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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

Media: Sunday Times
2006-05-20

Sunday Times, 4 June 2006

True leadership may mean admitting disunity
 

In this edited extract from the inaugural King Moshoeshoe Memorial Lecture at the University of the Free State, Professor Njabulo S Ndebele explores the leadership challenges facing South Africa

RECENT events have created a sense that we are undergoing a serious crisis of leadership in our new democracy. An increasing number of highly intelligent, sensitive and committed South Africans, across class, racial and cultural spectrums, confess to feeling uncertain and vulnerable as never before since 1994.

When indomitable optimists confess to having a sense of things unhinging, the misery of anxiety spreads. We have the sense that events are spiralling out of control and that no one among the leadership of the country seems to have a definitive handle on things.

There can be nothing more debilitating than a generalised and undefined sense of anxiety in the body politic. It breeds conspiracies and fear.

There is an impression that a very complex society has developed, in the last few years, a rather simple, centralised governance mechanism in the hope that delivery can be better and more quickly driven. The complexity of governance then gets located within a single structure of authority rather than in the devolved structures envisaged in the Constitution, which should interact with one another continuously, and in response to their specific settings, to achieve defined goals. Collapse in a single structure of authority, because there is no robust backup, can be catastrophic.

The autonomy of devolved structures presents itself as an impediment only when visionary cohesion collapses. Where such cohesion is strong, the impediment is only illusory, particularly when it encourages healthy competition, for example, among the provinces, or where a province develops a character that is not necessarily autonomous politically but rather distinctive and a special source of regional pride. Such competition brings vibrancy to the country. It does not necessarily challenge the centre.

Devolved autonomy is vital in the interests of sustainable governance. The failure of various structures to actualise their constitutionally defined roles should not be attributed to the failure of the prescribed governance mechanism. It is too early to say that what we have has not worked. The only viable corrective will be in our ability to be robust in identifying the problems and dealing with them concertedly.

We have never had social cohesion in South Africa — certainly not since the Natives’ Land Act of 1913. What we definitely have had over the decades is a mobilising vision. Could it be that the mobilising vision, mistaken for social cohesion, is cracking under the weight of the reality and extent of social reconstruction, and that the legitimate framework for debating these problems is collapsing? If that is so, are we witnessing a cumulative failure of leadership?

I am making a descriptive rather than an evaluative inquiry. I do not believe that there is any single entity to be blamed. It is simply that we may be a country in search of another line of approach. What will it be?

I would like to suggest two avenues of approach — an inclusive model and a counter-intuitive model of leadership.

In an inclusive approach, leadership is exercised not only by those who have been put in some position of power to steer an organisation or institution. Leadership is what all of us do when we express, sincerely, our deepest feelings and thoughts; when we do our work, whatever it is, with passion and integrity.

Counter-intuitive leadership lies in the ability of leaders to read a problematic situation, assess probable outcomes and then recognise that those outcomes will only compound the problem. Genuine leadership, in this sense, requires going against probability in seeking unexpected outcomes. That’s what happened when we avoided a civil war and ended up with an “unexpected” democracy.

Right now, we may very well hear desperate calls for unity, when the counter-intuitive imperative would be to acknowledge disunity. A declaration of unity where it manifestly does not appear to exist will fail to reassure.

Many within the “broad alliance” might have the view that the mobilising vision of old may have transformed into a strategy of executive steering with a disposition towards an expectation of compliance. No matter how compelling the reasons for that tendency, it may be seen as part of a cumulative process in which popular notions of democratic governance are apparently undermined and devalued; and where public uncertainty in the midst of seeming crisis induces fear which could freeze public thinking at a time when more voices ought to be heard.

Could it be that part of the problem is that we are unable to deal with the notion of opposition? We are horrified that any of us could be seen to have become “the opposition”. The word has been demonised. In reality, it is time we began to anticipate the arrival of a moment when there is no longer a single, overwhelmingly dominant political force as is currently the case. Such is the course of history. The measure of the maturity of the current political environment will be in how it can create conditions that anticipate that moment rather than seek to prevent it. We see here once more the essential creativity of the counter-intuitive imperative.

This is the formidable challenge of a popular post-apartheid political movement. Can it conceptually anticipate a future when it is no longer overwhelmingly in control, in the form in which it is currently, and resist, counter-intuitively, the temptation to prevent such an eventuality? Successfully resisting such an option would enable its current vision and its ultimate legacy to our country to manifest in different articulations, which then contend for social influence. In this way, the vision never really dies; it simply evolves into higher, more complex forms of itself. Consider the metaphor of flying ants replicating the ant community by establishing new ones.

We may certainly experience the meaning of comradeship differently, where we will now have “comrades on the other side”.

Any political movement that imagines itself as a perpetual entity should look at the compelling evidence of history. Few movements have survived those defining moments when they should have been more elastic, and that because they were not, did not live to see the next day.

I believe we may have reached a moment not fundamentally different from the sobering, yet uplifting and vision-making, nation-building realities that led to Kempton Park in the early ’90s. The difference between then and now is that the black majority is not facing white compatriots across the negotiating table. Rather, it is facing itself: perhaps really for the first time since 1994. Could we apply to ourselves the same degree of inventiveness and rigorous negotiation we displayed leading up to the adoption or our Constitution?

This is not a time for repeating old platitudes. It is the time, once more, for vision.

In the total scheme of things, the outcome could be as disastrous as it could be formative and uplifting, setting in place the conditions for a true renaissance that could be sustained for generations to come.

Ndebele is Vice-Chancellor of the University of Cape Town and author of the novel The Cry of Winnie Mandela

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