Team Effort Wins the Day
By Priyangwada Perera
Resident physician at NYC Elmhurst hospital Marc Ayoub wrote, “Everything was happening so quickly. Everyone was dying so quickly. We had to go from one death to another and the next. I was imagining it happening to my family and being in a situation like that.” This has been the picture frontline health workers dealt with, during the pandemic. In recognition of their unparalleled service the National Institute of Infectious Diseases, popularly known as IDH got awarded. They were felicitated in the category of Most Admired Leaders for Social Inspiration at the Most Admired Companies of SL 2020, organised by the International Chamber of Commerce of Sri Lanka and Chartered Institute of Management Accountants at which 10-15 companies were awarded.
Where it first started
When the pandemic broke in January 2020 this Malaysian was travelling from Mecca to her motherland and IDH got a message from the airport saying that three very ill passengers were on the plane and two had died on board. That was when the plane made a crash landing in Sri Lanka with the other patient in critical condition. They said this probably was MERS Corona or even Novel Coronavirus that the world was dealing with. It had 60 per cent mortality. “This version can be called the ‘Uncle’ of the corona we first knew. This was the start of the journey of the Novel Coronavirus,” elaborated the Director of the National Institute of Infective Diseases or IDH Dr. Hasitha Attanayake.
There came the question as to who would go in and check on the patients. Consultant Physician Dr. Ananda Wijewickrama was with them. As the senior consultant, Dr. Wijewickrama went into the ICU himself and came back to Dr. Attanayake and said that this couldn’t be MERS Corona or Novel Corona but some form of influenza. In a few minutes time the Medical Research Institute confirmed that this was not MERS Corona but Influenza B. That was the start of their journey. From that point, Dr. Wijewickrama, Dr.Damayanthi Idampitiya and Dr. Eranga Narangoda who were then with the IDH gave the required leadership to the doctors.
One to go in first
In a pandemic, unlike on any other occasion, the senior-most doctor has to go and see the suspected patient. One cannot afford to sacrifice two doctors. If a junior doctor goes and in case he/she has doubts about the diagnosis, another one cannot be sent in.
Therefore, the senior-most consultant and the senior-most nurse have to go. Along with their senior-most consultant Dr. Wijewickrama, their senior most nurse Geethani Udugamakorala went in. That was the first pistol shot of leadership and thus, began the run. The rest followed the example boldly. When the seniors showed such courage to go in without even proper protective gear, the other doctors and nurses were ready to follow their footsteps.
One can only imagine how the first days must have been. Around the world, people were falling dead. IDH had no proper equipment or protective gear. What was available were some things which had come as a donation and which had also expired. Even though it may appear to us like a piece of cake, usually medical personnel do not just plunge in only with mere grit. Who can afford to lose lives? Even if they are brave enough, the nation cannot afford to lose them. But this time, apart from what little information that came from Wuhan, they had only little medical literature to refer to. Single-parent healthcare workers were hesitant, knowing it might be death they plunged into. Being human, they must have wondered what would happen to their children. Things went from bad to worse. The hospital constructor was the first to leave. He was followed by those who operated the hospital juice bar and the canteen.
No vehicles passed their hospital. Their staff who travelled in public transport had to get down at Gothatuwa Junction and walk to the hospital. They had people staring at them and they learnt to ignore the discomfort. Once they entered the hospital, they felt like they were working in a cemetery. There was pin drop silence. But nobody complained. Nobody lamented and cried on Social Media saying they had no protective gear. They did not go online with their tales of woe, doubt and danger. They had it in their minds that Sri Lanka is a developing country. Service had to be provided with low resources. What they had in excess was courage and team spirit. “We have to do this, somehow or the other,” they muttered in unison. Dr. Attanyake spoke with pride. “Our team was almost 500 people, including the minor staff consisting of cleaning and laundry teams. They went forward with no protective gear and the fear ‘what if one of us gets it’ did hover at the back of their minds. But more than any of that, the thought that if we fail, we fail the entire nation, kept us going forward. It is with such determination that we took every step.” That is also the reason there was so much jubilation when the first Chinese patient was discharged, in spite of criticism that followed.
