In early April, Ismailia's Abou Khalifa Hospital witnessed an amazing scene. A nurse called Doaa Mohamed was signing Egyptian songs from inside the hospital, while the musician Islam Al-Sayyad was playing with a violinist from outside the hospital walls. The incident was not an accident, having been set up by a doctor who thought to surprise his colleagues inside the quarantine hospital, particularly as it is a centre for treating coronavirus (COVID-19) patients. He organised the small celebration for them to ease the pressures they face, and provide much needed respite for both healthcare workers and patients inside the hospital. Since then, Mohamed has been singing for the medical staff and patients at the quarantine hospital, providing relief and a much needed breather. This has been a time of great stress and pressure on healthcare workers, as Mohamed herself reported, saying she felt depressed at the beginning of her work at the quarantine hospital. "We were having mixed feelings when we received the news that our hospital will be a quarantine hospital, feeling of fear for our families and for ourselves, and feeling of great responsibility," Mohamed told Daily News Egypt. "Even our families were crying due to their fear for us, we all were thinking that the virus flies and that we are going to be infected easily." She said that her fear has disappeared with time, particularly as she has been dealing with many patients who have tested positive for the coronavirus. "My hospital, in cooperation with the Ministry of Health, has been guiding us since the beginning of the crisis on how to deal with the patients, and how to take all the infection control steps," Mohamed said. She added that by time, she has adapted to the work under the pandemic at the hospital, and has begun to think on how to relieve the pressure on patients. She noted that reassuring and treating patients is a national duty for any nurse. "I think that one of the positive sides of this pandemic is that people now appreciate the nurses' efforts and have become more aware of how hard we work and what challenges we face," Mohamed said. She is one of the millions of nurses that have served on the frontline of the coronavirus pandemic. No doubt there is plenty of stress and anxiety on the back of having to deal with so many cases of serious illness, with infection and death having become commonplace on the medical frontline. But the female medical staff have more responsibility to balance between their work and families, as they take on the added feelings of guilt and stress of dividing their attention between work and family. In this pandemic, this is further compounded as they leave their houses for 14 or 15 continuous days. And if they are at home, they feel added stress and fear of dealing with their families so as not to infect them. Through this article, Daily News Egypt sheds light on the amazing frontline role of nurses, and interviews several from Egypt's different categories of hospitals to find out about the challenges they face. Necessary precautions Egyptian Nursing Syndicate Head Kawthar Mahmoud told Daily News Egypt that 13 nurses nationwide have died of the coronavirus so far, and there are currently several nurses in isolation. Yet others have recovered and since returned to work. Mahmoud said that the syndicate tries to help nurses via all means of support, whether moral or psychological. This occurs through continuous communication or financial support through disbursing EGP 20,000 for the family of the nurse who died from the virus, and EGP 2,000 for the nurse that has tested positive for COVID-19. "According to a Ministry of Health decision, there are at least 20 beds in every hospital for medical staff, so that in case of testing positive they can go into isolation and follow the treatment protocol," Mahmoud said. Doaa Mohamed and Eman Gamal, a nurse at Qasr Al-Eini Specialized Hospital, confirmed the syndicate chief's statements. They said that nurses at their hospital work in shifts and sleep over at their hospitals for 14 days followed by several days off. They are also tested for the coronavirus when returning to the hospital at the beginning of their 15 day work shifts and also when they leave the hospital. Norhan Eid, a nurse at a private hospital in Cairo, said that every week, nurses who come into contact with coronavirus patients, they themselves are also tested for the virus. The three nurses agreed that in their hospitals, if any of the medical staff tested positive, they will be isolated at the hospital if their conditions need medical treatment there. If not, they take the medicines needed and undertake their isolation period at home. Isolation and Fears "The biggest challenge that I face is the psychological stress that I am isolated completely from my social life, friends, and parent, in these days all families feel safe by together supporting each other," Doaa Mohamed said. "But for any nurse, she will become afraid of coming into contact or dealing with her parents in case of the spread of infection, as we are not sure if we are carriers for the virus or not." She added that although she is entitled to take time off from her work, the fear of potentially spreading the virus remains very real. "I have worked in the quarantine hospital since 8 March, and took only six disconnected days as a holiday due to my fear of infecting my parents," Mohamed said. "I could to take a holiday, but I insist not to, as I do not want to infect them if I am a carrier for the virus." Hend Awad, a nurse at a private hospital, noted another, just as personal, side effect of the virus. "I have two children, and since the pandemic has begun, I left them at my mother`s home so she could take care of them, and I haven't seen them since 8 March," she said. "Every day, their father debates with me about leaving work, but due to my feeling of responsibility I refused." Eman Gamal, a nurse at the Qasr Al-Eini Specialized Hospital, said, "I felt that I am in complete isolation from my family, as I word at the hospital for 14 continued days, and when returning home, I am afraid about them even if my PCR test is negative." She noted that even if the test comes negative, she still fears being an asymptomatic carrier, so she isolates