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The masks are uncomfortable. In fact, all the personal protective equipment is uncomfortable. Then there is the constant thought about why, as a worker on the health frontline, it is needed.
“I think the most challenging thing is always having that anxiety that it’s near you,” says Emma Schroder, intensive care clinical nurse specialist.
“It’s close by and you just have to not catch it. I think that’s the hardest thing.”
Schroder has been working at The Austin hospital for about seven years, treating everything from cardiac to neurology patients.
She is one of a number of healthcare workers The Age has interviewed working at the forefront of the COVID-19 fight. They are nurses, midwives, specialists, doctors and paramedics. Some must navigate the complexities of meeting people in full protective gear, others deal with turning patients’ families away at hospital or juggle home schooling and the nagging fear of catching the virus themselves.
As of the weekend, there were more than 5.1 million COVID-19 cases worldwide and 332,000 deaths, according to Johns Hopkins University. Some 102 of those fatalities were in Australia.
With social restrictions easing across Australia, they are urging Victorians to stay vigilant as they continue to risk their health – and their families’ – to fight COVID-19.
The Austin hospital, Intensive Care Unit specialist nurse
As bodies piled up overseas and the first signs of the virus appeared in Australia, Emma Schroder remembers anxiety levels around the ICU being high.
“I think I was starting to feel quite scared not only for myself but for my family,” she said.
“I’ve got a young child. I’ve also got family members around me who are very close who are high risk. They see you become that person that people are a little bit scared of – because we were with these COVID patients all the time – so I think that was what I was nervous about at first.”
Along with learning how to wear PPE, her team now has smaller meetings and there’s “no water on the [ICU] floor, no food on the floor”.
The fear of catching the virus has been ever-present. It’s discussed constantly at work, then with family and friends. It has even seeped into her dreams.
“You don’t even realise it … but it takes over your life a little bit,” she says. “So it’s pretty much 24/7 coronavirus.”
A wellness special interest group at work helps; the staff eat lollies while they debrief about what’s happening on the ward or at home to boost morale. “That’s really important in this time,” Schroder says.
Walks with her dog or family and curling up with a tea and a book in front of the fire also ease the pressure.
The pandemic has also hit her personal life. Schroder cut her maternity leave short to come back to work full-time after her husband lost his hours.
“We’re very, very fortunate to have a job and can work full-time. But I’ve got to say … It has been hard.”
With a smile, she describes how grateful she is to those following the social distancing restrictions.
“I am a little bit worried about a second wave and what that impact might be to the state and the country. But I think that we as Australians are really prepared for what could happen. And yeah, I think we’re ready if there was anything to come.”
Every night at 7pm, New Yorkers open their windows and clap or shout to say thank you to their health workers. It’s happened at least once in Melbourne.
“Lots of people are saying we’re heroes and doing all that sort of stuff,” says Schroder, slightly embarrassed.
“And that’s really nice and a really heart-warming thing to say. We’re just doing our jobs and we just come to work every day and just do what we have to do. And we love it.”
Graduate paramedic, Ambulance Victoria
When Matt Carter walks into a patient’s home wearing full personal protective equipment, he knows it can be confronting. The only part of his face that’s visible is a pair of eyes.
“I think for certain cohorts it’s really difficult as well, like the elderly or people that are hard of hearing [who] might be used to communicating by reading lips – really, really difficult,” the 35-year-old says.
“Particularly with children, you come in looking like a bit of a monster. You get there – it just takes more time.”
The graduate paramedic had only been on the road for about a month when the pandemic hit.
Work now starts with a temperature check, a check-in with his paramedic partner, and leaving his boots outside the door of the Brimbank ambulance station, so as not to bring in any possible contamination.
He wears a mask to every job and should patients exhibit the mildest symptoms he’ll put on full garb: a Tyvek suit, gloves and mask.
Graduate paramedic Matt Carter says he still finds ways to connect with patients while wearing PPE. Credit:Eddie Jim
“You normally have to start trying to prepare while you’re in the back of the truck, particularly if it’s a high acuity situation. It’s harder, it’s warmer … you get a bit sweaty.”
Because of these robust precautions, Carter has never really been concerned about catching the virus.
