EFSTH Hospital in Banjul

A nurse at one of The Gambia’s coronavirus isolation wards shares his experience and recalls an incident where a suspected coronavirus patient nearly lost his life due to negligence by the medical doctors on duty. We have decided to protect the identity of the nurse. 

At about 06:00 hrs in the morning, the nurse on duty at the isolation ward reported to the Night Supervisors at  the duty room that she could not access one of the patient’s room because the door was locked from inside and that the patient was not responding to her calls and bangs on the door.

She needed a tall person who could check inside the room to confirm patient’s status. The orderly at O&G was call upon. Both the Orderly and the Night Supervisor confirmed that the patient was breathing after checking inside standing on a chair. 

At that height patient’s legs, abdomen and part of the chest were visible but the head was not. All efforts to wake the patient up standing on the chair proved furtile. The maintenance staff on duty was called for help in opening the door. On arrival, he removed the lock screws and succeeded in opening the door.  

Upon entering the room, the patient was found lying in bed motionless. The nurse on duty was asked to give 50% glucose and immediately inform the doctors to go and review the patient. After returning to the duty room the Night Supervisor called Dr. Badjan and informed him about the situation. He said, he received a call from the nurse on duty and that he asked her to give 50% glucose. He also indicated that he spoke with one of the doctors at A&E to go and review the patient. 

At around 07:45 hrs, the Night Supervisor went back to the ward to see what progress was made only to find the nurse struggling to fix a line for the patient. The BM was 1.6mmol/L; BP 180/102mmgh; temp 32.6°c. With the intervention of the Night Supervisor the canula was inserted and 25mls of 50% glucose  was administered. 

During the process the patient convulsed once. After administering the 50% glucose, he regained consciousness but he was restless and attempted several times to remove the canula. In the process the Chief Matron also came in and she also participated in controlling the patient to prevent him from removing the canula. The BM was rechecked which read 4.6mmol/L.

On reviewing the patient’s records, it was observed that this patient was not clerked on arrival at the A&E. Even the medication(tabs flagyl) being administered by the nurses on duty at the isolation was prescribed by a Student Community Health Nurse who referred the patient from Basang.

What was more astonishing was that, a sample was collected from the patient on the 14th April 2020 to test for COVID 19. The results came out yesterday 7th May, which was negative. It seems, the patient was not even reviewed by a trained health personnel (nurse/ doctor) in Basang Hospital. The presenting complaints written by the student community health nurse include, abdominal pain, anorexia, chest pain, and distended abdomen. 

Additionally the patient has jaundice. The vital signs read; BP 105/102mmhg, temperature 36.4°c. He prescribed tabs flagyl for the patient. Up to the time the Chief Matron and the Night Supervisor left the ward around 09:00hrs no doctor came in to review the patient. 

The second case that came last night, also from Basang via one of the quarantine centres in the coast came with no referral papers and he was also not clerked at the A&E. He was said to have been coughing and anaemic. He was only written a prescription for pneumonia and anaemia. This patient was isolated with an escort. The escort was going in and out of the ward. Since on admission, up to 09:00hrs in the morning they were not served with any food.

If this is the state of affairs at this point in time when the isolation rate is still low, what will happen when this pandemic escalate in the country. Are we going to face the challenge with our collective effort to save our people or run away from responsibilty and place them in limbo. 

Are we ready to protect ourselves at the same time protect our colleagues and patients from COVID 19. We should remember that the safety our colleagues and patients is our own safety. Their risk is our own risk. In the event that we receive more than two suspected cases for isolation where would the rest be accommodated? 

It’s high time we prepare ourselves before it’s too late.  The hospital needs an alternative isolation ward because the current one is not ideal for patients especially the very sick ones. It’s also not ideal for the nurses looking after the patients. 

There is a need to provide a written protocol for receiving and isolation of suspected COVID 19 cases in EFSTH even if it would be in flowchart format. 

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