KNH struggles to deal with coronavirus pressure, exposing patients and doctors to potential infection

Nurses stand outside the Accident & Emergency entrance at the Kenyatta National Hospital, Nairobi. Elvis Ogina/Standard]

Kenya’s largest referral hospital and the nerve centre of the response to the Covid-19 pandemic is in the spotlight once again over the preparedness of its medical workers to deal with the virus and other diseases. 

Yesterday, staff at the institution’s Accident and Emergency department declined to report to work without adequate personal protective equipment, bringing the often busy department to a standstill. 

While this happened, the hospital’s board opted to move the existing Cancer Treatment Centre to create space for anticipated Covid-19 cases, potentially jeopardising treatment regimens of current and future patients. 

The stand-off by medical workers was as a result of the death of a patient who was one of two individuals admitted at the facility on Friday night.

Sources told the Sunday Standard that the two patients were both presented to the Accidents and Emergency department with signs symptoms similar to those of Covid-19.

“A patient presented with a history of a one-day cough, difficulty in breathing and a fever,” one of the employees said.

According to those who worked the night shift, and who spoke to us on condition of anonymity, one of the patients admitted on Friday night was immediately put on oxygen as the medics tried to fill in forms to transfer them to Mbagathi Isolation Unit.

“The patient died when we were trying to resuscitate him,” a medic said.

The staff have demanded adequate PPE and that a designated area be set up under proper medical standards of infection prevention and control.

This, the medical personnel say, will be a holding area for persons suspected to have the coronavirus as they await confirmatory tests, whose results may at times take up to 24 hours.

The nurses and doctors are concerned over the health of their families whom they go back to every day, and risk exposing them to the coronavirus after working for 12-hour shifts or longer.

Tough night

“This has been a very tough night for us because this is a situation that can go wrong sooner or later,” one of them said.

Hours before the patients were taken to hospital, Health Principal Secretary Susan Mochache had visited KNH Mbagathi Clinic to congratulate staff for the good work they had done in the wake of the virus.

By this time, nothing about the moving of the Cancer Treatment Centre was mentioned, not even a warning that from today, cancer services at the hospital might be greatly delayed or halted for a certain period following the decision to relocate the ward from the ground floor.

In a letter to the heads of the centres and Ward 8C, all patients currently admitted to the cancer ward are to be transferred to Ward 8C and, according to an internal memo, any spill-over patients suffering from cancer will be accommodated in the nearby wards.

“A decision to temporarily designate Ward GFD a holding area pending results for inpatients from Paediatrics and Medicine has been made,” the letter said.

The Cancer Treatment Centre shares walls and corridors with the ICU above it, cancer clinics opposite it, paediatrics clinic and the kidney dialysis transplant and radiotherapy units neighbouring it, with any patients accessing these services likely to be exposed along the corridors, yet they are highly vulnerable and risk critical illness and even death from the coronavirus.

Whether cancer services like chemotherapy will be disrupted by this reorganisation is still unknown. The pharmacies and bio-safety chamber where these highly toxic medicines are prepared are all on the ground floor; a separation of the ward and the source of medicines might pose a risk or disruption in service provision. 

The affected departments and wards are supposed to relocate tomorrow, which happens to be a busy day for the cancer treatment centre when they admit patients.

This cancer treatment centre offers chemotherapy and other general cancer treatment services, stabilisation of cancer patients with emergencies and offers accommodation to those coming in for radiotherapy. The patients include those from far-flung areas and have no alternative accommodation in Nairobi.

Speaking on the phone, KNH Chief Executive Officer Evans Kamuri said a final decision on this matter was yet to be made and the move would not interfere with cancer treatment services. 

Potent transmitters

“We are moving the patients upstairs so that in the event we have cases which are suspect, they don’t mix with the main hospital,” Dr Kamuri said. 

He said the suspected persons will not be from outside KNH, but from within the hospital. This however raises questions about how such patients will have been missed in triage to make it all the way to the wards undetected.

“People develop Covid-19, it’s not something you see. Even if you do triage, people who are asymptomatic can still find their way into the hospital and develop the disease later on when already in the system,” says Kamuri.

He said the reasoning behind this move was a previous case of a child who died at the hospital. An autopsy revealed the child had Covid-19 and had exposed a line of healthcare workers who looked after him before he died.

The hospital management opted not to use its emergency ward, which Dr Kamuri says is within the main hospital block and might be necessary for other unforeseen emergencies like fires.

At the time of going to press, the ward had 17 patients but Ward 8C, where they were to be transferred to, only has 12 beds in two rooms. The CEO however insisted that they had more than enough space to accommodate all the students.

With the death of the second patient confirmed yesterday afternoon, nurses’ and doctors’ unions continued to react to the morning stand-off. 

“The same force and enthusiasm being used by the government to enforce curfews and mass testing of the public and healthcare workers should be used to distribute PPEs,” said Alfred Obengo, National Nurses Association of Kenya (NNAK) president.

“With no PPEs for healthcare workers no one is safe as the same healthcare workers will be potent transmitters of the virus.”

For the last two weeks, press briefings by Health Cabinet Secretary Mutahi Kagwe, Acting Director General Patrick Amoth or Chief Administrative Secretary Mercy Mwangangi have been full of promises of PPE provision by the government. 

“KMPDU confirms the situation at KNH casualty where there is currently a stand-off due to lack of PPEs and there is a suspected case of Covid-19. Therefore, the health workers are unable to attend to the patient,” said Kenya Medical Practitioners and Dentists Union Acting Secretary General Chibanzi Mwachonda.

“As a union, provision of PPEs to health workers is mandatory in these times of Covid-19. Health workers’ concerns at KNH must be adequately addressed by the management.” 

Yet, many of these medical officers still risk their lives daily.