They say the political is always personal, here Biznews team member, Chris Bateman, shares his knowledge of South Africa’s healthcare landscape and the Covid-19 coordinated response from his perspective as a 63-year-old highly immune-compromised cancer survivor and veteran healthcare journalist.
In case you missed Episode 3, click here.
Hi, Chris Bateman here again, continuing to share my cancer journey, just over a month since my last podcast in early March this year, 2020. This is the fourth episode in my tale of hope, awakening and navigation of this unpredictable road. I’m a father of two pre-teenage daughters, a successfully lapsed hang-glider, an active and keen fly fisherman (currently limited by the Coronavirus and my weak immune system to YouTube angling videos and fly-tying), and an apprentice oesophagal cancer survivor (Stage One, treatable/curable being the truth I stand on and draw daily reassurance from).
As I chew on the news that my major potentially curative operation has been brought forward to June this year, I cannot help as a long-time healthcare journalist, but ponder on my experience as an immune-compromised South African during this time of the Coronavirus. Perhaps more than most of my locked-down compatriots, I’m hyper-aware of the risks I face. With my treatment rendering my immune system compromised, I join the ranks of an estimated 3 million HIV positive South Africans not yet on anti-retrovirals, a large number of them co-infected with TB and even drug-resistant TB. They too, by dint of their HIV infection, have varying and often dangerously low immunity levels. I’ve become the bane of security guards, nursing staff, and even management at the Blaauwberg Netcare Hospital where I attend weekly chemotherapy sessions because I assertively keep them at arms-length and call them to order on any lapses I come across in infection control. I see it as constructive, essential feedback, not just aimed at my own survival but that of anybody who enters or leaves the hospital.
My perspective is best explained by quoting the words of my oncologist, Dr Krystyna Marzalek; “Chris is you get infected with your immune system as low as it is now, you will die.”
I figure if she’s so bluntly honest, I can be too. However, not everyone sees it for the truth it represents. I know my fellow cancer survivors are on the same page as me because I did a snap survey of six of them while we underwent chemotherapy in the hospital chemo unit last week. To my question; “are you more scared of dying of your cancer or from the Coronavirus?” the unhesitating answer from every-one was they fear succumbing to Covid 19 far more.
Juxtapose this with a security guard I remonstrated with for brushing up against me to inspect my computer notebook case. She was most put out. My explaining more gently to her in Xhosa didn’t seem to help. After I filled in the compulsory signing in book by ticking a multitude of “yes, no” answers to pertinent Covid-risk questions, I found myself wondering how often they actually checked the book. So, I asked the front-line nursing sister who told me that this happened at the end of each day. No imagination required for the tracing delay if somebody answered yes to having travelled internationally or having been in contact with a Covid-infected person. So, I called the hospital manager, introduced myself as an outpatient and healthcare journalist, and gave him the feedback. He was grateful and gracious. The hospital check-in book is now inspected at far more regular intervals.
The wider context at the time of making this podcast is that at least three private hospitals have suffered Covid outbreaks, with a disproportionate number of healthcare staff infected. The mind boggles should our stellar national Covid healthcare command be unable to secure sufficient personal protective equipment and jack up infection control policies and protocols across both public and private sectors. Our healthcare infrastructure, at least in the public sector, was struggling to cope with our globally-unequalled quadruple burden of disease, long before the Coronavirus hit our shores. Our health care workers are spread so thinly that if you halved the total healthcare workforce in the United Kingdom, the UK would still have five times as many staff on hand as we do. Protecting them is vital if we are to emerge from the pandemic strong enough to regain our physical and economic well-being. What I take great encouragement from however, is talking to key players in the national Covid command centre, all experts in their various fields, ranging from public health, epidemiology, virology, supply chain management and health education. There is a team effort on the go the likes of which South Africa has never seen before. The private sector (housing double the patient beds of the public sector), the State healthcare system, NGO’s, manufacturers, foreign donor bodies, procurement experts – all are working hand-in glove during this infection-curbing lockdown window which is designed to give us time to prepare for the impending patient onslaught. Field hospitals are being set up across the country, large buildings and convention centres repurposed as testing and treatment centres, tertiary hospital basement parking lots are being converted into stand-by mortuaries as we engage in the global scramble for personal protective equipment for realistically anxious healthcare facility workers. It bodes well for a future NHI, however downsized or protracted a working universal healthcare system it may become.
If I can briefly share my own dilemma and that of patients needing surgery and/or high-care for whatever reason in the coming days, weeks and months. At first, the strategy of my caregiving team was to shrink the tumor at the base of my oesophagus with chemotherapy, sufficient to enable good cutting margins when the bariatric surgeon removes most of my stomach and fashions a new swallowing pipe from the rest of it. But a CT scan after the first round of chemo showed I had developed pulmonary emboli (blood clots on the lung), now in advanced treatment with blood thinners. No surgeon wants to operate with a patient who may bleed out, so my op was put back to anytime between July and September this year. But wait, here comes the curved Covid ball. If we delay that long, my risks of a hospital-acquired Coronavirus infection increase significantly. Prof Salim Abdool Karim, whom I got to know and trust from my 16 years on the SA Medical Journal, leads the NDOH Covid team and is on record as saying the infection peak will probably come at the end of September. There’s no knowing what the Covid patient load in private hospitals will be then. My province, the Western Cape, stood at 900 confirmed Covid infections at the time I recorded this, 22nd of April, 2020.
One of the biggest problems, as echoed by Dr Richard Friedland, CEO of the Netcare Hospital Group, (of which my treating hospital is a member), is that it’s almost impossible to detect an asymptomatic patient who can be highly infectious. The lesson he cites from their St Augustine’s hospital Durban tragedy where five people died and 44 of 66 people infected in early March 2020 were healthcare workers, is that so called ‘safe’ green hospital zones (where non-Covid emergency cases are handled), were among the first to fall victim. Raising the infection control bar to the level of the yellow and red hospital zones is obviously an immediate priority.
I can only accept the reassurances of my hospital manager, surgeon and oncologist, that the ICU I’ll spend a day or two in before another two weeks recovery in a general ward, are and will be totally isolated from Covid patients. My operation has been brought forward to early June (pending a positive CT scan with no lung emboli or other developments), specifically to lower my risk as more and more Covid patients are admitted to hospital. To use an angling analogy; a clear CT scan showing good tumor shrinkage and no spread will be the equivalent of my hooking a prize trout in a difficult lie. Surviving the four-to-six-hour operation and being discharged from hospital, cured, will be like landing that trophy fish. I’d mount that magnificent, metaphorical trout on my wall, except that I’ve acquired a brand-new respect for all living things. So, to round off for today, here’s wishing you the very best with whatever travails you may also encounter in confronting the Covid pandemic. I have no corner on the market of trials and tribulations. Until after my operation, or perhaps even shortly before, I’ll say cheers for now. Never has there been a better time for remembering that a person is a person through people.
Ubuntu literally saves lives.
Salani kahle nonke.
