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29 April 2020 | Story Andre Damons | Photo Supplied
Intubation training on a manikin (Doctors from Department of Anaesthesiology).

The Department of Anaesthesiology at the University of the Free State, in collaboration with the Clinical Simulation and Skills Unit, has trained almost 500 hospital staff members dealing with the Covid-19 pandemic since the lockdown started.

The unit assisted doctors, nurses, and staff working at the Universitas and Pelonomi hospitals with training in the use of personal protective equipment (PPE), including protective clothing, masks, gloves, aprons, and eye protection. The training started the week of 16 March and was led by Prof Gillian Lamacraft, Head of the Pain Control Unit in the Department of Anaesthesiology, and registrars in the Department of Anaesthesiology. Training was not only limited to healthcare workers in hospital wards designated for COVID-19-positive or suspected COVID-19 patients, but workers throughout the hospital received training, lest they be required to care for COVID-19-positive patients in the future, especially if there is an increase in the cases being treated in the hospital.

Training members of the anaesthesia department
According to Prof Lamacraft, the training was initially started to ensure that members of the anaesthesia department would be protected if the need arose for them to wear PPE while treating a COVID-19 patient. Members of the anaesthesia department are not routinely involved in the medical care of patients with serious infectious disease (e.g. Ebola virus), and because they were not previously required to wear PPE regularly, they are not familiar with its use. 
“Internationally, the healthcare workers most exposed to the virus appear to be the ones most at risk of dying, presumably owing to the greater viral load they receive. COVID-19 patients who are severely ill, may require intubation so they can be ventilated – this procedure puts the doctor performing it very close to the airway of the patient, and greatly at risk of being contaminated with COVID 19 during this procedure.” 

“Failure to intubate the patient successfully can lead to the rapid demise of the patient, so it has been decided as hospital policy that anaesthetists will preferably be the doctors performing these intubations, if they are available, as they are considered the doctors best at this procedure. Therefore, anaesthetists will be a group of doctors in the hospital at great risk of COVID virus exposure,” says Prof Lamacraft.

Training other healthcare workers
To facilitate this training, registrars in the Department of Anaesthesiology made videos to demonstrate the donning (putting on) and doffing (taking off) procedure for PPE. Members of the Universitas Academic Hospital’s Infection Control Team provided them with the required information and assessed the training videos for correctness.

The department used the Clinical Simulation and Skills Unit’s facilities at the university to conduct this training, so that the participants could also physically practise putting on and taking off the PPE after watching the videos. 

“Since then, we have been doing this training every working day. Having trained our department, the members of the COVID-19 task team for the Universitas Hospital asked us to train other healthcare workers at the hospital. Accordingly, we have trained many other healthcare workers (over 430 for PPE training alone), including heads of department, professors of medicine, specialists, registrars, medical officers, interns, all ranks of nursing staff, clinical technologists, and household aids.”

The different types of PPE
Prof Lamacraft says it is important that all these healthcare workers are taught the different types of PPE (i.e. standard and aerosol-generating procedure PPE (AGP PPE). In particular, they had to understand that a special type of mask, an N95 mask, should only be used for AGP PPE, as these are in extremely short supply internationally. 

“Many healthcare workers did not know how to put these on correctly, or which size to wear – this had the potential for wastage of this precious commodity. Taking off PPE contaminated with the COVID-19 virus is a very risky procedure. Failure to do so correctly, can lead to not only the healthcare worker contaminating themselves (e.g. by touching their eyes or face while taking off their masks), but also to the contamination of the healthcare workers assisting the person in taking off their PPE; or even to the participant taking home the virus on their bodies and contaminating their family at home. Therefore, the healthcare workers had to be shown how to take off their PPE without contaminating themselves.”
In order to reduce the risk of trainers and other participants being infected during training by healthcare workers who are asymptomatic carriers of COVID-19, only two to four participants have been trained at a time and strict rules were kept regarding social distancing and the use of hand sanitiser.

