Earlier this month, Joe Kennedy sat down with one of his regular contacts in the medical field, located in Western Australia. Going into more depth about the experiences of doctors dealing with the effects of COVID-19 in Perth, Joe asked 6 simple questions that sparked tremendous insight into the current climate.
For privacy reasons, the doctor’s name has not been used in this interview.
To kick things off, how was 2020 for you and your colleagues?
Hi Joe, 2020 was pretty unchanged for most of us here in Perth from the COVID front – we had, like everyone else, the initial concerns about the arrival of COVID on our shores. We had a flurry of preparation trying to sort out new policies, protocols and PPE training, had a few patients to look after in the hospital and in the intensive care unit, and then, luckily for us in Perth, by June, it all settled down apart from a few cases in quarantine and thankfully, none since then who have been sick enough to require ICU admission.
I think I can safely say that my colleagues and staff in my unit have been very, very thankful that we’ve been spared the experiences of our colleagues, both internationally and nationally. We have pretty much been functioning looking after the “business as usual” cases almost all the way through 2020. The main bulk of cases in ICU here have been trauma, and despite an initial brief drop in case presentations during our very brief lock down, has been essentially running hot with high bed occupancy rates.
What were the major differences in 2020 compared to pre-Covid days from a clinical standpoint?
Interestingly enough, the pattern of presentations has changed somewhat – bearing in mind that we have an emphasis on trauma in my hospital, the pattern has fluctuated depending on the prevailing lockdown situation. There was a shift to domestic type cases – (falling of roof, fall from ladder, chainsaw injuries etc) as the lock down directed everyone’s energies towards home renovations (Hooray for Bunnings!) and much less high-speed trauma as travel was restricted between metropolitan and country areas. Subsequently, when those restrictions were lifted, there’s been a return to the usual high-speed vehicle trauma, and probably actually more cases, as WA’s strict border control has resulted in more travel within the state.
Mental health related presentations have also increased, as people have struggled to cope with the uncertainty of our current conditions. WA has been effectively living in a state of quarantine, with little ability for travel interstate or internationally, and the impact on family networks and supports has led to fracture lines in mental health and coping strategies.
Illicit substance related presentations have also been affected by COVID – availability was heavily impacted by the lack of international and internal logistics early in the Pandemic, and domestic manufacture of substances took over, with decreased drug purity leading to a variety of interesting side effects.
I think the biggest impact for us in our practice has been the difficulty in not having non-WA based next of kin see their relatives here in ICU. Exemptions (as the name suggests) are restricted and take time to process, and in a unit where trauma presentations predominate, untimely and sudden death have led to many difficult situations where family’s interstate and overseas, have had to have the end-of-life process managed via phone and video links. This change in our practice has continued here in WA because of the prolonged state-wide border closure, and our role in end-of-life care has been more demanding and difficult.
I recently had a patient with un-survivable head injuries who had no NOK in WA – speaking with his family, showing his distraught relatives images of him (they had wanted to see him, this was very distressing, as you can imagine with severe head and facial trauma), reassuring the family that whilst they couldn’t be here with him, he was still amongst people who cared. This was emotionally very difficult for all the staff involved, with everyone, from nursing staff, social worker, (myself) and the family all in tears by the end of that video call. This has been the new normal for us now for many months, but I also want to acknowledge that this is in no way as challenging as what our colleagues have faced on the COVID frontline in the hot zone.
When Covid first reared its ugly head, there was a lot of uncertainty as to how serious the virus was. How do you think your Health district coped with making sure all the Healthcare and Medical workers were protected in the right way?
Hindsight is a powerful tool and weapon, and whatever criticisms we had (and we had many) of the initial process, we have been in WA at least, really fortunate to have not had our preparedness tested to stress-point. We certainly didn’t deplete our stocks of PPE or go onto the second and third stage of the pandemic plan, where cohorting, using third party ventilators etc ever became a serious consideration, and so it is very difficult to fairly assess where we would have wound up had we needed to do so.
There’s been a lag time for us to learn from the experiences of the rest of the world and the rest of Australia. I feel that perhaps some lessons need to be learned more expeditiously, and the fact that we’ve had minimal impact on our lives has made the public complacent about general public health measures, which sets up an increased risk when we do finally have to confront an outbreak in this state.
Have you received help from the CICM during the past 12 months? If so, was if sufficient or what could they have done better?
CICM (College of Intensive Care Medicine) have been really, really effective helping our trainees. The exams are always a major stress for them, and the uncertainty of administering the exam under COVID restrictions was addressed really well by the college, with a lot of support provided to make the candidates familiar with the new format. As someone who is quite involved with the fellowship preparation, the feedback I have received from our candidates last year, and my own personal experience has been that they have been accountable, there has been excellent communication and planning and that the welfare arm of the college has stepped up and performed!
Australia has dealt with the Pandemic relatively well in comparison to other countries. This is because we shut the countries’ borders almost instantly, but this also meant State Leaders decided it would be a good idea to close borders internally. Do you think this was the right thing to do? What was the impact on your Hospital?
Internal border closure has been a blessing and a bane. I feel we have become more parochial in our outlook, and there has been a tendency to view ourselves as living in the garden of Eden, where life is unchanged, we can go to the Fringe festival, dance on the stage and enjoy ourselves.
No one is really considering the price of “freedom” – or what the impact of having complacency, a population that is ignorant and essentially unconcerned by public health measures will be when it eventually breaches our borders.
I am grateful for the normality it has given us, but it has been in place for so long that I think we have forgotten what the point of the closure actually was, which was to contain and minimise the outbreak, not to prevent us in WA from ever having to deal with community transmission.
In terms of the impact on the hospital – staffing has become even more of an issue, and the attractiveness of moving to an essentially COVID free lifestyle has to be balanced by the loss of our connectivity to family and friends (so many friends who have moved to WA for work have no ability to see family, go to weddings, see new nephews and nieces or to go home to see loved ones who are ill or dying). We certainly have lost a large proportion of residents from Ireland and UK due to these considerations, and those who have chosen to stay often struggle with the impact of their choice to remain.
Finally, I can imagine fatigue management must have been difficult to deal with from a hospital perspective due to borders closing and for a period, Healthcare workers were not able to get exemptions to travel interstate, did you find you were asked to work a lot more than your contracted hours? How was this discussed with the teams?
I myself have benefitted from this Pandemic, with the expected increase in patient leading to my appointment as a new additional consultant in my hospital.
However, there is a general increase in fatigue, especially the nursing staff.
I have worked more than contracted hours, partly because in order to support the Country Health Service during the worst of the lockdown and staff shortages, I had accepted extra work (as discussed with my head of service) to support them. I think there’s been a lot of consultants in the metropolitan area who have worked extra shifts in the country as well as metropolitan area to help with the shortfall from not being able to access interstate locums.
Thank you so much for taking time out of your day today, it’s been incredibly interesting listening to how you have dealt with COVID-19 personally in Perth, and how the same pandemic has been experienced so differently across the country. Stay well.
Joe has been working in Medical recruitment since arriving in Australia in 2015. He has worked across different areas of Medicine so understands the different idiosyncrasy of each area better than most. With a broad understanding of both public and private Hospitals, Joe would the best person to speak with if you are interested in exploring something different.
In his spare time, he tries to wake up most weekends early enough to watch his favourite team, Millwall (don't judge him - but we do) as well as spending time with his wife and beloved Samoyed dog, Leo.
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