herself for another 14 days. PPE shortage in some hospitals "The isolation wards in hospital are the most likely to have all the protective supplies available," Norhan Eid said. Gamal, however, said, "There was a shortage of protective tools at the Qasr Al-Eini Specialized Hospital before it became an isolation hospital, but since then all the protective tools have been provided." She also said that personal protective equipment (PPE) supply once started to dwindle, but this does get rectified. Gamal noted that using PPE and having to wear all the necessary protective tools in the hot summer weather is difficult more than anyone can imagine. On the other hand, a nurse at the Damanhour Chest Disease Hospital, who prefers to remain anonymous, said that there has been a shortage of protective tools. The nurse stated that there was even shortage of hand soap supply. The nurse added that the water supply was cut at the hospital sometimes, and that unfortunately, the hospital was not even sterilised or disinfected. Hadia Ahmed, who works at a governmental hospital, agreed that there was a shortage of PPE supply at the hospital she works at, with medical staff, whether nurses or doctors, having to buy their own protective tools. She noted that this negatively affected the efficiency of the work provided, as sometimes nurses had no money to buy the protective tools so the doctors had to take on some of the nursing work as well. This in turn delayed the examination process for other patients, of course delaying and affecting the quality of healthcare they received. In response, the Syndicate Chief Kawthar Mahmoud told Daily News Egypt that all protective supplies are available at all of Egypt's isolation hospitals. She also stated that she has herself inspected and is still inspecting hospitals to ensure the presence of all supplies. "I have not received any complaints about there being a lack in the protective equipment supplies," she said. Unawareness among some patients Norhan Eid mentioned that some patients remain unaware of the virus' severity and its ability to spread quickly, and are sometimes not committed to movement restrictions or social distancing. "Once, when the PCR test results of a patient were delayed, he insisted on moving around in the corridor outside his isolation room, and was deliberately coughing just to infect us as he was angry from the delaying in results," Eid sadly narrated. Overdue financial compensations Nurses at the Abou Khalifa Hospital and other private hospitals said that they have received all their financial receivables during the pandemic. However, a nurse at the Qasr Al-Eini Specialized Hospital said that they have not received their financial receivables, even from before the global health crisis. The nurse at the Damanhour Chest Disease Hospital said that they have not taken their bonuses from the hospital that the Ministry of Health has given over for the nurses. The ministry has assured that the hospital is the party responsible for the delay, as it has delayed the disbursal due to their desire for dividing the nurses' bonuses between the administrators and the nurses. She said that if the hospital has not disbursed the money before the end of the fiscal year on 30 June, it will be returned back to the Ministry of Health's treasury as no one has done this since March. No exceptional holidays are allowed Due to the state of emergency caused by the health crisis, hospitals have needed to work at full capacity all the time. As a result, many healthcare staff, including nurses, had not been allowed to take exceptional holidays to keep up with the extensive demands of patient care. Meanwhile, the nurse from the Damanhour Chest Disease Hospital said that nurses are overloaded with non-nursing work as most of the hospital workers are afraid to get infected. The nurse added that there are only two nurses on shift that have to care for as many as 45 patients, describing it as a huge load. Continual stress "Most of the time, the patient has anxiety when he tests positive for the coronavirus, so they tend to ring the bell for us a lot, and so I began to feel worried if I forgot to wear one of the protective tools even if it was only one of the many times that I came into contact with the patient," Eid said. "Every time the patient rings the bell, I move quickly as I think it is an emergency." Eman Gamal said that it has never been an easy feeling that you are exposed to, can get infected or even die from the virus. Added to this is the constant stress of potentially infecting a family member with the virus. "It is also hard to see a patient that was in good health yesterday become the fatality of today," Gamal and Eid said. Unfortunately, the only way for a patient's family to check in on their relative is to call the nurses. Gamal said that nurses have become stressed with hiding the truth from the family if the patient's case is severe, which is also hard. Hadia Ahmed said that on one occasion, a patient's family came to the hospital and assaulted her due to hiding the truth of his case. "I understand their feelings, but we used to hide the truth as not to impact negatively the patient's immune system, as his family might tell him the truth, and the immunity is the most important thing in the fight against the virus," Ahmed said. Hend Awad said that nurses suffer psychologically more than physically, either due to their fear for their families, our due to their feelings of guilt for leaving our children. Like other healthcare professionals, they also suffer the stress of the daily situations that they are exposed to, whether it is the daily intensive care or sometimes deaths of patients, to the deaths of colleagues. Society is not always supportive As they continue their daily work on the frontline against the coronavirus, nurses report varying responses from the public. Doaa Mohamed, Norhan Eid, Eman Gamal said that society supports them and always prays for them. On the other hand, Hadia Ahmed and the nurse at the Damanhour Hospital complained that people feel afraid of them as potential carriers of the virus. Ahmed narrated sadly that her neighbours demanded that she leave her home, and when she refused they put their waste and other rubbish in front of her door.
