Safety protocols of EMS in the province; School health service and mobile health service in Province

Meeting report

Western Cape Government: Health – Safety Protocols of the Emergency Medical Services (EMS)

Dr Shaheem de Vries, Medical Director at Western Cape Government Health, Emergency Medical Services, thanked the Chairperson and Committee for allowing the EMS to present. His presentation delved into the safety protocols of the Western Cape Emergency Medical services (EMS)

Early Response Phase

• Adequate Perosnal Protective Equipment (PPE) and training
• Emergency Control Centre training – case definition and pre-arrival instructions
• Dedicated Retrieval teams

Staff Safety: in a time of global scarcity

• The need to engage in a time of social distancing
• The problem of distance - physical and ideological
• The consequence of failure
• The importance of continuous engagement
• The call of duty in a time of crisis

Business as (un)usual – safety

• Deal with safety issue discussions, projects, workshops, and operations
• Protecting and supporting staff from external forces, primarily crime, and social unrest
• In the city a separate dispatch and communication desk was set up just to monitor crews working in the so-called red zones
• Current initiative around body-worn cameras and CCTV in ambulances

For the full presentation, see attached document.

Discussion

The Chairperson asked what the contingency plan for EMS services was, in instances where staff members were exposed.

Ms L Botha (DA) welcomed the presentation. She thanked Dr de Vries, the Minister of Health, and the team, for excellent work and support during the pandemic period. She wanted to know how the Department monitored frontline workers who were exposed, and when such workers were fully capacitated to go back to frontline duty.

Mr R Allen (DA) said when medical practitioners succumbed to Covid-19, it was presented in the media, and many felt heavy hearts at losing a medical practitioner who lost their life saving others. He extended his heartfelt and sincerest condolences to the families who lost loved ones during the pandemic.

Regarding the involvement and engagement with community neighborhood watch groups, he wanted to know if Community Policing Forums (CPFs) collaborated with law enforcement and if so, he wanted more details around it.

Secondly, he wanted to know what law enforcement was doing to ensure those who were part of the incidents were caught.

Mr M Xego (EFF) thanked the Department for its services during the pandemic, elaborating on its deliverance of a high efficiency emergency care training which was necessary, as well as putting engineering controls in place. This meant installing all necessary equipment to ensure things were working and staff were in a safe environment.

He wanted to know what the strategy of dispute resolution was, as he believed an essential service should not be withheld at such critical stages in time when it is needed most. He wanted to know what mechanisms were in place to avoid such situations or its reoccurrence.

Ms R Windvogel (ANC) welcomed the presentation from the Department. She asked for an update of the red zones, and how the Department would improve the waiting time for ambulances in those zones. People continued to wait for hours after requesting an ambulance.

Secondly, she wanted to know how many of the officials contracted the Covid-19 virus while in the line of duty, and what measures were in place to ensure the safety of both patients and staff members.

Lastly, she wanted to know who would bear the cost of the body-worn cameras initiative, including what the total budget for the initiative was.

Dr de Vries said, regarding the contingency plans, there were two areas which were of concern. The first related to ambulances and crew. It needed to look at how it enhanced its ability to respond to the ‘up to 50% workforce increase’.

It approached the Department, who agreed, a big portion of the isolation and quarantine sites be kept for staff. It had several staff members already stay at those facilities which made a massive difference to being able to say its concerns were heard and responded to. It also allowed staff to be able to report cases earlier and not only contain the virus, but also return back to work quicker. It had a meeting with the executive committee (exco) he previous day. It discussed the manner it would need to prepare for what lay ahead for the next three to five years, as a consequence of the code book. It saw this as a great positivity, which helped in drawing up a contingency plan for the decrease in resources which will occur.

The second concern related to the control centre outbreaks. In the initial phases, together with vendors, it had to set up satellite control centres at two or three of its bases. This allowed it to close down the main centre in Tygerberg to be deep cleaned and sanitised for reopening. It had to do this on three occasions, which led to a decrease in service for a considerable amount of time while trying to establish procedures. Currently, it was able to be fully functional within an hour, with the public not even knowing the situation at the control centre. It established efficiency procedures in the event the control centre ever has an outbreak, or in case of infection.

The commitment by frontline workers was just phenomenal. What happened was staff had what is called a ‘process report’, where workers were called and asked how they were doing, and screened according to symptoms. If presenting any symptoms, workers could choose to see their own General Practitioner, or could go to the clinic where they (workers) would be assessed and deemed fit for service or not. Workers would then be monitored for the next two weeks to see how they were doing. The Department established a great relationship with staff and management, which allowed it to make decisions in workers interest, and the public’s interest. The psychological impact was one which would be felt for years to come. This is said in light of the Minister highlighting mental health within the last week.

