By Dr. Lauren Tailor BSc., PharmD., MPH Epidemiology Candidate
The COVID-19 pandemic has highlighted the importance of healthcare providers locally and globally. Nurses, physicians, pharmacists, and other healthcare/essential workers continue to put themselves on the line daily as the case numbers and hospitalizations of COVID-19 rise in Toronto and the rest of the country. I had the pleasure of interviewing three young healthcare providers to get their perspectives on working through the pandemic.
Joining me for this interview are Tara Tameta (Registered Practical Nurse), Teffran Chan (Doctor of Medicine and medical resident), and Rob Nunn (Doctor of Pharmacy and pharmacy resident).
Thank you all for taking the time to speak with me today. Would you be able to briefly tell us about your healthcare background?
Tara: I am a Registered Practical Nurse currently working in the long-term care (LTC) field. Prior to this, I was working other jobs in medical clinics as well as working alongside public health administering vaccines.
Teffran: Growing up in a family predominantly invested in health care, it has always been an interest of mine. Exposure to multiple fields throughout the years reassured me medicine was where my passion lay, specifically surgical medicine. As such, I completed my medical school training at McMaster University and have since started my residency in Otolaryngology - Head and Neck Surgery, at the University of British Columbia, where I am in my first of five years of surgical residency training.
Rob: I am a pharmacy resident at St. Michael’s Hospital and a recent graduate from the University of Waterloo’s School of Pharmacy. Right now I am working on the cardiology unit at St. Michael’s as part of an interprofessional team helping to optimize medication therapy for patients who are admitted to the hospital. This includes making rounds with the physicians and residents, making suggestions and adjustments for their medication therapy, counselling patients on their medications, and lots more.
As a recent Doctor of Pharmacy graduate, I worked in direct patient care from March to August, and found that we had to adjust to the new pandemic changes almost daily. What were some of the major changes you faced during school or work due to the pandemic?
Tara: I started working in LTC right when we were declared in a pandemic. Although changes were already occurring, my work was still in a state of uncertainty at this time. When I was first hired, nobody in the home wore masks. However, overtime, masks became mandatory, hand hygiene checks became a new nursing task, face shields were necessary… Everything had changed. From coming in to work extra early to ensure you get to swipe in on time because of the lengthy COVID-19 screenings, to increased daily use of PPE. Doctors also refused to visit residents in person resulting in increased nursing dependency….everything had changed.
Teffran: Working in the hospital during the time of a global pandemic has been an interesting experience to say the least. I feel like it has really shown the best and worst humanity has to offer. Thankfully, I'm surrounded by a positive, motivated, and optimistic group of colleagues who are my source of support. Especially being the airway surgeon, managing stress and anxiety around procedures, operations, and patient encounters was difficult at the beginning. However, with the ever expanding base of evidence and understanding of the virus, we know we can mitigate risks with proper PPE usage and "don and doff" techniques. Inherently it makes each patient encounter more tedious, as well as adding more barriers between healthcare provider and patient. However, I'm grateful most of my patients understand that PPE is for mutual protection, and they've been very cooperative through it all. Lastly, one of the most difficult parts of working during the pandemic are hearing the stories of hardships and heartbreak. Truly, this pandemic has challenged every individual in all facets of the biopsychosocial framework, but to see people make big personal sacrifices to reduce our numbers in British Columbia has been inspiring.
Rob: The first wave began at the beginning of my PharmD rotations, and my classmates and I experienced a lot of shuffling as hospitals and other sites cancelled their rotations due to COVID-19. Once I started my residency, I was surprised by how much work I did remotely from home, and now that I am in the midst of my clinical rotations in a busy Toronto hospital, I can definitely see the strain placed on our ICUs and healthcare providers.
It’s so interesting to hear how your practices were affected. The pandemic has definitely made direct patient care more challenging. What obstacles did you face with respect to patient care during COVID-19? How were these obstacles circumvented?
Tara: The most difficult obstacle I faced with respect to patient care during these times was watching my residents slowly decline due to lack of family support. In the time when visitors were not allowed in homes, I was communicating with family members, who I had never met before, constantly over the phone. I watched my residents become less energetic and have increased episodes of anxiety and depression. COVID-19 was not killing my residents; it was their loneliness and isolation. Luckily, because of technology and modern times, we were able to break these barriers with window visits and facetime calls. Although it was not the same, it was something that brought a glimpse of hope to my residents that they would soon see their loved ones again, and vice versa.
