Recognising the role of Nurses and Midwives amidst COVID-19, May Day.

In this article, you will read about some of the roles nurses and midwives have played so far in the fight against COVID-19, some challenges we’ve had to face, effects these challenges have had on some nurses and midwives and what we expect of the government to make our work safer and easier in Ghana.

Introduction

The Ghanaian Nurse and Midwife did make a substantial contribution during the outbreak of the COVID-19 pandemic. It is of no doubt that through the extra care, ever diverse work schedules, critical observations, extra vigilance and monitoring coupled with personal needs such as illnesses and family responsibility, the backbone of healthcare in Ghana has managed to hold the frame till now. The struggle of nurses and midwives in Ghana pertaining to the Covid-19 public health emergency began from the very start or emergence of the disease partially due to unpreparedness and unavailability of resources. Do you remember how expensive it was to afford face masks and sanitizers? It even got to a time when some people sold a 300mls sanitizer for over GH¢ 100 and a box of disposable face masks for GH¢ 250. Even though these resources were scares and working without them carried a huge risk, Nurses and Midwives continued to work. Speaking of struggles or challenges, there has been and will be a lot unless someone does something about it. So why don’t we consider a few in the next paragraphs?

Challenges

Before we delve into the challenges caused by the pandemic, I’ll first give an overview of the health system even before the pandemic started.

When you hear Health Care Workers (HCW) complain about lack of resources, how do you perceive it? Do you feel they are just ranting or they probably are just not content with what they get? Well, that’s not the situation at all. At certain times, it is understandable for a nurse or midwife to improvise (to make use of whatever that is available when the right device or resource for the job is not available) especially in dare situations. As a matter of fact, a nurse or midwife who can’t improvise where necessary may find themselves wanting. However, the situation in Ghana has made improvising a constant, and that is very wrong.

To cite my first example, I first saw a tourniquet (a device that is used to apply pressure to a limb or extremity in order to limit – but not stop – the flow of blood. Under normal circumstances, it is used to pass intravenous catheters also called cannula. Here, I mean the real one) when I was in my second year of training. It wasn’t my first time on the ward, I had already completed at least 3 clinical attachments in different government hospitals but in all those attachments, parts of given sets (the tube used to pass infusions) were used to improvise for tourniquets and it felt as though it were normal because that seemed to have been going on for a long time.

A second example is the availability and use of Personal Protective Equipment (PPE) even before COVID-19. PPE entails about 5 different equipment e.g. Face mask, apron, gown, gloves, boots, head cap, goggles, face shield e.t.c. The kind of PPE to be used depends on the sort of procedure to be performed but all PPE are important. The most used PPE however is the gloves. The type of glove used in performing a procedure depends heavily on the type of procedure. For example, using a disposable glove to setup an intravenous catheter is very wrong since it is an invasive procedure which involves the blood stream directly. Hence, the least contamination can lead to phlebitis (an inflammation of the walls of the vein) and subsequently septicaemia (blood poisoning or infection of it). Yet, what do we see in Ghana?

Even before COVID-19, gloves were in inadequate supply as compared to demand. On the ward, it is now a norm to pass a line (intravenous cannula) using disposable gloves. What makes the matter worse off is the fact that some nurses and midwives are compelled to use a single pair of gloves to perform procedures on multiple clients or even perform infectious procedures with bare hands because the resource is simply unavailable. This puts both the HCW and the Patient at risk of infection.

This issue of gloves is so serious that most facilities force student nurses and midwives into purchasing gloves stating that “Students waste gloves” when all they really do is practice the aseptic nursing thought in the various schools.

A third example is when I was asked (as a student nurse) to immerse a disposable nasal catheter (a tube inserted into the nose for procedures, oxygen administration, or monitoring purposes) into a de-contaminant to make it reusable. When I asked for a reason, the answer was that 'the ideal thing is to dispose it off and use a new one on another patient but it was scarce' and it actually was. The ward had two at the time which they recycled. The three examples cited here are just to mention a few to give you an insight on the situation of Ghana’s health system even before the COVID-19 pandemic. It’s been years now but everything mentioned here is still ongoing. How sad!

            In 2020, the global pandemic arrived in Ghana and as if to serve as a check – demanding accountability, even the politician could not travel abroad to seek health care (their usual gig) so we were all left to lie on the bed we’ve made over the decades. It’s actually interesting how some of them have complained bitterly about our health system forgetting they are the hugest contributing factor to the bad system we are running currently. Anyways, at the outskirts of this article I mentioned how expensive some products that were needed for protection against COVID-19 were. By then, I was employed in a private hospital. The owner of the hospital informed us about the cost of PPE and sanitizer and also said he wouldn’t be able to afford them so simply put, we were to risk it or leave. I for one, chose the latter and peacefully resigned.

