The Ministry of Health and Medical Services had strategically planned to safeguard Fiji’s main hospital from the second wave of COVID-19 outbreak in April.

But today, the hospital’s emergency department is one of the hot spots for COVID-19 in Fiji.

Given the rise in the number of daily COVID cases and deaths, it is evident the situation is going to get worse, before it gets better.

Over the past few weeks, emergency department registered nurse Joshua Lewenilovo has had to deal with nine deaths while working his shift. He expects this number to increase over the next few weeks.

Some of the deceased arrived at the emergency door lifeless. Others died while admitted at the hospital.

Mr Lewenilovo is concerned that anti-vaxxers place the vulnerable at risk of succumbing to the deadly Delta variant.

For the months of June and July alone, not only has there been a spike in COVID cases, but also an increase in the number of COVID deaths.

As of 18 July, the John Hopkins University released data placing Fiji at the top of the chart as the country recording the most number of daily cases, with 1130 cases per million people.

On Wednesday, Permanent Secretary for Health Dr James Fong announced the country recorded 21 deaths, the highest so far, for the period of 14 July to 21 July.

Most of the deceased were the vulnerable population from the Lami, Suva and Nausori areas. They were either unvaccinated or had only received one dose of the AstraZeneca vaccine.

As the crisis escalates, the CWM Hospital has had to switch to a mitigation phase. A strategic move to protect the country’s already overwhelmed health resources.

CWM FIELD HOSPITAL 

Shine a Light was given access to the emergency department after consecutive in-depth coverage of lives claimed by this invisible virus.

Four makeshift tents were erected outside. They were put up about three weeks ago. This was part of the ministry’s contingency plan to cater for the influx of patients.

Inside are COVID positive patients. Most belong to the vulnerable group in our society burdened with pre-existing medical conditions. There was not a single young person on any of the beds. Majority of these elderly patients were on oxygen and medication.

Family members were not allowed inside the tent. They’d have to wear full personal protective equipment to enter the tents. All interactions were done via the healthcare workers at the entrance of the Emergency Department. This is how relatives are updated on the condition of their loved one.

Patients were later transferred to the COVID wards inside the hospital if their swab result came out positive. Getting swabbed was mandatory.

Once the result was released, patients are sorted into COVID and non-COVID patients.

The four tents can accommodate 21 patients. There are an additional 20 beds inside the Emergency Department for COVID positive patients. The sight inside the Emergency Department was both eerie and heartbreaking. Patients were on oxygen and monitors, some stable and some seriously ill.

Half of the west wing of the old hospital caters for COVID patients.

Bed spaces have also been provided in the Acute Medical, Acute Surgical wards, the two COVID intensive care units and the Critical Care unit.

Oxygen supply is consistent with enough stock available for patients treated at the Emergency Department. Oxygen is supplied by BOC (Fiji) Limited based in Lami.

Empty oxygen bottles are replaced twice a day. These oxygen bottles are also utilised by non-COVID patients.

The Ministry has also pre-ordered oxygen, considering the growing crisis.

Frontline health workers attend to another patients at the Colonial War Memorial Hospital in Suva on July 22, 2021. Photo: Leon Lord

EMERGENCY DEPARTMENT COVID SAFE PROTOCOLS

Patients who receive treatment  at the Emergency Department  field hospital are:

• Patients who suffer from severe respiratory distress and need oxygen;
• Patients with comorbidities, who deteriorate and test positive for COVID-19; and
• Those who are sick and require COVID-19 test.

Despite the spike in new COVID-19 case numbers, strict COVID-19 safety protocols and processes are maintained.

COVID patients are taken through the Emergency Department before they are transferred to the COVID wards or the COVID intensive care units for seriously ill patients.

The transfer of patients is conducted in an infection prevention control manner, ensuring there is no contact with other patients or medical staff.

Only a limited number of health workers transfer these patients.

There are also different pockets within the different wards where the non-COVID patients are kept.

These include the Tailevu-Namosi wards, Acute Medical and Acute Surgical wards, which also has a section for COVID patients.

The number of patients requiring treatment varies – averaging between 40 and 80 patients per day at the Emergency Department.

For non-COVID patients with underlying medical conditions they would average between 30 and 40 per day.

In a particular shift, there are eight nurses, five doctors and two consultants who attend to COVID and non-COVID patients.

Each teamwork three shifts, and get three days off work.

“Emergency departments are different, we need a large team to respond to mass traumas, cardiac arrest, resuscitation, that’s why we have that pool of people ready to respond to those emergencies,” head of the department Dr Amit Sewak said.

“The Ministry of Health has done a tremendous amount of work in preparing the place, staffing, transporting, and providing the consumables.”

ED FRONTLINER 

Mr Lewenilovo has been given extra responsibilities during this crisis. There are now two teams at the department – a team stationed inside and another outside in the tents.

Mr Lewenilovo oversees the outside tents.

“I have to double check if all my patients have oxygen, medications are given, temperatures are taken and make sure that all my patients are comfortable in the tent and they enjoy their stay,” he said.

For Mr Lewenilovo, his greatest challenges are nursing COVID positive patients. It’s worse when he must deal with deceased positive patients.

“It hurts me a lot to experience that, and I feel a lot of compassion for the family, because I know they won’t be able to farewell their relative properly during this crisis,” he said.

