo and Souci Mogga Frissa say that mental health and psychosocial support services need to be integrated into the pandemic response, and coordinated nationally.
Echoing this idea, HSRC researcher Professor Sibusiso Sifunda says the primary concern reflected in the results of the survey was mental health and finding ways to protect the well-being of all workers.
“We measured a high level of burnout and poor mental health, even at that early stage,” he explained. “There existed a lot of fear around catching the virus and bringing it back to your family.”
This fear became a reality for both Makadzange and Kebede, when they caught covid-19.
Makadzange believes she caught it after resuscitating a patient.
“There were about five of us in the room with her, she’d started gasping and all of a sudden she just stopped breathing. We started doing CPR, giving her oxygen and trying to put her on a ventilator. The exposure during this process is quite great.”
Having spent over three hours in the room, much longer than the advised 30 minutes, all but one of them tested positive for covid-19 in the following weeks.
”One feels dazed. It’s like your body was not yours,”
Fortunately for Makadzange, she was able to isolate and recover in her home after 14 days without spreading the virus to her husband and three sons.
However, Kebede’s recovery took over a month and she had to be hospitalised for a week. Having worked most shifts in the emergency room and being exposed to numerous covid-19 patients on a daily basis, she was not quite sure where she caught the infection.
“I started having flu symptoms and decided to isolate myself because of my family – my kids and my husband – and the patient too. I didn’t want to put anyone at risk while I waited for my results,” she said.
The mother of three describes the hospital as being very lonely.
HUSHED CORRIDORS: The wards of Manzini Clinic, lined with sanitiser machines on every wall, lie empty quiet and still now with cases slowing down in the country. Photo: Vetiwe Mamba.
“There’s a lot of fear,” she stated. “All the symptoms come at night. People would scream at night, everything is dark…”
“One feels dazed. It’s like your body was not yours,” she described.
“Everything is scary… Every day you see, it’s like death is coming.”
Manzini Clinic offers all their staff members counselling after they contract covid-19, a noble gesture, even if it doesn’t stretch out to those healthcare workers who continue to witness innumerable deaths and are accumulating trauma despite remaining healthy.
Sifunda feels the pandemic has proved to many African countries that the healthcare system can be prioritised and can thrive when money is allocated correctly.
“It has also shed light on the need for systems that look after healthcare workers. Traditionally, it [the system] has been a model where a healthcare worker is assumed to be okay and healthy enough to look after patients. This has changed.”
“Healthcare workers aren’t usually afraid of catching disease from patients, but now they have to worry about themselves and this is something new.”
Sifunda says national responses will have to design new ways to support healthcare workers and ensure that health and wellness programmes are proactive, leaving behind the passive approach that existed before covid-19.
Writers Bazghina-werq Semo and Souci Mogga Frissa say that countries in sub-Saharan Africa could learn from countries abroad and establish adequate services to address mental health.
These lessons consist of identifying high risk groups early on and providing them with targeted interventions to help get ahead of the problem, and routine screening of mental health problems.
Barnwell says it is important not to attribute psychological distress to individual issues: this calls for regular check-ins with team members and monitoring their current mental states. Lastly, the mental health of healthcare staff can be preserved by prioritising shorter work days, adequate provision of PPE and satisfactory training in infection control.
Both Nurse Makadzange and Nurse Kebede agree that their job cannot be done without passion – the crucial trait that causes you to continuously place a patient’s needs before your own, no matter what the cost.
Makadzange: “There’s a point where you need to remember the oath you made to take care of the patients. Whether you’re going to die as well or get infected, there’s a moment where you don’t have a choice. You just have to do it.”
FEATURED IMAGE: The covid-19 pandemic has put immense pressure on healthcare workers all around the world. Their exposure to the tragedies caused by the virus have led to a strong emphasis on mental-health in hospitals to ensure medical staff do not experience burnout, depression and other symptoms of poor mental health. Photo: Vetiwe Mamba.
BACK TO IN-DEPTH 2020 MAIN PAGE.
A new wellness campaign is raising awareness around food insecurity among university students.
The office of student success (OSS), under the faculty of health science (FHS) has been running a novel campaign, #MakeADifference, since June, which aims to encourage donations towards basic needs care-kits that include food and toiletry supplies that are given to Wits health science students in need, while simultaneously raising awareness of food insecurity in South African universities.
The #MakeADifference campaign was developed by master’s students in community-based counselling psychology (MACC), in partnership with the OSS, a student wellness department.
Erick Kabongo, a MACC student, says the campaign is intended to, “capture different aspects of a students’ well-being” and this includes ensuring access to basic necessities such as food and toiletries.
“Class issues vary and some students get access to things while others don’t. If we aid students with basics such as food and toiletry, we are allowing them to compete fairly within their academic pursuits,” says Boikhutso Maubane, a counselling psychologist at OSS.
Before the campaign launched, the OSS had a food bank that would receive donations irregularly and only catered to a small pool of students who expressed need. “What was important this year was being able to really provide for students, especially during these trying economic times in South Africa,” Maubane told Wits Vuvuzela.
