Dealing with a pandemic on a budget

Thursday 26th March 2020

A tale of kindness

The alarm goes off at 0630. I get out of bed knowing that today I do indeed have work, unlike my unnecessary trip to the hospital yesterday. (If you don’t know what I’m talking about, check our yesterday’s blog for a good laugh…)

I start the work day after a few days of annual leave and I feel slightly out of step with my colleagues. The patients are new and there is a new system in place. We now have a resident respiratory doctor based on our ward to look after the growing number of respiratory patients. Our surgeries are starting to take a back seat and I am informed this will increasingly become the case over the next few weeks. Concerning.

We undertake the ward round to start the day. The ward round consists of seeing each patient and checking in on how their last 24 hours have been. We review their blood tests, scan reports and any additional information from colleagues such as physiotherapists and nursing staff. We then formulate a plan for the next 24 hours for the patient and generate jobs to occupy us doctors for the rest of the day. The ward round takes a couple of hours and then onto the jobs. These can be gruelling on occasions and often monotonous but are essential for the patients trajectory towards improved health, and home.

As the jobs wear heavy on me and my colleague he suggests that we stop for a break. We dash down to the hospital coffee shop, which has defiantly remained open thus far. All other shops food outlets have now closed and we are down to a tiny number of shops to sustain the working population of the hospital. My colleague gets the whole team’s coffee order, in total five coffees. He then proceeds to buy snacks for the doctors- cookies and fruit. We arrive back to the ward with a small picnic for the team.

Our colleagues are overjoyed. An oasis in a desert. Fortunately the story does not end there.

During the afternoon, after succumbing to the sugar and caffeine crash, I produce a Kinder Bueno chocolate bar from my bag. My colleague sees this and is instantly reminded that the newsagents in the hospital sells Kinder Bueno ice creams that he has always wanted to try. “Don’t eat that, give me a minute!”, he exclaims.Five minutes later he appears with five ice creams. What a great guy.

These small acts of kindness were the pillars for a great day. Rays of light shining through the grey, monotony of ward jobs. If we can take anything away from this I think it should be this: Small acts of kindness, cost us little but are valuable beyond measure to those we can impart them onto.

Thinking about others

Let’s continue this theme of thinking about others by examining an editorial piece from the British Medical Journal today.

Cox’s Bazar is a small city, a fishing port, in the southeast of Bangladesh. It is home to an idyllic, 155km long sandy beach stretching the length of the coastline and picturesque waterfalls. The name “Cox’s Bazar” translates to “yellow flower”. Sounds dreamy, doesn’t it?

Well, Cox’s Bazar is also home to the Kutupalong camp, the world’s largest refugee camp. It houses 850,000 displaced Rohingya refugees from Myanmar. The camp is densely overcrowded, with around 10 square meters per person. $1 billion of aid has been poured into the camp through international development agencies. The camp is now a bustling city with transport systems, industry and a new sewage system courtesy of Oxfam. The private sector has been involved in the generation of a dynamic ad-hoc city through grants such as IKEA’s $1 million grant to Save the Children. This money has been used to educate and protect children in the camp. There are a host of fantastic and innovative schemes ongoing in Kutupalong camp, more information can be found here.

However, two days ago, the first case of COVID-19 was confirmed in the camp. This city and its inhabitants are at risk of the rapid transmission of the virus. In response, the WHO and UN have made monumental efforts to stop the potentially devastating spread of the SARS-CoV 2 virus through the densely populated city. Portable hand washing stations have been set up and hygiene information has been rolled out through local, reputable figureheads such as imams. Information boards communicate WHO guidance in three locally-spoken dialects to ensure maximum penetration of information within the local populace.

However self-isolation and social distancing measures seen across many countries, seem an unlikely intervention. All community centres and schools have closed which will deprive many of valuable spaces to problem solve the city’s issues. Testing for the virus is non-existent for now and medical stations are manned by well-trained but under-resourced humanitarian workers. Medicine and nursing here will be a challenge. A challenge unlike the task that we are experiencing in the UK, Europe and the US. In these high income countries we are able to call on industry to rapidly produce high-spec personal protective equipment and ventilators. Even basic medical equipment in refugee camps can difficult to source and in low quantities.

An excerpt from the BMJ article however shows the fighting spirit of local humanitarian workers.

“In some ways, we are prepared. We’ve learnt how to respond rapidly to outbreaks, to provide financial resources for protective equipment, for instance, and to ensure that access to food, sanitation, and other healthcare continues through a crisis”. (Louise Donovan of UNHCR, who is based in Cox’s Bazar).

The full article can be found here. I strongly encourage everyone to read it.

Containing an outbreak is no small feat in a technologically advanced and well funded health system. In the less well resourced Kutupalong camp stopping the spread of COVID-19 and other infectious diseases will be a monumental effort. I have great admiration for these brave medical professionals.

As the UK population claps at 8pm for its NHS workers, I clap in appreciation and admiration for all those healthcare workers around the world who work in stressful and strenuous conditions, every single day, to save lives. Here’s to you.