“To my knowledge, none [of the patients] have actually had COVID-19, the service has been really good about promoting information,” he says.
But the strict protocols have also become a cathartic ritual: “You go through the motions, you clean the truck, you wipe everything down and make sure it’s a clean environment.”
“It’s almost like it’s stepping away from the job when you take that PPE off, and you sort of throw it away in the garbage and move away and then get on to the next job.”
Since the pandemic, he’s surprised that the number of callouts at the Brimbank branch has decreased. Across Ambulance Victoria, there has been a 30 per cent decrease in callouts in the past few weeks.
“It’s normally quite a busy branch,” he says. “It’s a concern for us because we’re always worried that the people that are unwell … aren’t calling because they’re afraid of COVID in general and being outside or afraid of COVID being in and around hospitals.
“We just try and just keep reinforcing the fact that if you’re unwell, if you’re sick, if you’ve got that chest pain, it’s really, really important to call, because think of the worst-case scenario.”
Royal Melbourne Hospital, Emergency Department physician
“I feel like we’ve bought ourselves time,” says Dr Sarah Whitelaw.
COVID-19 nurses in full PPE walk past outside the Emergency Department’s doors, the wind whipping their plastic gowns.
Whitelaw has worked at the Royal Melbourne for 10 years and says the weariness she saw in her colleagues about the impending influx of COVID-19 patients was dissipating.
To have got to the stage now where we don’t feel that [anxiety] every single minute of every single day is something that I think all of us will be forever grateful to the Victorian community for.
There have been 102 coronavirus deaths in Australia, 19 of them in Victoria, so far. Although terrible, it’s much less than expected.
“When the pandemic first started, things were changing so rapidly that almost every few hours there was something else coming,” she says.
From what happened in Italy and New York, she thought they may have five or six really sick patients and then within 24 hours they’d be overwhelmed.
Emergency Department doctor Sarah Whitelaw at the Royal Melbourne Hospital.Credit:Simon Schluter
Anecdotes from friends and work colleagues in Britain and the United States had been particularly confronting.
“These people that are, like us, they’re used to dealing with invisible enemies and disease,” she says. “They’re used to dealing with overwhelming acuity in the emergency department.”
She’s seen and heard them “broken” by what they’ve had to do, and decisions they’ve had to make “in terms of not being able to give people treatment that might have saved their life”.
“So rather than a fear of the virus itself, I think it was a fear of not being prepared enough to allow us to do what we know we can do.”
Two months ago, that fear and anxiety was overwhelming.
“To have got to the stage now where we don’t feel that [anxiety] every single minute of every single day is something that I think all of us will be forever grateful to the Victorian community for,” she says.
But she has faced a lot during this time. Her “most awful experience” has been sending family members home who had either a very sick loved one in hospital or loved ones who died in the emergency department due to the current restrictions.
“It is very difficult,” she says.
During the lockdown Whitelaw has also buried her uncle, with the funeral streamed online due to the 10-person restriction. She said it’s the closest she has come to someone sick in hospital and impacted by the restrictions.
“It is really tough and horrible, no matter how much you know of the importance and reasons for that, that’s been really tough,” she says.
GP and HealthMint Medical Centre clinical director
When a Toorak Clinic doctor tested positive to coronavirus in March, after having consulted about 70 patients, it was a wake-up call for Dr Paul Tescher. So he made a drastic change.
“We could see from that potentially any doctor in Australia could be testing positive and potentially expose patients or be exposed from patients,” he says.
“Almost overnight we transitioned from seeing almost every patient face-to-face to nine out of 10 appointments through telehealth.”
There was no blueprint for that switch, so HealthMint Medical Centre directors had to figure out what technology platforms to use, how to change workflows and – with no official funding model – patients were paying out of pocket.
“And even now, the rebates haven’t really reflected what we deliver in terms of telehealth, and the government keeps changing the restrictions.
“It’s definitely been stressful and scary,” he says, particularly in the early stages of the last month.
Dr Paul Tescher.Credit:Simon Schluter
It culminated in a spiral of fears: “How do we cope with this? What if our hospital systems are overwhelmed? What will that mean for us in general practice? How do we cope if we don’t have the personal protective equipment that we know we need?”
