Before going into the isolation ward, nurses avoid drinking any water. This is because completely wrapped in protective gear, it is impossible for them to go to the restroom while wearing it. This was the first time that Choi, Ji-young, who has a twelve-year-career in nursing, wears Level D personal protective equipment or PPE. Level D PPE designed to protect medical teams from infectious diseases consists of a N95 mask, disposable gloves, a one-piece full-body protective suit, and overshoes. When wearing this gear for the first time, it feels overwhelming, short of breath and uneasy. It requires five minutes of deep breathing before entering the isolation ward. Commonly, the maximum amount of time a nurse or medical personnel can stay inside the ward wearing the PPE is about two hours before exhaustion sets in. Being weighed down by the gear, even simple movements create a power- workout sweat. The nurses exiting the isolation ward all walk out with a vivid goggle marks around their eyes and forehead.
Ms. Choi works at Daegu Dongsan Hospital of Keimyung University, one of the hospitals in the area designated for COVID-19. She was formerly one of the nurses in the Cancer Center of the same hospital but was assigned to the infection ward on February 26. “There was a shortage of nurses as patients began to flood in, and the nurses assigned earlier were bearing the situation sobbing with tears. When I saw it in person, I had no choice but to go,” she said. Choi has two children, eight years old and the younger one, three. She had to persuade her parents-in-law, the children’s caretakers while she works, before giving in to her. “Nurses should go where patients need them. Who knows who could be next; it could be your family. There is no guarantee that my family won’t be infected. Imagine if there is no one who can take care of them.”
On February 21, the Metropolitan city of Daegu and Cheongdo County, both in Gyeongsangbuk-Do Province were designated as ‘Infectious Disease Special Management Zone.’ The Ministry of Health & Welfare and the Daegu City Government assigned Daegu Dongsan Hospital, Daegu Medical Center, and other hospitals in the vicinity as bases to receive COVID-19 patients, and urgently started to call medical teams from all over the country. At the time, on February 21 the number of confirmed COVID-19 cases in this area was 84; after two weeks, the number swelled up to 4006. The front line nurses were the first ones to feel the change of the drastic situation. Daegu Dongsan Hospital, where Choi works, received 250 confirmed cases by opening six general wards and one intensive care unit in less than two weeks. Since the inpour of patients happened in a rush, the nurses began working in the wards prepared only by an eight-minute video on how to wear the protective gear.
Nurses refer the designation of base hospitals for infectious disease as “opening the ward”. By no means are these places open to the public and the patients are in full isolation; but for the nurses who must work there, the wards feel like an “open” space. “Originally three nurses were assigned in a ward with 60 patients, but now just two nurses must endure there. Even the intensive care unit has only one nurse,” commented Choi.
The shortage of nurses is far more severe than other medical staff and replenishing them with new personnel is an urgent matter. While working three shifts a day, they must take care of the patients from administering medicine to food delivery in this emergency situation, and the fatigue is accumulating in all of them.
Faced with shortage of labor, the Ministry of Health and Welfare recruited nurses to assign them to Daegu and the North Gyeongsang region on a large scale. According to the Korean Nurses’ Association in charge of the recruitment, nearly 1300 nurses applied as of March 2. Personal statements in the applications included such touchy messages like: “I want to work for the patients as soon as possible” or “I’m open to night shifts as well as three daily shifts.” One applicant said, “even though I’m on maternity leave, I applied with the support of my family. Remembering why I became a nurse, I hope to do what I do best for those that need me.” Eight-hundred seventy-seven among the new recruits were assigned to patient care wards, and 420 were assigned to ‘Selected Medical Centers.’ The COVID-19 prevention in Daegu and North Gyeongsang region is now highly dependent on their sense of duty.
“While the wards were being filled up by confirmed cases, the new nurses didn’t even have time to find dormitories. Some of them even had to spend the night at the funeral parlor of the hospital.” For nurses already working in hospitals in the affected areas, their workplace had suddenly been transformed into COVID-19 base centers. But no one bothered to asked them about their protection and well being. There was no discussion on whether they were allowed to have self-isolation period if infected or about hazard allowance. One such nurse, Nurse Woo, comments that those who were pregnant or had young children had no choice but to leave their jobs in the midst of it all.
