Medical interns bawling out

MEDICAL interns at Mandeville Regional Hospital (MRH) are agitated by inefficiencies and hazards that they have become exposed to at the Type B facility, located in central Jamaica.

At the top of the list of challenges is the scheduling of the interns to conduct COVID-19 swabs without being fit-tested for adequate personal protective equipment (PPE).

The interns, who spoke to the Jamaica Observer on condition of anonymity, said that when they initially began working in July 2020, the COVID-19 swabs were being conducted by nurses at a tent. However, in December when they were asked to join a donning and doffing workshop they were told by hospital management that they, the interns, would take over the swabbing at the tent.

The donning and doffing workshop is intended to educate medical staff on the proper way to put on and take off the PPE. However, the interns say they are yet to be fit-tested with N95 masks or receive them.

“There are several concerns, primarily on the basis that at other hospitals across the nation, interns who were taking swabs were being fit-tested. We have had about two meetings with the SMO [senior medical officer] and were told we don’t need to be fit-tested because our risk of contracting COVID on the wards is equal to us contracting COVID from swabbing a patient. He also outlined at that time that it’s not possible for us to contract COVID twice. Both he and I know that scientific evidence has proven otherwise. We informed him, but he was adamant that it is not possible for us to get COVID twice,” the intern shared.

Further, the intern said that consultants had threatened them, promising them that their assessments would suffer at the end of each rotation if they refused to do the swabs.

“We received an email saying we have chosen an insidiously dangerous path in this early point in our career by defying orders from the consultants and the SMO. We were basically threatened and everybody is just – for want of just completing internship in one piece – keeping our heads low and pressing on. We are conducting them now because we were threatened. Everyone has opted to go but to this day we have not been told whether or not we will ever be fit-tested,” the intern said.

The intern added that when concerns were raised, a clause from the medical handbook was quoted.

“The SMO has the right to curate the duties of the interns and senior house officers as they see fit. However, they are not acknowledging that the clause does not state that the SMOs are allowed to endanger staff, being that we do not have proper PPE to deal with the ongoing pandemic. We’re not fit-tested with N95s, and on that basis we’re not protected,” the intern said.

Apart from N95s, the intern explained that they should receive goggles or a face shield, a gown, cover shoes, surgical cap and two pairs of gloves – one sterile and the other non-sterile.

Added to that, the intern said senior doctors no longer conduct swabs nor respond to calls from the isolation ward. Instead, they send the interns. The Sunday Observer obtained a copy of the COVID-19 swab roster, which confirmed that only interns were being assigned to do the swabs.

“The rosters for swabbing are composed entirely of interns. So, the senior no longer swabs. We’re the only group being targeted for these swabs. We’re being sent to isolation on the basis that we’ve had inter-departmental referrals where it is that the medical officer is contacted by another medical officer but instead, the medical officer sends the intern to go and review the patient. This should not be the case because we should not actually be in isolation wards.

“In the case where we’ve been on call during the nights, if the patient in isolation might require things like IV access, fluids, again, medical officers are contacted but the medical officers send the intern and that’s not supposed to happen, as we are not supposed to enter isolation any at all on the basis that we simply aren’t fit-tested and there is not adequate PPE,” the intern stressed. “We’re not necessarily covered by the Ministry of Health directives and there are no specific protocols as it relates to our participation in swabs. Every other medical officer I have spoken to – KPH, Spanish Town, St Ann’s Bay, University Hospital – they’re in shock that we are the ones to perform the swab because that’s not the case for them.”

The whistle-blowing interns also disclosed that a number of them had contracted COVID-19 when performing CPR due to the lack of PPE.

“One such case happened to a colleague of mine last year and she did contract COVID-19. When we addressed these issues at the meeting we were told the PPE shortage is not unique to MRH and at this time it simply had to do with global demands. That did not necessarily make sense to me because if you’re asking us to perform CPR on patients for whatever reason, I would assume that you would make provisions that we ourselves or the personnel are protected. With that being said, the matter was not addressed,” the intern said.

In the meantime, the interns also stated there was intermixing of COVID-19-negative and COVID-19-positive patients on wards at MRH.

“Patients who are confirmed positive are still being held on the ward with negative patients. For whatever reason, there is a delay with them going to isolation ward or not being quarantined at home. Instead, they are on the ward and put other patients at risk. We have had a cluster outbreak on the surgical and medical ward so far, and between last Sunday and today [there have] been about three COVID-related deaths on the female medical ward as they have a cubicle for COVID-positive patients. They should not be on the wards, they should be in isolation. These are the things that cause increased COVID rates,” the intern said.

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