However, I noticed that despite the trying times, nurses and midwives in the public sector kept on working, regardless. The enthusiasm and effort they used to serve the country during the outbreak of a disease that wasn’t fully understood deserves recognition. We’ve already discussed just a few of the problems nurses and midwives faced on the ward. Those problems were with us, and more arose when the pandemic hit Ghana.

The challenge second to lack of protection against the virus was stigmatization. It was horrifying to see people shun Nurses and Midwives especially when they saw them in uniform because of fear of infection. Imagine how the HCW would feel after risking their life to save others only to be treated like the virus itself. Nevertheless, Nurses and Midwives kept serving the country amidst the outbreak of a disease that wasn’t fully understood.

Thirdly, after all the risk nurses and midwives together with their families had to take, many Ghanaians simply refused to observe the COVID-19 protocols therefore increasing the risk at home as well. In most settlements, nurses and midwives live in compound houses with a single main gate where everyone enters and exits. These caused infection among HCW especially Nurses and Midwives. Some of them ended up in Intensive Care Units (ICUs) just because another person refused to observe the protocols. At this point, it is worth noting that we also lost some of our colleagues to the virus just because someone else refused to provide them with the adequate supply of PPE and another man refused to observe the COVID-19 protocols.

The fourth challenge is the duration of exposure to patients due to inadequate staffing in some facilities. As we speak, there is a chunk of qualified nurses and midwives who are unemployed dating as far back as 2018 while some nurses and midwives are overwhelmed due to the poor patient-nurse ratio. Concerning this, only the government has the power to fix. Hence, we entreat the government to employ more staff into the health sector because even machines do breakdown when overworked.

Another challenge noticed is the unnecessary wait on salary imposed on newly posted nurses and midwives. Nurses and midwives purchase face masks and personal sanitizers hence newly posted nurses and midwives who doesn’t even have appointment letters after working for over 5 months talk less of expecting a salary just keep risking their precious lives for an agency that care less. This carefree lifestyle has got to cease. At least not when we are under such a severe attack.

Well, yet another challenge is having to accept the COVID-19 vaccine and vaccinating to help the public realize that it’s safe when HCW (with majority being nurses and midwives) did not even know what the long term effects could be. There were so many theories about the vaccine but nurses and midwives took a bold step to vaccinate just to assure the rest of the population that they could trust the government. This is a decision that deserves recognition. We've mentioned a few of the numerous challenges nurses and midwives face but just as mentioned earlier, the backbone still holds the frame and this is because they expertly handle their roles even though working conditions aren't so good.

Role

Nurses have been used in vital areas throughout the fight against COVID-19. The distinct triaging system began when COVID-19 broke out and guess who was assigned to the area, Nurses! It could have been consultants since they are trained to detect and diagnose diseases but the mantle was assigned to nurses. This means, they are the first point of contact to anyone who visits the hospital be it COVID-19 positive or negative and they are expected to interact with the patient in an effort to separate potential covid-19 cases from other patients thereby preventing further spread of the virus.

It is also nurses who care for potential COVID-19 cases who are detained at the isolation centers and when the test proves positive, the client is moved to the treatment center where nurses continue the care. Mr. Obiri Addo Isaac of UPNMG summarizes the care of COVID-19 patients and other surrounding circumstances in his write up “CELEBRATING the nurse, the HERO/HEROIN of our time” – 1st May, 2021 thus (in paraphrase);

  • The nurse feeds, baths and grooms the COVID-19 patient when every other profession step back.
  • The nurse serves them 'potty' and keeps them clean when they are done while others watch in awe.
  • The critical care nurse takes care of the COVID-19 patient when the patient is at his lowest point of health.
  • The community and public health nurses boldly contact trace them when others are weary and tired, even when the government backs down on its promises to cater for them. These were the same nurses who were ‘called on’ to vaccinate the whole nation including the politicians. They do their work with passion.
  • It is the nurse who selflessly and patiently takes data from COVID-19 patients, both demographic and biological, collate the data, and report findings to researchers but never get the acknowledgement.
  • However, the public regard nurses as disrespectful but they welcomes COVID-19 patients with the warmest smiles and gives hope to these patients, when the family fear and cannot draw closer.
The exposure to the disease, prolonged use of PPE especially face mask and the constant use of chemicals for disinfection poses a serious threat to the nurse but most of these nurses did not even fall into the criteria used to determine frontline health workers. You may be surprised that some administrative staffs who just get to work in their fancy cars, walk into their offices and stay there all day with less than 25% workplace risk qualified to take that package.