Woo got a room near the hospital at her own expense. It was impossible for her to be admitted to the dormitory since she was working at the terminal cancer ward and had to join the team a few days later. In spite of the PPE, Woo is worried about the possibility of the virus spreading among her family. “I have elderly parents at home. I can’t go home after my shift.” She plans to stay at her accommodation until her duties are over.
The Ministry of Health and Welfare Guideline clearly specifies compensation for the dispatched nurses. The guideline stipulates special allowance for two weeks of duties undertaken in disaster stricken areas, partial support for accomodation, self-isolation period after the assignment, and more. However, this kind of support does not apply to cases like the two nurses, Choi and Woo whose hospitals where they originally worked were transformed into base hospitals. Nurse Choi volunteered with the expectation that the epidemic would be over within one month. Now she is not that hopeful. “See what’s going on here. How can I ask to give me a day off as if I am working my regular shift? All nurses here and elsewhere probably are struggling to hold up in the best way they can under this stress”
Medical teams are as vulnerable as any ordinary person in being infected and there are such cases, especially so in Daegu and Gyeongsangbukdo region. Confirmed cases among nurses at Daegu Catholic Univ. Hospital, Gyeongbuk National Univ. Hospital, and Daegu Dongsan Hospital have been reported. On March 1 the Selected Medical Clinic in Nam-gu, Daegu has been closed, because a nurse who had been collecting samples was confirmed to have been infected with the coronavirus. She was sent from the National Traffic Rehabilitation Hospital.
Up until March 4, 23,499 samples has been collected in the city of Daegu alone. Of these, 66.3% are from ordinary citizens while 33.7% are from the Shincheonji cult members. Professor Kim, Dong-eun (ENT specialist) from Keimyung Univ., who volunteered for medical service, finds people waiting for test on a daily basis. “People suspecting of having symptoms are ready to pay 160,000 Won (around US$130) and wait for one hour to take the test,” said Dr. Kim. Daegu recently set up four more clinics, because it could not afford to meet test demands in spite of 15 Selected Medical Clinics. Dispatched public health doctors and nurses together are working on sample collection.
Why people are more concerned about body aches than COVID-19
Nurse Lee, Myung-ji was also assigned to one of the Selected Medical Clinics in Daegu. “I’m often worried about the safety of the medical team,” commented Lee. In conducting the test procedure, swiping the mouth and nose with the swab, some people can let out a cough. That is why it is essential that the medical personnel take extra precaution in taking off the PPE in case residues may have have been attached to the wear. During the ‘visit examination’ which is conducting tests visiting the house of people in self-isolation, the hazard is as bad.
It is important to remove the protective equipment in a negative pressure tent blocking air. However, many medical personnel remove the PPE in some isolated corner with the thought that walking around in the protective suit may arise anxiety among the people around. Public Health Doctor Lim, Jae-woo who undertakes the visit examinations asserted “we are confident we can manage to control the infection, but that doesn’t mean we are not nervous. Because we are young, even if infected, the virus may not develop into a serious level. But the biggest concern is that we may become the carriers of the virus.”
The health workers on site have one common concern -- they are uncertain how long the fight against COVID-19 will last. The number of confirmed cases is increasing into triple digits every day. Some patients who were unable to secure hospital beds have also died during self-isolation. Nurses in the front line say that they are more worried about the body ache that comes from fatigue than COVID-19. Under these circumstances, greater burden will fall on the nurses on site. Nurse Woo at the Pohang Medical Center said, “Our mission is to prevent the Coronavirus from spreading, but I dread the thought of a void that could occur in medical personnel as we become ever more exhausted.”
“I shall do all in my power to elevate the standard of my profession (...) I shall be devoted towards the welfare of those committed to my care.” This is an excerpt from the Nightingale Pledge. This ‘sense of duty’ embraced in the pledge is what motivated numerous nurses to apply to the COVID19 infection wards. “If we think we may die, we will certainly give up. But we cannot give up the patients. That’s what keeps us going. But sometimes I think how long will this ‘sense of duty’ will hold us,” said Woo. It has been two months since the battle against COVID-19 started. The nurses who have sworn the Nightingale Pledge are in the front line of this battle, and they are becoming deeply worried.
translated by Hyeong jun Ahn
translation supervised by Beckhee Cho
