Suddenly working in the intensive care unit

It’s March 2020, and I’m working in a rural hospital in Ghana, together with four colleagues from the Netherlands. During our two-week stay, we teach (student) nurses and physician assistants at the neonatal and paediatrics unit, and at the same time we learn a lot from them. While I’m working in Ghana, the coronavirus is spreading throughout the world. The first patient in the Netherlands was detected a week before we left, which made us hesitate whether or not we should travel to Ghana. We didn’t want to be “patient zero” anywhere, especially not in a country with a poor health care system. However, at that time, a pandemic seemed far away and we concluded travelling to Ghana would not be a big risk. We followed the news about the coronavirus spreading in Europe, and I must confess that we underestimated the crisis and even thought the drastic measures in Europe were a bit farfetched. We had never before stopped shaking hands to prevent a cold or maybe a severe flu, so why now? Was this virus really so harmful?

The Ghanaian medical staff appointed an outbreak management team, which presented guidelines for the hospital. They concluded that the hospital was not prepared for an outbreak, but on the other hand they did not fear a severe outbreak in Ghana, which is generally warm and sunny. They used to fear Ebola, and the corona virus seemed to be less pathogenic. In the weekend of our return home, we finally understood that this virus was a serious threat. We were worried about our flight being cancelled, but everything went well and we arrived home safely.

Home had changed. We had to keep our distance from one another, stop shaking hands and stay inside as much as possible. I drove to the hospital to see what was going on, and to explore at what kind of hospital I had to start working the next day. I saw piles of protection materials; my colleagues were very strict with hand-hygiene rules and I was surprised by my mail box which had exploded and was filled with regularly updated guidelines on procedures and the implementation of rules and regulations. Compared to this, the lack of personal protective equipment and even hand sanitizer in Ghana was confronting.

It’s April 2020, and I start working at the ICU. The WHO director has declared Covid-19 a pandemic, something I had only read about in literature and books, or heard about at conferences and seen in movies. I felt like I had to help, not only because I wanted to, but because it is my duty as a global health doctor. I started reading and learning about Covid-19 and about pandemics, checked the news almost every hour, talked about nothing else but corona, and followed webinars about Covid-19 on the ICU, for family doctors, for gynaecologists, from Médecins Sans Frontières and for the national army. At the same time, I prepared myself to work on the ICU, which is something I had never done before. I knew little about mechanical ventilation, and felt insecure about managing the airway in a resuscitation setting. I was working hard, studying a lot and sleeping too little. I even dreamt about patients lying in prone position, family members who became ill and people dying. It felt like a roller coaster ride, together with other health care workers in the world. It felt as if we were working in one big team. The support of so many people was overwhelming for me.

It’s May 2020, and I’m driving back home after another shift at the ICU. Eric Clapton’s song Tears in heaven is on the radio, and the tears stream down my face. He sings about holding hands, and I wonder when we can finally hold hands again.