Fewer facilities, more grit
It was interesting to hear how PCR facilities were not available at IDH, when they first started. Thanks to generous donors then they had both a Molecular Diagnostic Lab as well as PCR facility. Only at this time was it revealed that the disease was not air borne but spread due to droplets. They were yet to say that the spreading did not happen via blood or other secretions.
Dr. Attanyake gratefully recalled how their Chief Medical Laboratory Technician (MLT) Nayana Wijekoon, came to his office and said, “Sir, give me a room, a Point of Care Haematology Analyser, a Biochemistry Analyser and a safety cabinet to analyse. Give me those three things,” she had requested. She was immediately provided with what she wanted and the Chief MLT was true to her word. Dr. Attanayake said that this MLT’s leadership should at least come to about 10 per cent of their national performance. A lot of us forget the crucial role played by the minor staff of a hospital. “It was scary because unlike in the case of dengue only a few had worked through a pandemic experience. To be precise, Leonard Perera, Priyantha, Dhammika, and Sunil were the only experienced people who had handled two or three pandemics prior to this. “These four in the minor staff volunteered. They came to me and said, ‘Sir, do not let the new workers enter. There is more possibility of something going wrong, simply due to one’s lack of experience and the excitement it may cause. If they mess it up, the disease may spread to us, from us, it might go to you.’ I was deeply moved,” said Dr. Attanayake. The patient was a female and hence they had to send a female minor staff worker and the experienced female went in and brought her out. Our success was nothing but unselfish teamwork,” said the Director Dr. Attanayake.
We also spoke to Dr. Wijewickrama whom we referred to earlier. “Many days after that first incident, this may sound like an easy enough task. But when all you know is fear and doubt, when all around you people are falling sick and death has become a mere number elsewhere, we started. After all, not just the entire nation but the entire world also was standing tiptoe,” Dr. Wijewickrama said.
IDH did not have enough personal protective equipment and the hospital nurses and minor staff made them in the hospital itself. From overalls to face shields, they made them on their own. By the time the first patient came, IDH was ready with the equipment. They had been given some training and were somewhat ready.
The first Sri Lankan to be diagnosed with COVID-19 was sent to them by a general practitioner. The patient did not fit the exact criteria so as to be tested for COVID-19. “But we have to give all credit to the doctor who directed the patient to us,” said Dr. Wijewickrama. “He suspected and we thought his suspicion was justifiable and went ahead with testing. He became positive. That led to the detection of other patients as well.” The very humble Dr. Wijewickrama said that even though he went in first, it was not because others were reluctant to go.
Two passengers had died on the same plane and this was the third who was quite ill. “This was a very unusual incident. We inserted a tube to the airway and connected the person to a ventilator. I did it without sending my juniors. One can never say it is not this disease or that when two passengers have died on the same plane. They were on their way to Malaysia and the patient was coming from a country in the Middle East. It was diverted to Colombo because of the two deaths,” Dr. Wijewickrama explained.
Teamwork is their success
Nobody was fully aware of the virus or its behaviour. There were unanswered questions and fears. Patients getting admitted were scared. “When they were brought to the hospital, some were asked not to bring any extra clothes because they were going to be burnt and so on. Some were doubtful about being able to go back to their houses. Reassuring them that they were going to be fine, was what made a difference. That was the best cure, much more than the work we did.” The entire hospital went out of their way to work, discarding their shifts.
There was a lot of stress and the reaction of the general public and so on. The fact to be stressed is ‘teamwork’, Dr. Wijewickrama re-emphasised. It is in recognition of their unparalleled service that they received the award. They have won thousands of hearts of the patients they have served.
(Pix courtesy IDH)