The training is essential to protect healthcare workers
Prof Mathys Labuschagne, Head: Clinical Simulation and Skills Unit, says volunteering doctors and nurses are also trained to work in ICUs with COVID-19 patients. The ICU department trained these volunteers in the use of ventilators, to assist with putting up drips and lines, intubation, and PPE. The goal is to train healthcare providers to assist in ICU when needed. 

“This training is essential to train and prepare healthcare workers when the patient numbers are increasing. The training is also essential to protect the healthcare workers against infection, because we need them to stay healthy to be able to manage the patients,” according to Prof Labuschagne.

Dr Edwin Turton from the Department of Anaesthesiology says the training is for frontline healthcare workers (nurses, cleaners, porters, doctors, and even washers from theatre) who need to protect themselves in order to protect their patients and all other staff helping them to care for the patients.

“Doctors and nurses need different forms or levels of PPE for working in the clinical environment, and we need them to train to wear appropriate PPE for AGP and contact with PUI and positive patients. They need to be able to protect themselves. The training is for all healthcare workers and not only for doctors and nurses,” says Dr Turton.

News Archive

‘Is the South African university curriculum ‘colonial'?’ asks Prof Jansen
2017-11-24

Description: Jansen readmore Tags: Prof Jonathan Jansen, colonial, university curriculum, western knowledge

From left; Prof Corli Witthuhn, Vice-Rector: Research; former Rector and Vice-
Chancellor of the UFS, Prof Jonathan Jansen; Prof Michael Levitt, and
Prof Francis Petersen at the celebration lecture at the UFS.
Photo: Johan Roux

One of the critical issues that emerged from the South African student protests during 2015 and 2016 was a demand for the decolonisation of university curriculums. 

A senior professor at the Stellenbosch University, Prof Jonathan Jansen, said the number of people, including academics, who joined the cause without adequately interrogating the language of this protest, was astonishing. “The role of social scientists is to investigate new ideas … when something is presented to the world as truth.” Prof Jansen was speaking during a celebration lecture at the University of the Free State in Bloemfontein on 15 November 2017. 

Large amount of knowledge not African

He said the accusation is correct to a limited degree. “The objection, in essence, is against the centring of Western, and especially European knowledge, in institutional curricula.” There is no doubt that most of what constitutes curriculum knowledge in South African universities, and in universities around the world, derive from the West. “The major theories and theorists, the methodologists and methods are disproportionally situated outside of the developing world,” Prof Jansen said. 

The dilemma is, how will South Africa and the continent change the locus of knowledge production, considering the deteriorating state of public universities? “In the absence of vibrant, original, and creative knowledge production systems in Africa and South Africa, where will this African-centred or African-led curriculum theory come from,” Jansen asked. He says the re-centring of a curriculum needs scholars with significant post-doctoral experiences that are rooted in the study of education and endowed with the critical independence of thought. “South Africa's universities are not places where scholars can think. South African universities’ current primary occupation is security and police dogs,” Prof Jansen said. 

Collaboration between African and Western scholars
“Despite the challenges, not everything was stuck in the past,” Prof Jansen said. South African scholars now lead major research programmes in the country intellectually. The common thread between these projects is that the content is African in the subjects of study, and the work reflects collaboration with academics in the rest of the world. These research projects attract postgraduate students from the West, and the research increasingly affects curriculum transformations across university departments. There is also an ongoing shift in the locus of authority for knowledge production within leading universities in South Africa. Prof Jansen feels a significant problem that is being ignored in the curriculum debate, is the concern about the knowledge of the future. How does South Africa prepare its young for the opportunities provided by the groundswell of technological innovation? “In other parts of the world, school children are learning coding, artificial intelligence, and automation on a large scale. They are introduced to neuroscience and applied mathematics,” he said.

Prof Jansen said, in contrast, in South Africa the debate focuses on the merits of mathematics literacy, and what to do with dead people’s statues.

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