Nurses and midwives never forgot their role of being observing or attentive to other disease conditions such as cerebrospinal meningitis, cholera, and malaria which could have surged as well if left unchecked. We can confidently state that without nurses and midwives in the fight against COVID-19, it would have been impossible. This is why their effort and role in the fight against the public health emergency deserves recognition.

Assistance

As we get to the end of this article, it’s best to recognize the assistance and efforts of the government and other institutions that has aided nurses and midwives in their work.

In an effort to strengthen the work force of the country, the government has been able to post 1 and a half year group of nurses and midwives since their previous tenure of office. This is the 2017 and a part of the 2018 year groups of nurses and midwives. More human resource on the job means less exposure duration since the staff are able to rotate or run shifts.

The government together with some NGOs and other institutions donated PPE, veronica buckets, sanitizers, soap and other essential products to the health sector which was of great importance. These products aided in diminishing the risk of infection to an extent. Some hospitals such as Sene District Hospital, began to manufacture sanitizers to help protect their staff and that was a wonderful move.

Policies such as the tax waiver added some amount to the take home salary of nurses and midwives providing an avenue to afford some protective equipment such as masks and sanitizers. In this regard, the government went to the extent of extending the policy till the end of 2020 upon written request by the Union of Professional Nurse and Midwives, Ghana (UPNMG).

            It is of no doubt that majority were confused as to how to handle the virus at the early stages, especially when bad news of the enormous lives the virus claimed hit the atmosphere, but due to the courage, enthusiasm, dedication and perseverance of the health team and leadership, we have come this far. Speaking of leadership, an association that played a critical role in ensuring the well-being of nurses and midwives was a priority is the aforementioned UPNMG. Quite apart from the request to the government to extend the tax waiver, they made provision to insure the lives of nurses and midwives who decided to join the union. This insurance package came with no extra cost to the members but has effectively paid and continues to pay money to affected nurses and midwives while acting as an intermediary to process claims to the life insurance. The numerous testimonies of the package attests to the fact that it was of great help. The interesting part is, the policy is meant to last forever. Furthermore, donations were made by UPNMG to War memorial hospital, Komfo Anokye Teaching Hospital, and Tamale Teaching Hospital when the fight was intense. This evidently helped the benefiting hospitals and the nation as a whole in the fight against the virus in Ghana.

Conclusion

Did we learn any lessons from the attack? There is likely going to be another pandemic in the future because these things usually happen. How prepared are we to face it? Nurses and Midwives are ever ready to apply their training in the best way possible by giving the care, advocating for, and educating the patient, but don’t expect even the best carpenter to perfectly roof a house using a knife. We need the required resources, protection and motivation to be able to function fully.

There will always be good hearted institutions such as the UPNMG who will have the interest of nurses and midwives at heart, going as far as listening and assisting individual nurses and midwives but the government as the employer, the Ministry of Health and the Ghana Health Service (GHS) as an agency, has a critical role to play. It is about time the unnecessary delay of salaries stopped. Empower the newly posted nurse or midwife by handing a proof of employment (the appointment letter) to them even before their first day at work. The GHS should learn from the Ghana Education Service (GES) in this regard, it is very possible because the GES isn’t lazy when it comes to giving out appointment letters. It is worth noting that Nursing and Midwifery is a risky profession hence any member of this fraternity who incurs an occupational hazard, will need someone to reach out to but if you’ve been working for over 5 months without an appointment letter in a health crises, then who really is your appointer and in times of trouble, who do you reach out to?

What can the government do to make the work and lives of nurses and midwives easier and more enjoyable?

We’ve already talked about logistics in this article. Your job is to provide them, so do it with pride. Also, a happy employee boosts productivity. This is why we need better condition of service, but please remember that the nature of this profession is practical so don’t keep our young nurses and midwives at home until they have forgotten most of the practical work. As an example, the 2017 year groups of nurses were left unemployed for 3 years even though you promised immediate employment. Going forward, we expect these, integrity, truthfulness and many more from you because that is the only way we can overcome the never ending threats to health.

Indeed, We praise you Nurses and Midwives. You have proved once again that you are really the titans of Health Care. What do we call someone who lay down their lives to save that of others? Dear reader, please find the term out. We say 'Thank You So Much' for all the effort and sacrifices. We celebrate you today and forever.

Ladies and Gentlemen, this is tellitnurse.com and this was our MAY DAY message to congratulate the TITANS of Health Care!

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