NCRHA prepares for a future beyond covid19

THE North-Central Regional Health Authority (NCRHA) is preparing for a future beyond covid19, its chief executive officer, Davlin Thomas says.

In a wide-ranging release, in which he outlined some new initiatives and the progress of those already in the system, Thomas admitted that the covid19 experience inspired courage from all staff and the authority took the challenge to “further develop and create ground-breaking ways and methods to provide its patients with the highest possible quality of healthcare.”

In a climate such as this, it was imperative that we were able and willing to adapt, innovate and even expand our capacities to treat with any challenges that may present themselves now and in the near future,” Thomas added.

The release identified one of the successful projects implemented in 2020: the covid19 executive wellness clinic at the Arima General Hospital which targets post-covid19 patients who were critically ill and hospitalised in intensive/high dependency care units but who have remained negative for at least three months since.

The unit offers diagnostic examinations and specialist services in cardiology, physiotherapy, nephrology, pulmonology, social work and nutrition, among other things to these patients.

Medical Chief of Staff Dr Ravi Lalla said the service serves as a one stop shop where all facets of the service is conducted during one visit, although it is split into two rotations, one in the morning and the other in the evening.

“During the morning rotation, clinical assessments such as echocardiograms, chest x-rays, ECGs and Blood investigations, focus directly on areas susceptible to compromise by the virus. Additionally, counselling services such as psychiatry and social work forms part of the second rotation, with compounded services from our team of specialists - cardiologists, nephrologists, pulmonologists, physiotherapist, dieticians, and nutritionists.

“It is really a concentrated team effort, multi-faceted with varying functions, but it is in the coming together of each part as a whole that we are able to ensure improvements in the quality of life for every single one of our patients,” Lalla explained.

Thomas said of equal importance to treating covid19 patients, the authority has also placed emphasis on post-covid19 care.

Thoracic Medical Director at the Caura Hospital, Dr Michelle Trotman said the clinic was conceived on the premise that post-covid19 patients experienced post-traumatic issues like lung failure, renal failure and life threatening conditions.

She said the NCRHA, and the Ministry of Health, were concerned because of the novelty and uncertainty of the disease, and its possible lingering effects on the body.

The NCRHA’s release said examination of post-covid19 patients have provided insight into scar tissue and organ damage, supplied data for research and development and will even advise possible health management approaches in the future.

Thomas commended the diligence of the medical staff on the frontline, highlighting their commitment to do whatever necessary to ensuring that the patient always benefits. “Patients are no longer required to seek out and attend clinic sessions with varying doctors, but are afforded the value of having each doctor attend to them in seamless collaborative effort.

“The implications for which, as you would imagine, are tremendous, as patients have consistent access to a cross-section of interdisciplinary specialists providing them with the necessary medical interventions – simultaneously. These doctors and nurses do not work in isolation, but are committed to working in tandem to ensure continued improvement in the health and lives of the citizens of TT,” Thomas added.

To engage and to improve patient comfort and well-being, the NCRHA introduced into its services - respiratory physiotherapy by employing specialist therapists at its covid19 centres, the release added.

Under the guidance of specialist physician Dr Gerard Antoine, who has 10 years’ experience in respiratory care in the US, and Dr Trotman, a pulmonologist, a three tier respiratory care programme was instated to educate and equip medical staff at the NCRHA, more specifically patient care assistants, enrolled nursing assistants and registered nurses.

Initially, covid19 centres were assigned specialists on rotation, but the release noted that upon seeing the need for an expansion, more specialists were assigned and additional medical staff were trained to increase capacity.

Antoine indicated that the training, which is ongoing, covers basic and immediate level care for patients who require minimal respiratory care; oxygen management; pharmacology; nebulisation therapy (tier 2) and also training in incentive spirometry.

“Dr. Trotman and myself, in collaboration with the training unit, and our dedicated physical therapists who are committed to the success of our training sessions, have taken directives from the board of directors and the CEO to orient staff to world class health care practices, specific to the needs of those patients suffering with respiratory illnesses,” he said.

Before, there were no specialist respiratory care programmes in TT.

Plans are also in place for a nine-month respiratory technician programme. “Metrics have shown that there have already been significant improvements post-training from the first round of participants. This is evidenced, not solely in the retention of information and completion of classes, but we are seeing it, in real terms, in the application of healthcare and in the feedback received from our patients,” Antoine said.

As part of its covid19 treatment plan, the NCRHA also introduced the patient liaison unit which operates as a point of contact with patients and their families. The unit was specifically designed to call and engage patients and enquire of their needs and provide real-time intervention or direct their concerns to respective clinical heads for assessment and assistance.

“The reality is that, for many patients warded at the Couva Medical and Multifunctional Facility and Caura Hospital, their covid19 experience has been frightful, stressful and extremely distressing.

“We cannot begin to imagine, but we were deeply moved to put as many mechanisms in place to ensure that the impact of the ordeal for each patient was subject to the impact of the intervention. These mechanisms could only happen through the efforts of our staff, the dedicated members of the NCRHA team who willingly put themselves on the frontline time and time again,” Thomas said.