Patients at A&E Department were not at risk – CMO

Staff on duty at the Accident and Emergency (A&E) Department of the Milton Cato Memorial Hospital (MCMH) followed protocol when a patient who had recently visited Nigeria went there last Monday, with a mild fever.

Chief Medical Officer (CMO) Dr Simone Keizer-Beache, in an interview {{more}}with SEARCHLIGHT on Wednesday, said despite what has been rumoured, the staff at the A&E took all the steps required.

Dr Keizer-Beache said the initial list of possible diagnoses for someone with a fever who had travelled from Nigeria includes Malaria and Ebola.

“Once you have a query, you are going to investigate further, which involves contact with the patient. Our protocol says that the individual who is going to be in close contact with the patient, that is, less than three feet, should be protected.”

The CMO said, while further investigations are being done, at the same time, the staff and other patients must be protected.

She, however, added that the persons who were going to be in close contact with the patient were the doctor who did the initial checks and a nurse.

“In an attempt to minimize transmission, one person put on the full gear and the other nurses, some of them, put on masks and gloves and a light gown. The physician who had seen the patient put on the full protective suit,” explained Dr Keizer-Beache.

The CMO noted that the patient was placed in a room where the air conditioning was not connected to the main air conditioning unit of the A&E Department.

“The patient was placed in a one room cubicle. An isolation room has a series of rooms, but we do not have that, so we placed the patient in the one room area and we protected our staff and moved the patients who could have been moved.”

Dr Keizer-Beache said in isolating the patient in the manner they did, the other patients in that department were not at risk.

“The persons at risk were the persons going into the room. What we did was move patients who could be moved and those who could not be moved were kept at a distance.”

She explained that all these procedures — dressing the doctor, notifying the lab, contacting the Caribbean Public Health Agency (CARPHA), moving people — were happening simultaneously, while a detailed history of the patient was being sought.

She said questions that the patient was asked included: ‘Have you travelled to any Ebola country? Did you come into contact with anybody with any symptoms or visit any country other than Nigeria?

“…and that is how we got the history that this person had had Malaria before and that we suspected it was Malaria. All of this happened in 30 minutes to an hour and by that time, we had already cleared the department, because you can’t sit and wait to know before clearing.”

She stressed that while they didn’t have a confirmed diagnosis, the answers to the questions given by the patient made them suspect it was Malaria, “but we still said that people needed to leave.”

Among the answers given was that the student had come into the country two weeks prior and had presented a negative test for Ebola.

Two blood samples taken from the patient and sent to the CARPHA in Trinidad and one local spot test have since confirmed the diagnosis of Malaria.

Dr Keizer-Beache said that she was on hand during the procedures and she did not witness any nurses running from the A&E Department, as had been said by some persons.

“I was there and as far I know, no nurse ran out. I understand that a nurse may have told somebody ‘take your child and run,’ and if a nurse did that, that is unacceptable because that is creating panic.

“Some members of staff maybe did not communicate in a professional way … but we will have to work on that; but the idea that the health care persons put people at risk is wrong, because as soon as we thought anything was wrong, we protected the staff who were going to be in direct contact,” stressed Keizer-Beache, who added that health care workers are usually the ones most at risk.

She, however, noted, “at no point there was any vomiting or diarrhoea. There were no body fluids lying around. There was a mild fever and a feeling of tiredness, that’s all.

“Whatever we did, we had to do very quickly. We had to do it as quickly as possible to mitigate or reduce any risk.”

She said that persons were not allowed back into the A&E Department until the patient in question was moved to another part of the hospital.

Explaining what should happen in the future if a person suspects they may have an extremely contagious disease, Dr Keizer-Beache said that protocol says that a call must be made to the A&E and that department becomes responsible for picking up the patient, wherever they are.

“Protocol, according to the Ebola response plan, is that if a person is coming from outside, for example, if you are at home and you realize you have symptoms and you know you have travelled from an Ebola country, what we have been saying is that you inform Accident and Emergency and we would go for you.

“There are queries about what happened and that there was panic and patients were not informed. The idea that we thought only about our people is wrong,” stressed Dr Keizer-Beache.

She said that the patient has since been released from hospital and is currently being medicated. Also, the Vector Control Unit has visited the area where the person lives and has determined that the Anopheles mosquito that spreads Malaria is not present in that area.