Reflecting on the Papua New Guinea response

Critical care nurse Christina was one of ten UK-Med members who flew to Papua New Guinea in October 2021 as part of an eight-week response on behalf of the UK Emergency Medical Team to help fight a second surge of COVID-19 cases across the country.

Delivering direct medical care to patients and supporting the hospital teams with much needed training, Christina reflects on why for her this was such a worthwhile response: 

A full and overwhelmed hospital

“Surrounded by mountains and set in lush green grounds with vibrantly coloured flowers in soil beds, we arrived at Mount Hagen Hospital in the Western Highlands to support staff who had been overwhelmed by the recent surge.

The hospital wards were full and multiple overflows had been created to cater for the sharp increase in patients including the Multidrug-Resistant Tuberculosis (MDR TB) ward and a rundown building which housed the COVID-19 Intensive Care Unit (ICU).

From the very beginning, we saw the depth of the challenges the staff on the COVID-19 wards faced. As a critical care nurse, I usually deliver a wide range of therapies for COVID-19, however, in Mount Hagen Hospital, the range of treatments available at that time was limited to steroids and oxygen via a face mask.

Proning – a simple and widely used technique integral to the treatment of patients with coronavirus – is not always commonly understood or practised in some parts of the world. The staff at Mount Hagen Hospital had not used it before so, it was little wonder that trying to solve the problems in front of them must at times have felt entirely futile.

On our ward rounds, we immediately set to work showing the staff how turning the patients onto their stomachs (proning) could improve blood oxygen levels and the importance of checking those levels on a regular basis.

After a number of days of information gathering, learning hospital processes, and talking to Mount Hagen staff, we felt that the best thing we could do was to help train the staff in how to manage their own safety and to improve the clinical care they were delivering to patients.

I worked closely with Sister Margaret who was a senior nurse in charge of the acute COVID-19 wards and ICU. She described the many challenges, including a lack of training and not having enough staff to cope with the volume of patients. Working alongside Margaret as she oversaw the frantically busy clinical areas helped us to shape our response.

Darren and Eric outside Mt Hagen hospital.

An opportunity for training and empowering staff

We began to devise a training programme which would teach all staff the fundamentals of COVID-19 infection before each staff group then had additional training in areas relevant to their specific role.

Sophia, our Emergency Department nurse, suggested the use of a more advanced observation tool known as an ‘Early Warning Score’ (EWS) to help with the assessment of sick patients and the escalation of their care. This is particularly critical for COVID patients as often they can appear to be reasonably well, even sitting up and managing conversations, whilst in reality, their clinical picture is poor.

With the support of our greatest allies; Jolly, a midwife and educator, and Lucy her Deputy, our team trained around 200 staff in three weeks. For many it was their first formal training in the transmission and management of COVID-19. We also worked with IPC (infection prevention and control) to improve the donning and doffing areas so these high-risk moments where clinicians change in and out of their PPE were safer for staff.

We helped to develop existing clinical guidelines in line with WHO standards, and the process of Nurse Management was adopted to support ‘named nursing’ – so each nurse would now be responsible for their own group of patients.

As a result of the training, we noticed a marked improvement in not only the clinical practice, but also in the motivation and pride that nursing staff took in the care they delivered.

Eshime, a community health worker in the wards spoke to me about how much the ‘Early Warning Score’ was helping her and how it had given her confidence to make decisions about when to conduct more observations. This sentiment was echoed by a number of nurses from the hospital, who added that proning, EWS and clearer lines of communication with their doctors meant that they now had more options on how to assess and treat patients. And most importantly, they could now better influence their patients’ outcomes.

Christina discussing a patient on the COVID-19 ICU.
Eric conducting a chest physiotherapy session with Nurses in the isolation ward.

The joy of patients going home

If I am left with any particular feeling about this response, it’s that teaching and sharing skills is the foundation of strong health care practices. And I can confidently say that the nurses, doctors and other staff we have worked with have all been given the opportunity to develop their clinical practice significantly.

Before I left, Carol, the nursing lead for COVID-19 told me: ‘We don’t have the privilege of going to other countries to learn but you came here so we could learn from you and we will continue using these things you have taught us’.

On the ward, when a patient’s bed was vacated, the nurses cleaned the mattress and folded it up into a V shape. Barry, a former headmaster who had previously taught many of the nurses who cared for him, had been a very unwell patient since before our arrival in early October.

As Dr Darren (the Emergency Department consultant who had overseen so much of Barry’s care) and I were leaving, Barry said to us, ‘We’ve had a lot of deaths here. Before you came, they were folding mattresses because people were dying. Now, they fold mattresses because they are going home’.”

Christina and Darren bidding farewell to Barry as they left Papua New Guinea. Shortly after, Barry finished his recovery and was able to return home for Christmas.

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