Inside Our Partner Hospitals during the COVID-19 Pandemic

Some hospitals fight COVID-19 by treating patients directly. Others don’t have COVID-19 patients but have to cope with the challenges that arose from the pandemic. The most common concerns we hear from our partners are providing timely access to care for children and also the morale of health care workers on their team

Photo by Scott Streble

 

“Trying to find ways to operate more”

Due to COVID-19, most hospitals are providing only emergency surgeries, and waiting lists have ballooned.

“Because of the social distancing due to the pandemic, we perform emergency surgeries only. Our waiting list is longer than usual. We try to find out how to operate more cases,” says Dr. Do Thi Cam Giang, a pediatric cardiologist from Nhi Dong 1 in Ho Chi Minh City, Vietnam.

“My hospital doesn’t have a separate block for COVID-19 patients. According to government regulations, we are not allowed to admit any COVID-19 patients,” says Dr. Raju Vijayakumar from India, a pediatric cardiac surgeon at GKNM in Coimbatore. “Our children, often newborns, come from various parts of the state. They have to travel far, up to 250 miles. So when they come, it’s difficult for me to say ‘no.’ We don’t know their COVID status. We must admit them in the area separate from the regular unit and wait for the COVID-19 results. I have a child who is sick and intubated, but because of these guidelines, I have to wait for the test results. That puts a lot of stress on me. So far, we’ve operated on about 20 children during the lockdown, and all of them were COVID-19 negative.”

Several hospitals, including his, are resuming elective surgeries. They expect to slowly ramp up the number of surgeries in the next weeks and months.

Patient access and communication

For many partners, communication among their teams and patients is a challenge. 

“Some families don’t have cell phones. They don’t have a way to communicate with us, and we don’t know if they are safe or not. I think this is the main problem we are facing now,” says Brazilian pediatric cardiologist Dr. Klebia Castello Braco from Hospital de Messejana in Fortaleza. She added that all the hospitals in her area will be filled with COVID-19 patients in a couple of weeks. She hopes that patients in pediatric cardiac services will stay safe and not get infected with the virus.

Dr. Mahesh Kappanayil, a pediatric cardiologist from Amrita Institute of Medical Sciences (AIMS) in the Indian state of Kerala says: “Patients have found it very difficult to reach us. It’s something that is out of their control as well as out of our control because of the many restrictions on travel. Even patients that really needed to access this care were unable to. At least three of my own patients faced these challenges and couldn’t get to the hospital on time. We try to give them some telemedicine consultation, but we are painfully aware that despite all of this, there are a lot of families who would benefit from being able to come and show their babies to us. This is a social tragedy, and it will be impossible to estimate the real magnitude of that.”

However, technologies also opened up educational opportunities to others, and medical teams are becoming more comfortable using these technologies.

Pediatric cardiac nurse and educator Bruna Cury from Hospital da Criança e Maternidade (HCM), Brazil, says that her team reinvented the way they work by using more technology. “Even daily visits in the ICU we do via FaceTime or Zoom, which brings us together at the bedside. We’ve also been sharing educational information we receive with other hospitals in Brazil, especially the ones that refer patients to our hospital. They have a lack of educational opportunities, and now they have been benefiting a lot from this training.”

As safe as possible 

While some hospitals have adequate access to personal protective equipment (PPE), some have PPE and ventilator challenges.

“So far, we have at our hospital about 20 cases that are confirmed and about 20 suspected cases, but in our town we have a lot of cases. We know that we will have challenges related to protective equipment and ventilators so we are trying to get prepared as best we can,” says Cury from HCM in São José do Rio Preto.

Some partners have instituted special staff accommodations and specific shifts to reduce the risks of infection.

Dr. Riyan Shetty, a pediatric cardiac intensivist from Narayana Hrudayalaya Institute of Cardiac Sciences in Bangalore, India, says that his hospital is in a preventive mode. “However, we want to be as safe as possible, and we want to protect our nurses. Now, nurses come for seven days for 12-hour shifts, so they do all the hours for two weeks in one week. Then they quarantine themselves at the hotel for another week before going back to work.”

Protocols around testing and isolation of COVID-19 patients have been a priority. But an additional concern among partners is the morale of the staff.

Cardiac surgeon Dr. Debasis Das from Narayana Superspecialty Hospital, Howrah, India: “Our state has designated hospitals for COVID-19 patients. However, the emergency rooms are open for all the patients. The biggest challenge we faced was infecting our health care workers. That affected their confidence and put a question to all the safety protocols we were following. When we went through our protocols, we found out that we had never had a shortage of PPE in our facilities, but not all people went through PPE training properly.”

Thinking outside the box

Our Indian partners from AIMS anticipated that they might run out of PPE because the supply chain was impacted due to the pandemic. They decided to think outside the box and create their own protective equipment. Dr. Mahesh participates in this project, using 3D technology at the hospital’s in-house lab.

“Our hospital has worked closely with Amrita University that has an engineering college, a management school, and a medical school. So it was unprecedented when people came together with different backgrounds and specialties. We put our heads together – engineers, planners and medical professionals – to innovate and rise to the challenge. We buy material appropriate for PPE and make our own equipment.”

Now, AIMS and its partners create up to 200-300 low-cost face shields every day. They also innovate on face masks and intubation boxes that significantly increase safety for the doctors. “We create new PPE designs and make them available for many health workers. We share these innovations on social media and other platforms so that more and more people can use it,” says Dr. Mahesh

“It has been incredibly inspiring to hear about the innovations and hard work of our partners in the face of some very serious challenges,” says Children’s HeartLink Vice President of Programs and Evaluation Anne Betzner. “We would like to continue connecting with each other to find solutions and assist in any way we can.”

COVID-19 Resources