“When positive cases appeared at the hospital, we were afraid. We’re all susceptible to infection. But in the end, we don’t have any other choice because this is our job. And we’re not going to let people die.” These conflicting feelings of fear and a strong sense of duty are present throughout the interview with Hekmat Ismail, the head nurse at Abbasseya Chest Hospital, as she describes her 12-hour shifts treating potential COVID-19 cases while they undergo testing.
“Every day, we receive patients suffering from pneumonia. We run the coronavirus test and hold them in the ICU for a week until results come back. Throughout that week, we treat them as though they are already diagnosed.” This has been the case since the beginning of March, according to Ismail.
The Abbasseya Chest Hospital has been treating pulmonary diseases for Cairo and its neighboring governorates for 80 years, and normally receives around a thousand patients a day. Now, it only admits patients with suspected coronavirus cases. As soon as a patient’s test results come back positive, the Health Ministry sends an ambulance to transfer them to one of the quarantine hospitals. If the test results are negative, the patient continues their treatment at the hospital.
Ismail has worked in nursing for 25 years. “Suspected coronavirus cases receive special treatment,” she says. A designated area inside the ICU is reserved for suspected cases, with only one nurse attending to them during the daytime shift, which starts at 8 am and ends at 8 pm. Another nurse takes over for the night shift from 8 pm to 8 pm, and so on.
There are several measures a nurse takes before attending to suspected cases, including handwashing and wearing both a regular mask and an N95 mask, as well as gloves, an overhead cap, an apron and a plastic shoe cover.” Nurses stay in this gear for the entire 12-hour shift, changing gloves after attending to every patient.
At the end of the shift, they dispose of it in a container reserved for medical waste and washes her hands a second time. “We urge nurses to shower before putting on the clothes they will go home in to ensure the infection doesn’t spread.”
Since the rate of infection has increased in recent days, the hospital administration has been stricter about pressing doctors and nurses to adhere to infection control procedures, and the infection control team makes several rounds per shift to make sure doctors and nurses are using the appropriate infection control tools for their work.
As of the day of this interview, March 24, the Abbasseya Chest Hospital had not recorded any positive COVID-19 cases among its doctors and nurses. Nevertheless, Ismail says nurses are panicked and afraid. “I’ve had problems for 10 days — the nurses don’t want to attend to patients.”
“As positive COVID-19 cases increase, so does the fear, especially among nurses in admissions who attend to a large number of people without adequate precautions.”
Ismail thinks that the risk of infection is a distinct possibility for all members of the medical team in normal and abnormal circumstances. “A soldier joins the army knowing that they may die. We’re just like them. And that’s on normal days, not just during the time of coronavirus.”
She talks about how she manages her work amid the crisis. “I have male and female nurses. One male nurse’s wife is dead, and he has five children. He asked not to work with COVID-19 cases because he takes care of his kids. So, I took him away from [the cases]. I have a female nurse who is pregnant. I completely removed her from the ICU and told her to go to the insurance [department] to request sick [leave] because the risk to pregnant women is higher than to those with children. There are also nurses living with their parents.” Aside from these particular cases, Ismail thinks that there is no room for nurses to step back. “We’re all at risk and we have to work, we’re not gonna let people die.”
She notes that “some nurses’ fear of contracting coronavirus drove them to threaten to stop going to work, and several actually did in a few hospitals and were brought back to work by the police.”
Ismail has faced other outbreaks in her career, such as bird flu in 2006, and the swine flu pandemic in 2009. “I will never forget the bird flu cases — so many cases, most of them from the countryside. There was a family that walked in the hospital and six hours later, they were all dead because they were raising chickens. We admitted to pregnant women who died within hours. Their families would come to pick up their personal belongings and our hearts would break for them.”
In 2006, 60 people died of the bird flu in Egypt, most of whom were under the age of 35.
The ICU at Abbasseya Chest Hospital has 19 beds and 29 full-time nurses, with another eight available for urgent cases. The team is divided to work in alternation, with each nurse working 12-hour shifts three times a week. Ibrahim stresses that nursing in government hospitals is scarce, especially in departments that require extra effort like the ICU.
Aside from a nursing shortage, Ismail fears a shortage in protective equipment. “Masks are the only thing that keep us working. Without them, we’ll stop.” The head nurse says that masks and the rest of the equipment are currently available at most government hospitals. However, the problem lies in the coming days. She explains that this equipment could have been misused or wasted already. For example, nurses and doctors have been taking masks — especially the highly protective N95 mask — back home for their families to use. There is a shortage of such equipment in pharmacies and their prices have increased tenfold.