Operations Co-ordinator Daniella Ritzau-Reid reports from Lebanon
It is 8:30am and the nurses in Baabda government hospital’s coronavirus intensive care unit (ICU) in Lebanon are starting their morning round. All 12 beds are full, and two people are intubated for breathing support.
The mood among the ICU team is mixed: one patient is gradually showing improvements, but another sadly passed away during the night.
In the ‘clean’ area outside the ICU, UK EMT nurse Katy Drillsma-Millgrom is also donning personal protective equipment (PPE). She will accompany the Lebanese nurses on their shift, providing coaching and guidance on the specialist care needed by critically ill COVID-19 patients.
Tackling a deadly new disease
Lebanon is battling multiple overlapping disasters. A long-term financial crisis has crippled the country’s economy. In August 2020, an explosion devastated the Port of Beirut. And now, surging numbers of coronavirus cases are overwhelming an already fragile healthcare system.
Hospitals are struggling to cope. There are not enough nurses and doctors, and shortages in essential medical supplies are widespread.
Under these circumstances, training hospital staff in how to care for COVID-19 patients is not simple.
“As a completely new infectious disease, there are many new topics that staff need to be trained on, as well as many new global protocols and clinical guidelines” says Jihane Abi Chacra, Baabda hospital’s staff development coordinator.
“Things are changing so quickly – we might receive one protocol, and the next day it has already changed!”
Teaching and learning on the job
In addition, staffing gaps mean that wards and ICUs are frequently stretched beyond capacity, and it can be difficult to find time for education.
That’s why the UK Emergency Medical Team (UK EMT) is supporting the six government hospitals across Lebanon with a blended learning approach. This combines hands-on practical teaching through coaching and simulation exercises with more theoretical training such as case reviews, presentations and webinars.
“We wouldn’t achieve much by just sitting people in a room and giving them lectures on managing COVID-19,” explains Katy.
“Clinical coaching means we create a safe environment for staff to practice new techniques and ask for guidance. We’re in the hospitals every day, which gives consistency and helps embed the learning, to ensure people feel empowered to provide this care once we’ve gone.”
Building confidence, improving care
Patient positioning is an important element of COVID-19 hospital care, and it’s a technique we’re supporting hospitals to use more frequently.
“The clinical personnel were not familiar with positioning and proning techniques and thought it was unsafe to prone a patient with breathing difficulties” says Mrs Abi Chacra.
“However, the UK EMT team provided teaching and demonstrated how to prone properly, and we were able to see how patients improved. Now our nurses have the confidence to practice it themselves and they are proning patients regularly.”
Achievements like these are important, as they help to improve patient care and staff confidence in caring for people who are critically ill with coronavirus.
A heavy toll on health workers
The situation in Lebanon is unlikely to improve soon. Despite a recently-imposed strict national lockdown, infection rates remain high and over 90% of ICU beds are full.
Months of tackling COVID-19 is exacting a heavy toll on Lebanon’s frontliners. “It’s been six months since I’ve seen my family” says Baabda ICU nurse Sajed Al Moussawi.
“I moved out of my home and am staying in a rented place to keep them safe, because I am exposed to COVID-19 in my work. It is very hard. I often feel depressed.”
UK EMT staff have faced similar experiences tackling COVID-19 in their home countries. As a result, their presence in Lebanon can also offer fellow medics a sense of solidarity and a morale boost.
Putting a smile on someone’s face
In Baabda’s ICU, after finishing the morning rounds, Katy returns to the nursing station to take off her PPE and prepare a personal gesture for the ICU team. She has brought a bag of manoukshe, traditional Lebanese breakfast bread, for everyone to share.
“We bring breakfast on every visit” she explains. “It’s is important to people here; it’s that moment when the staff can sit together and prepare themselves for the rest of the day.”
“I do it because I know what it’s like to come off a long ICU shift. That feeling of being exhausted and overwhelmed, when you just have a constant influx of patients who are sick and dying.
“So if I can help bring a smile to one person’s face, then that’s also a success. At the end of the day, we’re all in this together, all frontline workers, everywhere in the world.”
We’ve been working in the UK and around the world to respond to COVID-19. To read more about the work that UK-Med have been doing, visit our COVID-19 response page.