The UK Emergency Medical Team is in Beirut at the request of the Lebanese Government after the massive explosion at Beirut Port which killed more than 200 people and left 6000 injured on August 4th.
After an initial health needs assessment, it became clear the Lebanese medical sector had dealt with the majority of trauma injuries caused by the blast and that the main priority was to respond the rising numbers of COVID-19 cases.
The UK EMT team, made up initially of 11 UK-Med members and one member of staff from Humanity & Inclusion are in Beirut for three months until mid November.
Meet Team Lead and medical doctor Ram Vadi and nurses Harriet Walton and John Irvine:
Your role at home and now in Lebanon?
‘I’m an emergency department charge nurse working in a London hospital. I’ve been working on the COVID-19 response since the start of the pandemic.
I’m an infection prevention control (IPC) nurse with the UK EMT in Lebanon.
Initially, I helped carry out a health-based assessment for the hospital we’re supporting, focusing on areas highlighted by the WHO as key for the COVID-19 response.’
First impressions of Beirut?
‘We arrived 17 days after the blast. The initial role of the UK EMT had changed from responding to the blast to a COVID-19 response. My first impression to both Saida and Baabda hospitals was how welcoming the staff were.
But there was so much fear and mis-information being spread. I can understand. You’ve seen other countries struggle with COVID-19 for the past nine months and are scared about what could happen in your own country.’
Experiences working with local team members and how they’re adapting to manage the COVID-19 surge?
‘The staff in Saida and Baabda hospitals are keen to learn from our experience of the pandemic back home. Hospital staff have been quick to allocate separate areas for COVID-19 and non-COVID-19 patients, and have looked at the flow of patients to minimise cross infection.
Both hospitals have truly embraced us into their teams, and it’s been great learning from each other. Staff are anxious as to what is to come in the months ahead, as flu season begins in October.’
How does this compare to managing COVID-19 in the UK?
‘This is different. At home I have a clinical role with the NHS.
I’ve had similar IPC nurse roles in Cambodia and Beirut; providing training and hospital assessments to help hospital staff stay safe and follow WHO IPC practices.
Here in Lebanon, I’ve trained staff in PPE donning and doffing. Both in Lebanon and Cambodia I’ve found staff feel more protected if they put on lots of PPE, such as two gowns or two masks.
We’ve been trying to alleviate staff fears and discuss the rational use of PPE as it’s still in short supply.
The fear of COVID is the same in Lebanon, Cambodia and the UK.
There’s so much to learn about this virus as it’s still relatively young in the world. But we continue to give the very best care possible and to help all of our colleagues remain safe.’
Your role at home and now in Beirut?
In the UK I work in central Scotland as a critical care nurse in intensive care (ICU) and as an anaesthetic assistant in theatres.
Now in Beirut, I am part of the UK-EMTs ICU team consisting of three ICU nurses and an A&E/ICU Doctor. Our role is to support the local staff in their response to COVID-19, by providing training advice and clinical coaching.
When I go back to the UK, after my quarantine period, I will go straight back to caring for COVID patients in ICU.
First impressions of Beirut when you arrived?
‘I landed at 03:00hrs. My first impressions were that the local people were friendly, full of character and it was hot.’
How are you finding working with local team members and how are they adapting to manage the COVID-19 surge?
Everyone in the local teams I have met and worked with have been very friendly and welcoming.
There is a mixture of skills and knowledge but generally they have had good training but are limited by the availability of equipment and staffing numbers. I came out halfway through the first team’s deployment and they had done an excellent job building relationships with the local staff.
Some hospital staff have refused to work with COVID patients, leaving the staff working on the COVID wards with a greater workload.’
‘One of the biggest challenges has been trying to plan and implement best practices with limited resources and poor staffing levels.
The Lebanese government hospitals that we have visited have all been short staffed, some staff are working six days a week and not had a break for months, some have not been paid recently, yet they still come into work.
Due to Lebanon’s economic crisis and the subsequent fall in currency value some specialist equipment, for example video laryngoscopes are now unaffordable to the hospitals.
Labs are starting to struggle to get reagents to carry out routine tests.’
How does this compare to managing COVID-19 in the UK?
‘The NHS is a well-resourced organisation. It is easy to take for granted that when working in the UK. If we need equipment or medicine, it is there. Or if we require blood tests for a patient, they will be done in a timely manner. We also expect there to be enough staffing for patient safety.’
Any stand out moments?
‘One memorable moment was the first time that I persuaded the ICU nursing staff to prone (to lay face downwards) an awake COVID patient.
We had previously delivered training explaining the benefits of proning patients, however, there seems to be a culture of “bed rest” in the hospitals.
The patient was breathing on their own but needing a very high level of oxygen, the oxygen monitor was showing the amount of oxygen in his body was at dangerously low levels.
Initially the staff were hesitant to move the patient, saying that he’d been like this for days and was “stable”.
Once we got the patient positioning in prone (lying on his front), an intervention that has proven beneficial in the management of COVID-19, the patient’s oxygen levels dramatically improved – returning to safe levels and the patient could speak to us and said he felt much better.
I think the staff didn’t believe that there was any point in moving the patient, so to see such a sudden improvement was a good practical demonstration of how a simple intervention can be effective.
I think that the staff witnessing incidents like this will lead to other patients being proned and as a result hopefully less patients needing to be put on ventilators, which carries high risks of a secondary complication.