The Bhutanese Leading the way.
A Bolero vehicle with an assigned driver waits outside a hotel to pick up the health workers bound for the isolation ward in the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH). The health workers reach the hospital and start donning their Personal Protection Equipment (PPE), which takes around 20 to 30 minutes. Once fully donned with PPE, they are not supposed to touch anything, especially the face. The daily checkup routine then starts.
A medical doctor at JDWNRH, Dr Chezang Dorji, said once they are ready to get inside isolation ward, it becomes really stressful since the isolation ward is a contaminated area.
He said the current medical team attending to the COVID-19 patients now is the seventh batch. He said a new team with different set of doctors and nurses replaces the team that has worked for 2 weeks at the isolation ward. The old team then is put under quarantine for two weeks.
At 9 am, the doctor along with nurses go for the morning round and talk to the patients individually in the room. “We discuss about their problems which are all those medical and mental aspects. If they need any counseling, we make sure that they receive good counseling from the counsellors. Every patient is happy with the services, and I can see they are not stressful and all the patients are stable right now,” said Dr Chezang Dorji.
The doctor does all the paper work and medication routine after doing the hour long round. The doctor also attends to video conferencing with the clinical management team that comprises of specialists. The consultation and the discussions of the cases goes on, he added.
At around 1:30 pm, the doctor comes out of the isolation ward, but if there is any new admission then the doctor stays on in the isolation ward. At the time of the article were 14 patients in the isolation ward. There was a maximum of 21 patients in isolation at one point of time. After the doctor is done with the daily routine, the assigned driver drops the doctor at the hotel.
Dr Chezang Dorji said attending to the COVID-19 patients is really stressful unlike his regular duty. He has worked in the emergency department which is also stressful but one does not have to be really worried about getting infected, unlike in the isolation ward.
“I am extremely happy because I could serve the country during these trying times. Even if I am asked to continue, I would happily do it,” said Dr Chezang Dorji.
Other than donning of PPE, every health staff has to have minimal contact with the patients. Only if the patient is asymptomatic and is completely stable then the health staff would minimize the time exposure with the patients and maintain some distance. If the patient has some problem then the doctors and nurses take care of the necessary checkup and vitals monitoring, like any other patients, at 6 am in the morning, at 2 pm, 6 pm and 10 pm at night.
Health workers and patients in the isolation ward have created a group chat on WeChat to communicate and alert each other on any problems. All new patients admitted in the group are added in the chat group.
“My family is really supportive and encouraged me to go forward although they are worried. I am glad that I got an opportunity to serve my country,” said Dr Chezang Dorji.
The first thing after reaching the hotel after the duty is washing and cleaning up. Then he reads books, watches some movies and does physical exercises.
Clinical nurse Geeta Karki said working in the isolation ward is completely different from the general ward, as one has to work in a confined room unlike in the general ward. She said looking after the COVID-19 patients in isolation itself is very challenging and risky. She shared that sometimes, while taking RT-PCR samples, which is through nose and throat, the patient unintentionally sneezes and some patients cough. “Back of my mind, I am worried too about getting infected or what if I infect others,” she said.
Exuding much positivity, she said she will never regret working and looking after the COVID-19 patients, and more than that she gets the work satisfaction in the isolation ward.
Apart from routine checkup, the doctors and nurses also have normal talks with the patients. She shared that patients tend to get worried while waiting for the test results. Some of them get high blood pressure, especially the patients who have been in the isolation ward for almost a month. The health workers always try their best to calm them down and counsel them saying that they (patients) are asymptomatic with no health issues, and it is just that the virus in their body is taking time to eliminate.
She said she understands the feeling of each of the patients, as unlike in general ward where an individual patient has a personal attendant, the COVID-19 patients feel lonely with no one to talk to. It makes it more difficult for them to control their emotions. So the nurses advise them not to get stressed out and provide them with psychological support, she added.
“Sometimes I too experience emotional stress and miss my family and friends,” said nurse Geeta.
The team gather together in their hotel during dinnertime, and discuss on how to bring improvement in the isolation ward and in doffing room because there are chances that they might take the virus outside ward, she said.
Similarly, clinical nurse Ugyen Dorji said nurses have to attend the patients for more than five times in a day. They spend 6 hours in the isolation ward. Working in the isolation ward is challenging and worrisome, but they work as a team to manage all the patients so far. If one of them makes a mistake or gets infected then the entire team will be infected with the virus. They have been very carefully taking care of the patients and themselves as well. He also said that donning is not as risky as doffing of PPE, so they follow the steps of doffing PPE with utmost care.
“Being a health worker, I am committed in the field to handle the worst scenario. The only worry is infecting ones family members,” said nurse Ugyen Dorji.
While his family encourages him for serving the nation, but at the same time, they are also worry about him and send reminders to him to take extra precaution every day.
He said he prays and usually uses Google search to find out more about COVID-19.
“I think doctors and nurses in the isolation ward have never felt so happy and excited to inform a patient and the nation about a negative test result,” he said.
However, if there is severe case of COVID-19 patient admitted then it will be very challenging because the patient has to be monitored throughout.
A bedside nurse will be placed which imposes higher risk for the health workers, said the clinical nurse.
There are eight clinical nurses, two doctors, three ward boys and cleaners, one X-Ray technician and one assigned driver working in the isolation ward at any time.
