The staff at the parallel health care system needs to be cared for, and given access to supplies and equipment in order to better care for covid19 patients.
That seemed to be the one of the main points of the report from the committee appointed to investigate the factors contributing to clinical outcomes of covid19 patients in TT which was laid in Parliament on Friday.
The report gave 16 physical and intangible recommendations to improve conditions of staff and patients in the parallel health care system, mostly to assist the staff in caring for patients more efficiently and effectively.
Some of the shortfalls in the system included staff shortages at every level from executive management to doctors and nurses to orderlies and patient escorts. It said there were difficulties with turning the patient to lie on their abdomen because of shortages of attendants and orderlies.
It added that at some sites, young doctors had to sleep on mattresses on the floor. Whether male or female, three or four doctors had to share the same sleeping accommodation and some room doors could not be locked. And locum doctors complained of one- to three-month contracts that created uncertainty and affected their moral as they risk their lives.
“Almost every single doctor we met complained of overwork almost to the point of exhaustion. Some of these doctors also had to do non-medical jobs eg, lift and move patients, pull up patients in bed, process nasal swabs.”
The report said under normal circumstances, the nurse to patient ratio would be one nurse to one or two patients in an intensive care unit (ICU), and one nurse to four to six patients on the ward.
However, the committee was told that often there was often one ICU nurse to six ICU ventilated patients, and one nurse to 20-30 patients on the wards, negatively affecting the nurses mentally, physically and psychologically. And, that is in addition to the psychological pressure and stress dealing with many deaths per day, including when one of their colleagues died from covid19.
There were reports of shortages of tocilizumab, midazolam, propofol and methylprednisolone, and dexamethasone was often substituted for methylprednisolone, as well as difficulties in getting tracheostomies done to make it easier for patients to breathe.
Also, in Tobago, the parallel health care system was not as sharply defined as in Trinidad, so there was no structured parallel health care system there.
What should be done
The list of recommendations include a specific feedback system to monitor the needs of frontline workers, as some felt abandoned by the leadership, onsite recreational facilities for all RHAs, 24-hour access to the C40 central stores, and a review of the policy regarding Tocilizumab use.
“Tocilizumab is given at an advanced stage of covid19. Most staff were very impressed by its effects and perhaps C40 needs to increase purchasing of this drug. Though it is an expensive drug there is a cost-benefit to be realized from its use.”
It suggested the urgent implementation