Tescher said there had been uncertainty about how much PPE they needed and what type. “We’d been told that ideally we’d be having full, you know, N95 face mask and gown and goggles and everything else,” he says.
But with limited availability, not only from government supply but private stock, every GP and medical professional in Australia was facing the same predicament.
“There’s only so much to go around … I was seeing stories online of my colleagues trying to make their own masks and goggles and visors, because there was simply nothing available in the market.”
Scared that his or his wife’s family could catch the virus, he decided to cut close physical contact with them before official restrictions were even in place.
“Because we could have the virus and not know it, we might not have symptoms … [it would] be terrifying to think that I could get one of my close family sick and they could even die from something like that,” he said.
Fear of catching COVID-19 has also stopped people from seeking treatment for other ailments.
“What we’ve found is a combination of people are very frightened, uncertain, so they’re putting off their health needs,” he says.
“If you’ve got chronic health issues, or if you’ve got symptoms that you’ve been sort of putting to the side, the longer you leave it the worse things can get.”
He warns against complacency as Victorian social-distancing restrictions are eased.
“Unless it’s zero cases, there’s always the chance that it can come back.”
Midwife, Angliss Hospital
Midwife Leah Middleton and her two children Kai and Kora. Credit:Eddie Jim
Most women don’t ever imagine giving birth during a pandemic. But for those who do at Melbourne’s Angliss Hospital, Leah Middleton is one of the midwives there to guide them through it.
As a single mum-of-two, she has had to juggle the workload with COVID-induced home schooling. Mindfulness tags on her work lanyard help keep stress at bay.
The World Health Organisation has designated 2020 the International Year of the Nurse and the Midwife, to recognise their vital role in meeting essential health needs and the need for 9 million more nurses and midwives to achieve universal health coverage by 2030.
With a host of changes to policies, including how many people are allowed to be with a mother during birth, Middleton says some families are “mourning” the experience they had expected.
“They never expected to be in the situation. And so what they envisioned it to be is a little bit different.”
Pandemic restrictions have meant one support person is allowed in the birthing suite and partners can’t stay in postnatal wards overnight.
The restrictions have meant doulas may miss out or siblings may not be able to visit their mother or their new brother or sister if they need to stay in intensive care.
“In the birthing room or culturally, some families have the birth room filled with family members, that’s their support system, and they were unable to have that.”
But being a frontline healthcare worker doesn’t mean she is more concerned about catching it.
“I am as concerned when I’m at work as I am when I go to, say [the supermarket] and you know, touch all the things in the shops,” she says.
Senior Clinical Nurse Consultant, Infection Prevention
Daniela Karanfilovska keeps having to remind herself that getting through the pandemic is a marathon, not a sprint.
The specialist does everything from contact tracing to education and guidelines on prevention practices around infectious diseases.
Infection prevention nurse Daniela Karanfilovska at The Alfred hospital.Credit:Eddie Jim
“The clinical work that we do on healthcare workers is often hands-on and can’t be done at a distance, [as healthcare facilitators] we are particularly vulnerable due to the type of work that we do,” she said.
One of the biggest challenges for her is how all-consuming work and knowledge of the virus is.
“It’s actually really hard to step away from it,” she says.
She now relies on work-related communication to inform her of things she needs to know and tries to relax by doing quiet things like reading.
“It has been really hard maintaining some semblance of a healthy distance to recuperate. And I think personally that’s been very difficult for us as a team. Because even though infection prevention is our bread and butter … applying it at this kind of level has been really challenging. I think what I found the hardest is just trying to keep our staff and our patients feeling safe.”
Karanfilovska actually feels most at risk in her personal life.
“I actually feel really safe when at work. When it’s outside of work things are a little bit more out of control,” she says.
The special shopping hours for healthcare workers at the supermarket made her feel more at ease, having to navigate fewer people.
“I feel really good to be honest to say that we did this very early on. We put a lot of big changes and recommendations and processes into action very quickly,” she says.
“So I feel like we were prepared and worked really, really well together as a team to get that done and get the support we needed to do that.”
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