Teffran: One of the big obstacles of providing patient care during the global pandemic has been trying to counsel patients on a pathology which is so novel to the scientific community. As physicians, we are often looked to for all answers of medical ailment and pathologies. I think managing this expectation and explaining how limited our knowledge is regarding COVID-19 has been difficult. With expanding knowledge comes frequent changing public health recommendations. As a result, confusion and frustration by the public is quite understandable. I address these obstacles addressed with patience, clear communication, compassion, and proper patient counselling. Understanding my privilege of health literacy helps keep me grounded when addressing seemingly egregious questions and opinions.
Rob: One of the main challenges I’ve faced as a recent pharmacy graduate has been delayed licensure. To become licensed as a pharmacist in Canada you need to pass an in-person exam, but this exam has been postponed indefinitely due to pandemic restrictions. This means I’m in a bit of a limbo where I’m no longer a pharmacy student but I’m also not fully licensed as a pharmacist yet, and I’m still not sure when that will happen. In addition to that, not being able to see patients face-to-face a lot of the time makes it more challenging to counsel them on their medications or know what they are taking at home, since some patients have trouble describing their medications to me. To overcome this, we use things like Facetime.
All of your challenges are so unique and really highlight the complexity of pandemic’s negative impacts. Thank you Tara for shedding light on the mental health impacts that come as a result of isolation, particularly for those in LTC who have to be more isolated than many of us due to their high risk of infection. Teffran, your comments on knowledge translation based on evidence in an ever-changing environment really resonate with me as a PharmD graduate and public health professional. Our patients look to us for up to date resources, and we often face blame or frustration when we don’t immediately have the answers. I really love your approach to tackling this issue, since the best we can do is try to explain the evidence at hand and put our patients first. As a fellow PharmD classmate, I am in the same boat as you Rob, and hope the situation will be resolved soon (and safely). When interacting with your patients, how do you minimize risk to them and to yourself?
Tara: It is nearly impossible to distance yourself when you are a frontline worker, however, the best I can do is make sure I have proper PPE on and follow all safety protocols in my LTC home.
Teffran: Yes, I agree. Proper PPE usage, "don and doff" techniques, and proper hand hygiene around the hospital are key.
Rob: I minimize my risk when taking care of patients by only interacting with them when absolutely necessary and by wearing appropriate PPE and practicing hand hygiene.
On the note of personal protection, have you received the COVID-19 vaccine?
Tara: I have received both doses of the Pfizer vaccine. I will do everything I can to protect myself, my residents, and my family members at home and I strongly believe that I made the right choice.
Teffran: Yes, I have received my first dose of COVID-19 vaccine and fortunately have not suffered side effects from it. I highly encourage eligible groups to strongly consider getting vaccinated when the appropriate opportunity presents itself!
Rob: Yes, I have received both doses of the COVID-19 vaccine and feel very fortunate to have done so.
I’m glad to hear it! Thank you all for sharing your different experiences working in healthcare on the frontline. Do you have any final advice for Ontarians and Canadians with respect to COVID-19 safety?
Tara: My advice for Ontarians and Canadians is to stay strong and stay home. We are living in a new normal and this may not go away for a while, but it definitely will not go away if we do not comply with the government’s advice and recommendations. We are all sick and tired of what is going on, but this is real life; this is now. Please continue to social distance and only leave for essential services. Many young healthcare workers like myself signed up for this job but no one signed up or expected to work in a pandemic so soon in our careers; or at all. Many of us are burnt out and exhausted, but we are trying our best to keep our Canadians safe; so please wash your hands and stay home, and stay safe.
Rob: My advice for Ontarians and Canadians with respect to Covid-19 would be to follow the guidance of your local public health units, continue to practice social distancing and hand hygiene, and try to think of yourself as part of a collective effort to beat this pandemic. I would also encourage everyone to get the vaccine when they are able to. Personally, I’ve found that Facetiming with my friends and family has helped me get through the isolation a little easier and I would encourage everyone to find ways to stay connected with their loved ones to support their mental health.
Thank you to all three of our young healthcare workers. This pandemic has demonstrated just how vital our frontline workers are, and I think I speak for all of us at UTIHP when I say thank you for being heroes in this pandemic.