That’s the way the cookie crumbles

Practising with PPE is a daily challenge, writes Angelo Pricolo

Wearing a mask when going for a walk is tedious but spare a thought for healthcare professionals doing their usual job while wearing full personal protective equipment (PPE) for eight to 10 hours a day.

We have known for some time that the COVID-19 virus is hideously contagious yet the measures taken and amount of PPE required seems to have increased in a stepped pattern. It now feels like we almost need a double barrier to be safe.

Eye protection is now mandatory for all GPs in Victoria for face-to-face care, whether patients have COVID-19 symptoms or not.

Doctors are furious that the PPE is not readily available and even more outraged that in many cases they are being told they need to source and pay for much of this equipment themselves.

Melbourne GP Dr Mukesh Haikerwal said the situation was ridiculous.”I’m tired because nobody’s listening. The level of income is dropping dramatically in practices, and in that environment you are dealing with COVID and having to procure your own PPE. It’s another bloody brick in the wall.”

The reality of working with these new conditions means many are forced to wear mask, glasses and a face shield. Some have even proposed earplugs!

AMA Victoria president Associate Professor Julian Rait said private non-GP specialists were also facing challenges accessing eye protection from the national stockpile.

The ophthalmologist said there was evidence to show coronavirus could bind to receptors in the eyes and eye protection was essential: “It’s very disturbing that these resources are not adequately stocked,” he said.

Other GPs have complained that at the frontline it’s even worse: sweats, fogginess, breathlessness under shield, glasses and facemask and difficulties talking to patients directly or over the phone, difficulties seeing the blurry computer screen, typing errors.

Communication for many is the biggest barrier to compliance with PPE. How many times have we, or have we seen others, remove their mask at the most critical point in an interaction. Usually when two people are closest together the need to pass on an important message overrides the need to stay safe.

This is a daily challenge and adds a level of complexity and difficulty to what used to be a simple task. Counselling has become a communication nightmare as patients also struggle to give feedback with physical barriers creating a massive obstacle.

Eventually personal comfort also influences compliance whether it’s the elastic behind the ears or the foggy glasses; we have all been less adherent to best practise. Anti-fog sprays and wipes are remarkably useful though!

So although many onlookers demand full PPE as essential and expect it to be mandatory across the board, I suspect few have actually had to wear the gear for a full days work. Only then can someone really understand just how difficult a day’s work has become.

So thank you to the thousands of health professionals working under these conditions, trying to keep themselves and others safe, while also attempting to treat their patients. And let’s not confuse this with the difficulty others are having from their new working from home requirements.

Speaking to a mate recently it was interesting to reflect on his new COVID existence. He lives with his wife; they have no kids and have been working from home for the last 5 months. Other than the lack of social life sounded pretty comfortable: work, food and wine.

A job that can easily be done from home sitting at a computer! This is so far from the role of a healthcare professional, who on a daily basis manages public perception, the patient contact, patient care and the inherent danger of COVID…but that’s the role we have chosen and unfortunately some would say… “That’s the way the cookie crumbles.”

Angelo Pricolo is an addiction medicine pharmacist and former National Councillor of the Pharmacy Guild of Australia.

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