Covid-19 turned Parirenyatwa into a better hospital

AT the peak of Covid-19, the Government introduced a number of measures to contain the disease. Parirenyatwa Group of Hospitals became the major referral centre for coronavirus cases. Our reporter Debra Matabvu (DM) caught up with Parirenyatwa Group of Hospitals’ chief executive officer, Dr Aspect Maunganidze (AM), to discuss how the institution has fared in the past two years.

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DM: Take us through the journey of how Parirenyatwa Group of Hospitals fought Covid-19.

AM: We started hearing about Covid-19 towards the end of 2019 and at that time it appeared to be a foreign disease. However, it spread very fast and we had our first local case in March 2020. At that time, the Government was concerned with putting in place measures to curb the spread of the disease.

The Ministry (of Health and Child Care) then instructed all heads of institutions to present submissions on how to handle the pandemic. The question was: Should we leave treatment at traditional infectious hospitals or we take it to other better equipped hospitals? Parirenyatwa then felt it should help with the treatment and handling of patients. We came up with what we called a Covid-19 Expert Group Committee, which comprised experts in infectious diseases, physicians and microbiologists.

I was the clinical director at that time, so I became a resource person for that committee. That group then helped Parirenyatwa Hospital to do all preliminary preparations for setting up the unit. It became a 450-bed unit, which we called the Covid-19 Treatment Centre. Its purpose was to divide the main hospital into half.

The southern part of the hospital became the Covid-19 Treatment Centre. The main hospital has 900 beds. At that time, we treated the disease as something that should be barricaded totally from the rest of the hospital.

We made a lot of infrastructural changes, with barricades separating different units of the hospital to come up with the 450 beds for the centre. Those 450 beds were meant for severe cases, while hospitals such as Wilkins, Beatrice Road Infectious Diseases, Thorngrove and Ekusileni in Bulawayo were supposed to take in mild cases. So, we designated 24 beds for the ICU for Covid-19, of which two beds were for theatres, with nine for surgical Covid-19 cases. As you are aware, if you had Covid-19 and needed surgery, it was supposed to be done in the Covid-19 unit. So, we came up with a single unit that could cater for all services. Some hospitals could offer Covid-19 care, but if someone needed surgery while infected with Covid-19, they would be referred to Parirenyatwa.

DM: Were you not overwhelmed?

AM: We were overwhelmed. However, we had assistance from the army and medical cadres from the Zimbabwe Republic Police and Zimbabwe Prisons (and Correctional) Service, who assisted our health workers. In 2021, we went a step further and partnered Arundel Hospital, which has a private facility in Mt Pleasant that had been overwhelmed with numbers. They acknowledged our capacity in fighting Covid-19. We went into partnership and, in that regard, we set up what we called the Pari-Arundel Covid-19 Unit, where we designated 60 beds, which were called C1 and C2. They put equipment. Our partners also renovated and refurbished our elevators, which had been down for ages.

DM: May you highlight some infrastructure setup at the institution to continue serving patients post-Covid-19?

AM: We are the only centre that has what we call negative pressure ventilation. This is a high-tech mechanism that ensures the centre is free from bugs, and, in our case, we did that for our ICU critical areas, which have 24 beds, and our mortuary. As you might be aware, as long as Covid-19 is blown into the air, it will still be transmitted, even during post-mortem, where someone has already died. So, it becomes dangerous even for our pathologists to perform. We have provided negative pressure ventilation and it is now safe to do Covid-19 post-mortems.

We had to upgrade our infrastructure to suit this disease, which really demanded the best infrastructural preparedness. We spruced up that whole 450-bed unit. We did not have to build totally new structures, but we had to upgrade our infrastructure. It included water reticulation, especially in that area. Remember, it was a difficult time. Even our engineers did not want to go there once there were people inside. We received a lot of ventilators, oxygen concentrators, monitors and even theatres for Covid-19 care, as well as basic equipment for theatres, from the Government and its partners.

DM: What are some of the successes recorded by the institution during the Covid-19 pandemic?

AM: One of our worst Covid-19 seasons was the 2021 winter and 2021-2022 festive season, but we managed to do very well in terms of treating infected people. That alone was a success. We managed to handle Covid-19 well and we were successful in terms of international expectations and comparisons with other countries.

We had a low mortality rate of less than 5 percent, which is very remarkable, even in international statistics. All our teams were guided by World Health Organisation (WHO) protocols. We had a system of having guided dedicated health workers who worked in the unit. We managed to treat Covid-19 patients who needed specialised care, including pregnant women and renal failure patients.

DM: Do you have statistics of Covid-19 admissions at Parirenyatwa?

AM: We had a total number of 6 500 admissions, 5 923 recoveries, 577 deaths, 245 maternity cases. We also had 103 theatre cases and 85 dialysis cases.

DM: What challenges did the Covid-19 pandemic bring that you are still grappling with?

AM: We are proud to have gone through that phase, but we are turning around now to change our mode to non-Covid-19 care. However, this transition means a lot of challenges. I think it is natural to have aches and pains as we go back and focus on traditional non-Covid-19 services.

DM: In terms of human resources, how did you incentivise Covid-19 caregivers?

AM: There were incentives that were given to those who worked in this area. Of course, there were those given on a broader scale for all civil servants, which they are still getting up to now. However, we had incentives for those who work in the Covid-19 area. Their incentives were classified into three, depending on the risk. So, at Parirenyatwa, the health workers receive an allowance specific for working in the area. Up to now, we have an allowance for those who work in the Covid-19 area.

In addition, we went into partnership with the University of Zimbabwe (UZ). They provided accommodation for our workers who were treating Covid-19 for the whole two-and-half years. Those who worked in the Covid-19 areas were accommodated elsewhere as long as they were on duty because of their work schedule. The corporate world also came through with initiatives like “Business fighting Covid-19”, especially to incentivise workers because no one wanted to work in the Covid-19 unit.

DM: Any parting shot?

AM: The major highlight for us as a hospital was the ability to be versatile to adapt not only in Covid-19 care throughout the waves, but also being able to continue providing non-Covid-19 care. It meant a lot of dedication and innovation from our staff because this was a new disease. It meant learning and adapting to new equipment. It also meant a lot of synergies with Arundel Hospital and other experts I have already mentioned.

Another important factor was that we were able to learn from our Chinese friends, who had experienced Covid-19 earlier. Experts from Wuhan province in China visited the country to help us set up and designate different areas, and we had the privilege of having the Chinese medical team, which is still present, and we continue working together.

So, right now, as we turn the corner, we still make sure that there is enough care at our Covid-19 centre, even though we are at our lowest in terms of cases. There is still a dedicated space for Covid-19. We always reclaim that 450-bed space in between waves for non-Covid-19 care.