Dr de Vries thanked Mr Allen for his condolences and assured him the message would be passed onto the teams, as many lost loved ones during the pandemic. Regarding SAPS, he said SAPS was always great in responding to any help needed. Despite not being in much contact with the high-ranking officials of SAPS, he and his team engaged frequently with the Station Commander. SAPS gave phenomenal support which was pivotal in responding to incidences. There were 41 incidences, with an overwhelming 80% of the cases reported. Cases were opened, with arrests already made in one of the cases.

Where staff withheld services, they (staff) were dismissed. Those dismissals stood successfully throughout the process. The Department took the refusal of the response call very seriously. The constitutional imperative was denial of a response call was one of the most actional misconducts. When 90 staff members did this for three days, all were dismissed immediately, as the severity of the action was extremely high.

The Department would be foolish to ignore the context in which this occurred, and as such, the Department initiated a formal disciplinary process as well.

Regarding the red zones, it remained a challenge. The Department instituted temporary zones where it did temporary checks. It felt staff needed a sense of protection. Most recently, it instituted a temporary red zone for 48 hours. This meant it would be lifted, and normal duties would resume thereafter. However, one could not respond to the zone unless escorted by police officials. One of the strategies which came out of the safety forum was the notion of green corridors. Here the Department tried to encourage a move from red zone declarations to the maintenance of green corridors. What this essentially meant, was to establish a safe route with active Neighborhood Watch, into a neighborhood deemed as unsafe. The Department had some success with the initiative in the Hanover Park area.

The body camera initiative was mostly from the United States, Australian Police, and EMS services system. It was highlighted by the safety forum as an initiative to explore. It advertised exploration of it, and the tender published was an attempt to find out what the cost of such a program would be, including its implementation costs across the city platform. It was in the process of adjudication. It would be difficult to currently assign budgetary amounts to it. There would be a conversation going forward on the initiative’s sustainability.

Western Cape Government: Health – Safety Protocol on Mobile Services Presentation

Ms Catherine Bester, Director: West Coast District, said she would be doing the presentation, and thanked the Committee for its time. The presentation dived in and focused on the safety protocols of the mobile services unit.

Preparation of mobiles

• Cleaning and sanitising initially done
• Routine cleaning and sanitising at end of day service
• Minimum required stock, consumables, were packed in preparation for routes
• Staff team: only a professional nurse and staff nurse.

Patients/Clients

• Wear cloth masks. If not worn patients are given surgical masks.
• Sanitising hands, routinely done
• Health promotion and education: five golden rules
• Delivery of Patient medicine parcels to the homes
• Patient collects Patient Medicine Parcels from the mobiles
• Collaboration with farmers were exceptional

Social Distancing

• Patients waiting to be seen are required to sit or stand one point five metres apart
• Only one patient in the mobile consulting area with the nurse at any time

Lessons Learnt

• Good stakeholder collaboration
• Excellent partnerships were built with farming communities

For the full presentation, see attached document.

Discussion

Ms Windvogel thanked the staff for working so hard under the difficult circumstances. Her concern was, the previous day she visited one of the clinics, where there was a long queue. However, what she saw was everyone was served regardless of the circumstances or the illness. She wanted to know how chronic illnesses in the mobile stations were dealt with when there were no doctors or pharmacists.

Lastly, she asked for clarity on the staff composition of the different mobile services.

Mr Xego said his issues related to farm workers. Concerns were raised regarding people not having access to testing. He wanted to know what the best possible solution was in this case. He asked what the plan was going forward, to ensure everyone, even those in dwellings and farming communities, had access to tests and resources.

Mr Allen asked about the average time spent by a patient once entering the mobile units. Secondly, he asked how long a patient waited outside before entering the mobile units.

Ms Bester said she would definitely be forwarding the Committees thanks and acknowledgement of hard work to the rest of the team. It would a great morale booster of acknowledgement after a very tough year.

Regarding the long queues, she said it was a result of staff shortages. Despite Covid-19, a significant number of staff assisted high risk cases. Where people could not be assisted with direct contact people were assisted by agency staff successfully.

Regarding the rural area, she said the shortage of staff was not always due to a shortage of budget, but rather also a result of recruitment. Competent people willing to work in the rural areas could not always be recruited. As a result the Department struggled to assist farm workers. However, the Department worked very closely with Health Facility Boards and Clinics to get assistance out to the farming and rural areas. Staff shortages continued to be a work-in-progress.