Despite being disrupted by the covid-19 pandemic, the campaign has increased the visibility of the food bank to potential donors as well as students who may need support.
Since June, OSS has distributed over 70 care-kits and has recently received 74 care-kits valued at R200 through a single donation, which will be distributed to students for the remainder of the year. Care-kits consist of non-perishable foods and basic toiletries.
Anelisa Mofokeng , administrator at the OSS, says an average of 10 students fetch a care-kit when available from the office. Students are identified through the health science course coordinators or they approach the OSS independently. There are roughly 70 students who form part of the campaign’s database and receive an email when care-kits are available. The office prioritises self-funding students when distributing care-kits but NSFAS students are not excluded from receiving aid.
Due to the pandemic, the campaign has been forced to function largely online, taking away the ability to engage with the Wits community. However, Maubane says the campaign has still managed to make a difference in this difficult time and it still has a lot to accomplish for the benefit of student communities.
FEATURE IMAGE: The #MakeADifference campaign supports health sciences students in need. Photo: Vetiwe Mamba
RELATED LINKS: Wits Vuvuzela, Students society raises funds for shelters, July 2020.
Wits Vuvuzela, NSFAS students in catered residences to get food allowances, August 2020.
Khetho Mayisela (22) is a fourth year MBChB student (Bachelor of Medicine and Bachelor of Surgery) at the University of Pretoria (UP). Mayisela is one of the thousands of medical students who are under lockdown in South Africa and nursing her anxieties of losing time on her course and possibly having to repeat it. Mayisela is back at her home in Eswatini and awaiting communication from her institution on the way forward for the year.
As part of her fourth year activities, Mayisela would attend clinical rotations every day in local hospitals around Pretoria, two of which are now designated for covid-19 patients. When the virus first hit South Africa, Mayisela had to remain on rotation for three weeks before heading home. She talks about the experience of working in a hospital in the early stages of the panic and what her current fears are as universities remain closed.
As told to Vetiwe Mamba.
We, as students, didn’t really take the pandemic seriously when it was still overseas because it felt very distant from us and we didn’t really think it would reach us. Our pediatrics lecturer had begun giving us small bits of information about the virus in our lectures; what it is and how it works but we were all very laid back, cracking jokes about it and all.
When it eventually got to South Africa, we were still casual about it because it was all the way in Durban and it was only one case. I was personally under the impression that it wouldn’t really spread that far, which, in hindsight, was quite an uneducated assumption considering I’ve been taught about this before – I know how a virus works. I suppose it was wishful thinking on my part, thinking South Africa was more likely to get it under control because they had had time to prepare for it, unlike China and other countries that were first affected by covid-19.
In the following days, we started to feel the weight of the pandemic as we entered hospitals for our rotations and we’d see everyone in masks. I was doing my rotations at Tembisa Hospital one day when I walked in to find everyone in masks: the security guards; the doctors, the sisters and even patients were wearing masks. It was very scary, especially because we weren’t given masks; we very quickly began to fear being exposed to the virus and we wouldn’t even know it. There was this one day when we walked out of a ward and found a masked patient sitting in a wheelchair, shaking violently and sweating profusely with a blanket covering them, just in the middle of the corridor – we were all convinced that patient had covid-19. Working in the hospitals was extremely tough, I became very paranoid. Simply getting an itch in your throat would have you thinking “Oh no, I’ve got it now.”
As the virus escalated, I grew quite anxious and I was tossing a lot of worries over in my head. I was torn up about the possibility of an early recess because that would result in an extension of the academic year but at the same time, I didn’t want to stay and risk the borders closing because I am an international student. Then when it was made official that UP was closing and we were given 2-5 days to vacate the residences, I started to worry that I might have contracted the virus during rotations and I’d be bringing it back home and spreading it to my family and the country. Fortunately I am healthy and so is my family.
Working from home is a bit distracting because we spend quite a lot of time together and that eats up most of my study time but my mom is very supportive. She always asks me if I’ve managed to cover all my lectures and she’ll buy me more data if ever the wifi is being problematic. Staying focused is definitely more difficult, I get caught up watching television or reading a book or I simply get lazy. I am a night owl though so I spend most weekends up late trying to catch up on everything. Surprisingly, being at home has reduced the stress I usually feel because I’m not in an academic environment so there’s less pressure.
My biggest fear currently is an extension of my degree, fourth year is also one of the hardest years at UP medicine so the possibility of dragging this out is extremely disheartening, especially when I have two and half years left.
We’ve been told that we’ll finish the first semester online and we are yet to hear what the medical faculty has decided with regards to our clinical practice, because as much as we can finish our theory online, our clinicals are still a requirement to pass the year.
While we wait to start online classes, we’ve been receiving daily notes of the new block we’re meant to start like we usually do at school. Our chair of medicine is definitely working his hardest to give us updates and make online learning easier for us, they have attempted to give us access to date free websites and the lecturers save their lessons as zip files so that we use less data. All in all, the faculty has really tried its best to accommodate everyone.
FEATURED IMAGE: Fourth year MBChB student, Khetho Maysiela who is currently back in Eswatini due to the covid-19 pandemic. Photo: Provided.