Mr Lewenilovo last saw his son, girlfriend, and parents when he left Vanua Levu in February. He misses them. He longs for the day to finally meet them.

“The misinformation out there does not make things easy for us, especially when people post negative comments on social media.

“It’s mentally challenging, and sometimes it really affects me emotionally. Often I’ve felt like quitting.”

But it remains an honour to serve the people of Fiji, he said. To see his patients, recover happily is the best part of his career.

MITIGATION PHASE 

While things look grim already, Dr Amit and his team are expecting a further surge in COVID case numbers over the coming weeks.

“So far our resources and projections have been in response to the situation,” he said.

This includes the training by the Australian Medical Assistance Team (AUSMAT).

The AUSMAT teamwork with our health workers at the Fiji Emergency Medical Assistance Team (FEMAT) and Ministry of Health in creating capacity and rapid vaccination.

Dr Amit said their priority was to prevent positive COVID-19 patients from getting sicker and ensuring that non-COVID patients did not contract the virus.

The 2021-2022 National Budget was also positioned to not only cushion the impact of the pandemic, but also facilitate the growing crisis.

The Attorney-General and Minister for Economy, Aiyaz-Sayed Khaiyum, announced the allocation of an increased budget of $403.3 million to the health sector.

The budget included the hiring of 238 intern nurses, 140 medical interns, 114 doctors, 10 nurse practitioners, 43 midwives and $25 million COVID-19 contingency fund.

AUSMAT RESPONSE 

Two significant issues stood out for AUSMAT Bravo Team Dr Dan Holmes.

First the tireless efforts of the frontline health workers and secondly the amount of preparedness by the ministry to deal with this ongoing outbreak.

He said: “It’s very clear that the nurses and doctors and all the other staff in various healthcare facilities are working incredibly hard. It’s tiring. In many overseas countries, we’ve seen how this pandemic has affected healthcare workers disproportionately, and in places people have become sick, Fiji is no different. When health workers become sick it puts extra stress on the health system.

“Fiji has done a lot of preparedness work in getting ready for this event over the past few months. You can already see what’s happened with the tent facilities, the extra capacity that was set up by the FEMAT team and also outside the CWM Hospital.”

Dr Holmes said AUSMAT provided personal protective equipment (PPE) to cater for the shortage in supplies.

The team is focused on training frontline health workers in dealing with the growing crisis.

These areas include:

• Infection and prevention control training, given healthcare staff are one of the ways that diseases are transmitted on hands, on equipment. It’s not only about protecting staff but the patients as well. Ensuring that frontliners do not transfer the virus from COVID to non-COVID patients.
• COVID-safe movement within the hospital, how the patients have to move from one area of the hospital to another, how the ward works, how the staff moves in and out; and
• How the staff need to wear the PPE and how to take it off to ensure low risk of cross contamination.

Dr Holmes said the hospital and the other healthcare facilities were managing the crisis admirably.

“But we’ve seen in high income countries like the United States and the UK that their health systems have buckled under the pressure that this disease causes.

“No health system in the world was built to cater for the number of patients that we’ve seen because of this pandemic.”

But for how long can Fiji’s health sector deal with this invisible threat as we reach 100 days since the start of this current outbreak?

Dr Holmes believes the situation has increasingly become serious, it will strain the country’s health system.

“What we are seeing is now, I don’t think we have reached the peak of what this COVID can do yet and for the next few weeks, it will be a challenging time for the health system.”

This is the second AUSMAT team to visit Fiji since the second wave of outbreak. They are here until mid-August.

AUSMAT is a World Health Organisation verified emergency response team that attends to requests for assistance during a disease outbreak.

COVID-19 frontline health officials on July 22, 2021, on their way to attend to some of the patients accommodated in tents set up outside the Colonial War Memorial Hospital in Suva. Photo: Leon Lord

WHO RESPONSE 

MOH has been working with the support of WHO and partners like Australia, the European Union, New Zealand and the United Kingdom to expand current capacity.

These included setting up remote monitoring systems for patients at home (focusing on the highest risk), expanding intensive care units, and establishing intermediate care sites such as the ones at Vodafone Arena and the FMF Gymnasium.

This was the response from WHO Technical Officer, Risk Communication and Community Engagement Rose Aynsley to questions sent by Shine a Light.

Countries around the world have recognised that this virus would be with us for some time to come.

The only way to return to the old normal is to fully protect ourselves through vaccination.

“COVID-19 is a highly infectious disease and the new Delta variant spreads even more easily. Until enough people around the world are vaccinated, this virus will continue taking lives,” she said.

Ms Aynsley said the recent death of 15-year-old Semaema Rabukawaqa was a tragic reminder of how this virus does not discriminate.

“Although most cases reported in Fiji have occurred in younger age groups, people over 50 years of age have been most likely to experience severe disease and death; hence, their prioritisation for vaccination,” she said.

“The experience in Fiji is in line with global data (e.g. only 0.2 per cent of deaths worldwide have been reported in people under the age of 20 years).”

She reiterates that while younger people are at much less risk of suffering severe COVID-19, they must remember that low risk is not zero risk.

Practising COVID-safe measures is critical during this growing crisis.

Edited by Rosi Doviverata

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