An acute child who presented a fever of 38 degrees would be looked at before someone else with less severe symptoms. However, the long queues made it challenging to identify cases which needed priority, especially due to social distancing. The Department tried to learn and adapt its approach in rendering services. Covid-19 as one example of the Department working on a new service design to render services, to help alleviate congestion at clinics.

The Department would like to take its services out to the towns, and not only focus on acute clinics, to deal with the congestion. It is working towards this on a constant basis. It was a common complaint. There is a very close relationship with farm workers. The Department always followed up where necessary and were really trying to make sure it not only addressed its community needs, but strived to improve rendering services to communities on a daily basis.

It took a holistic approach to community in trying to provide the best possible medical care, and not only get healthy, but improve life expectancy. When people were suffering from chronic illnesses and diseases, parcels were delivered to the farm.

Members need to remember circumstances differ from area to area. As such, the Department needs to adjust its approach, so at the end of the day it can say the patient benefitted from its approach and services rendered.

Western Cape Government: Health – Integrated School Health Programme

Ms Eugenia Sidumo, Director: Professional Support, Western Cape Department of Health, presented on the Integrated School Health Programme.

Service Delivery Platform

• Integrated service
• Wellness mobile/busses (three in rural and two in metro)

Covid-19 Support

• Staff training – mainstream and special schools
• Infection Control & Prevention information
• COVID 19- screening tools
• Outbreak response support

Performance: Wellness Mobile

Optometry service

• Eye tests conducted: 3 595
• Spectacles issued: 489

Dental service

• Fissure sealants: 10 551
• Polish: 9 525
• Fluoride: 5 895
• Extractions: 6 331

For the full presentation, see attached document.

Discussion

Ms Botha asked the Department if tracing was done with learners who were not tested for Covid-19. She was referring to a school oversight visit the Standing Committee on Education did. Regarding the 3595 optometry tests done, the slide showed 489 learners received spectacles. She wanted to know if it meant only 489 learners needed spectacles, or if there was only enough funding to provide 489 learners with spectacles.

Mr Xego said the presentation highlighted the beautiful and noble cause being pursued. Life line embarked on a screening process in schools, and he wanted to know how far the process of screening was. He asked because there was an anticipated second pandemic wave expected before the end of the year, and learners were mostly back at schools.

Ms Sidumo said only when the school told the Department a learner needed tests, would the Department refer the learner to the optometrist for an actual test to be done. The evidence showed there were approximately 10% of learners who got tested, who required spectacles.

Regarding tracing, she said officials would go as far as possible to send community health workers into those communities. The health workers went to address those concerns at a Primary Health Care Facility or a Community Based Centre. However, as far as the case mentioned by Ms Botha was concerned, it was dealt with successfully. She said she would double check on Ms Botha’s question, however, feedback received showed the outbreak was successfully managed.

Love Life was not available in all of the Districts, and Sub-Districts. It was not active in all schools. With regard to screening learners, it was more of a partnership.

Dr Nomafrench Mbombo, MEC for Health, Western Cape, said there were other interventions occurring within the schooling context, but not necessarily linked to Covid-19.

In summary, the Department was involved in vaccines to prevent cervical cancer in girls, and some immunisation for boys and girls. She said the information presented focused mainly on Covid-19 and the mobile division services. However, there are other initiatives also, which were not mentioned, as it does not fall under the branch of what the Department presented on.

Committee business

The Chairperson said there was a proposal to schedule the Committee’s visit for 28 October, during the first week of constituency week.

The Procedural Officer for the Committee said the idea behind the week was for the Committee to visit other facilities, since the Committee hardly got an opportunity to do visits outside the Metro area. She asked for an indication if visits to the facilities would be announced or unannounced visits. Announced visits mean officials need to prepare presentations, which could be time consuming.

Mr Xego said perhaps the Committee could do two days of visiting facilities. He fully supported the dates proposed, and suggested the Committee leave a day before it started conducting its oversight visits.

Ms Botha proposed identifying more facilities to visit over those two days, and suggested unannounced visits. She suggested the Committee leave Tuesday, 27 October, and set aside Wednesday, 28 October and Thursday, 29 October for the oversight visits.

The Chairperson asked if Members agreed to Ms Botha’s proposal for Committee to leave on Tuesday, 27 October, and set aside Wednesday, 28 October and Thursday, 29 October for its oversight visits. These would be the provisional dates for the oversight visits.

Members agreed.

The Chairperson thanked the Committee, and said the information regarding the facilities would be provided in due course.

The meeting was adjourned.