- Wits Vuvuzela, First week of remote online learning challenges practicals, April 26, 2020.
- Wits Vuvuzela, PROFILE: Dr Ann van Staden, a medical intern, April 25, 2020.
- Wits Vuvuzela, COVID19: International students left to their own ‘devices’ as remote learning starts, April 23, 2020.
Head of chemistry department assembles team to produce hand sanitisers to assist in the fight against the covid-19 pandemic in the Kingdom of Eswatini.
The chemistry labs of the University of Eswatini (UNESWA) have been bustling since the announcement of the first covid-19 case in the kingdom on March 13, 2020.
Senior lecturer and head of chemistry, Dr Thabile Ndlovu, had already made the decision to start producing hand sanitisers in the UNESWA chemistry laboratories a week before the announcement due to the scarcity of sanitisers in stores.
“There were no sanitisers in shops anymore. Something was required and we had the equipment to assist the country,” Dr Ndlovu told Wits Vuvuzela.
As an awardee of the Instrumental Access Award from Seeding Labs, a global science organisation that provides scientists with tools and resources for ground-breaking research, Dr Ndlovu was the recipient of lab equipment that was intended to support research and teaching in her department. It is this equipment that helped her start the production of the sanitisers.
In a single day, Dr Ndlovu and her team of 10 lab staff, were able to produce 100 litres of sanitiser using the World Health Organisation recipe, and have since made over 200 litres in total. The sanitiser is then packaged in containers with sizes varying from 150 to 500 ml and sold to members of the Eswatini community.
Hand sanitiser produced at UNESWA, packaged and ready for distribution. Photo: Provided
Given the rising demand for sanitiser as the pandemic spreads, Dr Ndlovu admits that “supply is an issue”, especially because the key ingredient, ethanol, is usually imported from South Africa, which is now on lockdown.
Dr Ndlovu said, “Our production has been restricted by the lack of ethanol but we are being offered assistance from local companies who are making donations to the department.”
These companies include USA Distillers and Coca-Cola Swaziland, which have been pivotal in the continuation of the production of sanitisers, offering to donate ingredients as well as manufacturing equipment to turn the production into a large-scale operation.
“People are coming together to assist. The country is coming together,” Dr Ndlovu told Wits Vuvuzela.
She also said, while the kingdom’s ministry of health is supportive of this initiative, a solid partnership with it is yet to be finalised. That would facilitate the donation of sanitisers to the rural communites of Eswatini.
FEATURED IMAGE: Lab assistants producing hand sanitiser in the UNESWA chemistry labs. This photo was taken before the lockdown, before masks were mandatory. Photo: Provided
Witswaters residence will house Wits students that have been squatting in libraries and labs until the end of June. Photo: Vetiwe Mamba.
The Wits SRC scores temporary accommodation for homeless students.
As many as 36 homeless students were expected to have been granted temporary accommodation at Witswaters residence in Parktown by the end of Friday, March 13.
SRC president Thuto Gabaphethe said, “Yesterday (Thursday) there was a group that was moved in and today we shall be finalising that process… It is confirmed that by the end of today (Friday) all students will have moved in.”
Although, according to deputy SRC president Rebecca Mahaule, the SRC had requested that the building be made available for the entire year, the rooms will only be available until June 30. That is because the rooms are for the use of medical students who are out on rotation, who will be returning to work at Charlotte Maxeke Hospital from July 1.
“Upon the request of the SRC, the [Gauteng] department of health made the building available to house Wits students needing accommodation assistance on a temporary basis until the end of June 2020,” the dean of students, Jerome September, told Wits Vuvuzela. “However, this is not a Wits residence, it will not be set up as such, as it is a temporary relief for students currently in need,” he added.
The deputy director of the academic hospital, Tiny Kubheka, said Witwaters, which is in Block D of the Charlotte Maxeke Residence Complex, currently houses 280 students. These include South African medical students who had studied in Cuba, postgraduate nursing students from Wits, fourth-year medical students, Sefako Makgatho Health Sciences University students and medical technologist interns.
Sizakele Davani, a 25-year-old master’s student in politics who has been without accommodation since she arrived from Cape Town on January 22, is hopeful that the SRC will help her.
“This psychologically affects me because it’s difficult to focus in lectures and I’m still sleeping in labs. I am on the [Hardship Fund] list but this isn’t helping at all,” she told Wits Vuvuzela. She said she had applied for National Research Foundation funding last year, but her application was “still pending”.
Mahaule said rooms at the residence would be allocated to students who had applied for the Hardship Fund and “squatters who have been identified by the Wits Protection Services in libraries and computer labs”.
FEATURED IMAGE: The Gauteng department of health has made the Witswaters building available to homeless Witsies. Photo: Vetiwe Mamba.
Wits Vuvuzela, Wits SRC deliver memorandum to Lesufi. March 1, 2020.
Wits Vuvuzela, Homeless students forced to sleep in 24-hour study area. March 5, 2020.
Wits Vuvuzela, Wits has no emergency accommodation – Dean of Students. January 28, 2019.