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I hope you are healthy. I hope you are well. Or at least, as well as you can be.
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The last five weeks have been a stark reminder of how fickle life really is. How insignificant we really are. How frail our plans for the future can be, and how little we really know.
Regulation 11A of the Disaster Management Act has changed my practice significantly. Although it provides for “essential services”, the definition of “essential services” in the surgical field is very narrow, and for the last five weeks I have been prohibited from earning an income as I know it: I was not allowed to perform any surgery, unless it was to save a life. Nor was I allowed to consult with a patient, unless it was to save a life. This has certainly created a huge amount of stress and uncertainty.
I can no longer wallow in the quagmire of uncertainty. I have to look forward. I have to look upward. I have to live. I need to live now. Maya Angelou wrote this quote, it would seem, just for me:
My mission in life is not merely to survive, but to thrive; and to do so with some passion, some compassion, some humor, and some style.
The lockdown has many negative effects, but this one concerns me right now: it makes us believe that when it is over, so will Covid19. It lulls us into complacency, laziness and relaxation, which will make returning to work more difficult. Covid19 will remain with us past lockdown level 5. It will remain with us until it either miraculously disappears, or adequate vaccines can be manufactured to protect us all. Until then, it is here to stay - for the next months and possibly years. We can choose to stay at home until then, but when we venture out of our homes eventually, will we realise that we still need to protect ourselves?
We therefore have to start looking at life rationally, and plan for living life within the boundaries of the lockdown, whether it is at level 5, 4, 3, 2 or 1. We need to plan for living life with Covid19, and the safeguards it requires of us: washing our hands regularly, protecting our eyes, nose and mouth, keeping a physical distance from those around us, wearing masks, sneezing into our elbows and elbow tapping in greeting. This will not change in the foreseeable future, and the sooner we make this part of our regular life, and accept it as our new life, the easier it will be for us to adapt.
My practice managers have spent the first four weeks of the lockdown at home. Uncertain about their futures. Uncertain about the practice future. Ill-prepared for a life after lockdown.
Sr Beryl, Amori and I have attended to patients that needed urgent medical attention, and have also had to take the necessary precautionary measures to keep our patients and ourselves safe during this time.
Just how ill-prepared our practice managers were to cope with the new normal, became abundantly clear when we brought them into the practice this week: they were out of their comfort zone, suddenly realising that this new reality is not what they have been used to.
Therefore, they have spent this week in the practice, learning about their new normal. We have drawn up strict guidelines that need to be followed, strict protocols to keep one another safe and to keep our patients safe. They have practised and applied these guidelines.
We have put many measures in place to keep ourselves and our patients safe, including:
- Strict access control to the practice
- Strict hygiene measures
- Strict personal protection measures
- Changing of practice schedules, to ensure that we do not have more than one person in the practice at any given time
- Strict logging of anyone that gains access to the practice
- Strict screening of anyone gaining access to the practice, in addition to the screening that is done by the hospital for patients to gain access to the rooms
- Physical distancing measures put in place, which include changing the waiting room layout and moving admin desks to ensure physical distancing of staff
I want to assure each of you that we are well equipped and trained to manage your safety in the practice.
I need to urge every patient who is concerned about skin cancer or other lump or bump, or who have neglected a chronic medical condition during the lockdown, not to further delay because you are scared of contracting Covid19. We suspect that the indirect fatality rate of Covid19 world wide is huge. Figures from Europe, Britain and America confirm this: many patients with various cancers and with chronic conditions do not seek the necessary help they need, and then end up in trouble.
South Africa has astounded the world - not only by the timeous manner in which our government has reacted to Covid19, but also with the number of cases we are registering. We have also determined, at this stage, that our early lockdown was implemented mainly to allow our health system to prepare adequately. We have therefore not reached the “peak” cases as experienced in most of Europe, the UK and USA. And we do not expect to reach this peak before the last week of July and August in the Western Cape.
What we do know is that the winter months lie ahead, and everyone contracting the common cold or flu this year, will be considered to have Covid19, until proven otherwise. Once hospitals are filled during this time, you will inevitably find it impossible to receive the necessary medical care, even if it was urgent.
I therefore want to urge you to make that appointment now. To get that medical attention now, and if necessary, to have that surgery now. Before it impacts on your health. Before you are asked to wait another three months (or longer). We have all been in lockdown the last five weeks. Our hospitals have been mostly empty of ALL patients, including Covid19 patients.
The two hospitals where I practice have had measures in place since the beginning of March. We have all been trained, and every patient is treated as if they have Covid19. The hospitals have separate entrances for patients who show symptoms and those who don’t. The hospitals have dedicated wards for Covid19 patients. The hospitals have separate theatres for Covid19 patients. Everyone is as careful as they can be.
My procedure rooms are fully equipped and I will proceed with surgery with the necessary care and within the parameters of the law.
However, stringent criteria are in place to determine whether we can consult with you, and whether surgery can proceed. My staff are adequately trained to guide you in the right direction. Phone or email us if you are not sure, but do not delay a possible cancer or other medical condition. We have a very small time frame within which we can still treat you. Thereafter you will have to wait until the big wave passes us.
When you emerge from lockdown, whether it is now, or at a later stage, you will not find the world as you knew it. We will all be hiding behind cloth masks, we will be washing our hands, sneezing into our elbows, elbow tapping in greeting, taking care to stand 1.5 metres away from one another.
And so your visit to our practice will be different:
- You will receive a screening email before every appointment, which you need to complete, sign and email back to us. If you do not have scanning facilities, one of my practice managers will phone you before your appointment, and complete the screening telephonically. If you show any of the known Covid19 symptoms, you will not be consulted with, and referred to your GP for medical attention.
- You will not necessarily be able to get an appointment for a physical consultation. Where a telephonic or video consultation can reasonably be done, this will be the preferred means of consultation. We will explain this to you when you phone or email us for an appointment.
- Patients with proven cancers will have the option to be consulted and operated on the same day, in order to prevent multiple visits to the practice.
- You will not be able to bring a friend or family member with you to your physical consultation. We will only allow one person at a time in the rooms, unless we are consulting a minor or a frail person who needs a carer present at the consultation.
- Whereas we will see you for your wound check, dressing changes and removal of sutures, your routine follow up will be telephonic. Only if, during this telephone call, it is determined that you need to be consulted physically, will we bring you in.
What will not have changed:
- You will still see the friendly faces of our practice managers.
- It will still be my honour and privilege to see you and care for you.
- Sr Beryl will still look after you after surgery.
- We will still continue to inform you, stand by you, and support you through this journey of chaos and uncertainty. We endeavour to make it a bit less chaotic, and a whole lot more fun.
What this time has taught me, most of all, is that we don’t have all the answers. We don’t know a lot, and most certainly, we don’t know what we don’t know. For this, Maya Angelou has an answer: Do the best you can until you know better. Then when you know better, do better.
And this is my promise, and my support team’s promise to you: We will do the best we can, until we know better. Then, when we know better, we will do better.
We will do better, together.
Wash your hands. Keep a physical distance. Do not touch your eyes, nose and mouth. Sneeze into your elbow. Wear your mask. Double tap greet with your elbow. Smile and nod or wave. Always remain positive.
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