Covid-19 frontline worker’s noble task

By Nadia Khan Time of article published Jul 30, 2020

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Durban - SHAMIM Khan was inspired to become a physiotherapist more than 30 years ago to help make a difference in people’s lives.

And since April, Khan has been working at the front line in both the intensive care unit (ICU) and general ward at a private hospital providing physiotherapy to Covid-19 patients.

The 55-year-old, from Durban, said physiotherapy played a key role in the management of patients with the virus.

“Physiotherapists play an important role in the treatment of Covid-19 patients. If a patient is in ICU and ventilated, physiotherapists assist with positioning the patients in the prone position to improve oxygenation,” said Khan.

“We also do passive movements to prevent any stiffness of their limbs once they recover from the respiratory issues.”

Khan said patients were usually sedated and had no recollection of what transpired during this period.

“As the sedation is reduced, when the condition improves, the patients get more involved in their rehabilitation and are encouraged to do active exercises. This is important as patients lose muscle strength from lying in bed. Also, being in the ICU for a prolonged period can result in ICU-acquired weakness.”

With early intervention the patients have a better chance of recovery, she says. Once off the ventilator, the physiotherapist would help the patient with mobilisation.

“We start with sitting over the edge of the bed. If a patient has been receiving physiotherapy while ventilated, this task is easier for the therapist and the patient. Otherwise, it can be a completely passive process, depending on how weak the patient is.”

“If the patient is stable on the ventilator, we also start by sitting them over the edge of the bed and sometimes standing while they are ventilated.

“In the patients who are not ventilated, we focus on respiratory therapy by teaching breathing control and specific breathing techniques.”

Khan said apart from the therapy, counselling formed an integral part of the management of patients.

“They’re afraid. They read horror stories in the media. The stress and anxiety associated with the unknown also affect their breathing patterns. Talking to them, counselling and reassuring them makes a difference to the way they breathe.

“They slow down the breathing rate and are more efficient in their respiration as they take deeper breaths instead of the short, sharp breaths when they’re anxious. The worst thing one can do is do nothing for these patients. Every bit of breathing exercise and general exercise is beneficial,” Khan says.

It was often difficult to keep her composure while treating patients. One of them, said Khan, was an elderly woman who missed seeing her family.

“She would say to me every day, ‘I wonder if I will ever see my family again?’

“She was appreciative of every little thing anyone did for her and despite feeling tired, she did her exercise. She said she had to get better to go home.”

Khan said she worked alternate weeks in the designated Covid-19 wards and that there were between one and two physiotherapists assigned to each ward - depending on the number of patients. They wore full protective gear that comprised scrubs, a gown over the scrubs, a plastic apron, an N95 mask, a cap, gumboots and double gloves, which needed to be changed between patients.

She said working with Covid-19 patients was emotionally and mentally challenging.

“You fear for the patient and you fear for yourself. The patient’s condition can change suddenly so you have to ensure that you don’t push the patient too much sometimes it can be emotionally challenging when you do all you can for a patient and despite that, the patient’s condition deteriorates. This is the most difficult for me.”

Khan said despite the safety precautions, the front-line workers could still contract the virus.

“There’s always the fear that I will get the virus. I think about my family, my husband, children, mom and mother-in-law who live with me, so I have to be extra careful.

“Physiotherapists have a lot to offer to the patients and the patients should not be denied this because of our fears.

“We see the improvements of our interventions when the patients are moved from the ICU to the ward and when they are discharged.”

She encouraged fellow South Africans to wear their masks, wash their hands regularly and practise social distancing.

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