CROSS-CULTURAL PERSPECTIVES DURING PANDEMIC

U.S.A., ISRAEL, JAPAN, CANADA

Pandemic Medical Care Through The Eyes of ESSENTIAL WORKERS.

by Valeria Fugate

As the world waits for the effects of COVID-19 to subside, essential workers are helping society muddle through while keeping our civilization afloat. The experiences seen through the eyes of three essential workers, abroad and at home, give us a sense of the luxury we haveof being safe at home.

It’s a luxury not all can afford.

MEDICAL CARE AND COVID-19 IN THE U.S.A.

Kristen Bertolini works as a certified nurse assistant (CAN) for UC Health in Colo., U.S.A. Her job is to aid nurses and bridge the gap between medical staff, patients, and procedures. Currently, the staff there are provided with Personal Protective Equipment (PPE) like masks and gloves.

The dissolution of the Global Health Security and Biodefense unit in the U.S., responsible for the pandemic response established in 2015 and disbanded in 2018, means aspects of medical preparedness have fallen short, leading to rationing and in some cases hoarding, of certain medical equipment and supplies amid this pandemic. For Bertolini, PPE rationing means hospital staff gets one mask a day, then they are recycled. Masks are later re-tested for quality and reuse.

Hospital staff can wear their own purchased masks with filters if they can find them amid scarce resources, and if it has been approved by their human resources department.

When patients are especially sick, staff are required to go into an isolation room where they “gown up” with face shields and masks to protect them from contact or airborne saliva and mucus droplets.

The only time staff is required to wear an N95 mask is when conducting a procedure that causes airborne droplets (for instance, a nasal or oral culture that may cause sneezing or coughing, or for airborne illnesses such as tuberculosis and COVID-19). N95 masks then are used to prevent the health practitioner from getting infected.

According to the information given by the U.S. Centers for Disease Control and Prevention (CDC) for contact droplets, regular masks are fine and are typical practice within North America.

When airborne droplets occur, N95 masks are used to prevent the health practitioner from getting infected.

New procedures and protocols are updated daily for hospital and frontline staff as knowledge of COVID-19 and medical resource availability change. Citing other hospitals, Bertolini’s hospital has done its best to prepare for a rush of patients, but have yet to see overwhelming numbers, though she says the ICU units remain busy.

My hope is that the fear doesn’t over-run what we need to be doing, to keep (contracting) this as minimal as possible.

Kristen Bertolini, certified nurse assistant (CAN) for UC Health in Colo., U.S.A.

Despite being in the middle of a pandemic, UC Health hasn’t seen the numbers they were anticipating. Cutting staff member hours helps prevent layoffs since the hospital is not even at half-capacity. Cutbacks will be implemented on June 1 for an undetermined time, meaning staff will lose bonuses and raises due to low volume.

Bertolini hopes that hospitals will soon start re-instating elective surgeries and non-emergent patients to compensate for money lost during the COVID-19 lockdown realizing the ethically tricky situation that it would present, hoping they can find a safe way to re-open. Child care has also presented problems for Bertolini since no one wants to babysit the children of a hospital worker. She and her husband have had to juggle who can work and when.

TRAVEL DURING COVID-19

One of the hardest-hit industries during the pandemic has been the travel industry. Commercial Pilot Kevin Girard’s airline saw a drastic decrease in travel, with a 50 percent drop in March alone. The airline is predicting a 90 percent cut in flights by the end of May. As a precaution, airlines have reached out to the U.S. Department of State to offer their services and to keep their companies afloat. Flights are now providing essential services, which move state officials, medical personnel, and supplies nationally and internationally to COVID-19 hot spots. As a result, flights are now full in freight and almost empty in passengers. The 787s Girard flies carry a cargo capacity slightly under two semi-trucks worth of cubic feet and are always full.

MEDICAL TRANSPORT

Bringing back ex-pats and officials from abroad have also given leeway to courier critical medical supplies to the U.S. At the beginning of this pandemic, major cargo distributors such as Fed Ex and UPS couldn’t keep up with the demand. Passenger carriers have helped alleviate some of the load. Since the beginning, Girard said that every country had been overly accommodating in wanting to help and receiving help.

Pilot Kevin Girard.

“We have stuff they need, they have stuff we need, and it seems everyone is happy to see an airplane show up because there are hardly any of them in the air,” Girard says. “I see a very cooperative spirit, at least in the trenches.”

Policies have changed as health screening occurs before and after bordering flights now. Pilots are required to wear gloves and masks, and several countries will not let flight staff disembark without wearing N95 masks. Countries like Israel and Japan also require flight staff to sign papers that state they will not leave their hotel rooms once in the country — essentially self quarantining for the duration of their stay. Some even serve flight staff with disposable dishes to keep potential cross-contamination to a minimum.

New policies require that as of April, passengers must be socially distanced six feet apart. Aircraft are cleaned by staff after each flight, with international flights receiving electrostatic spray to all fabric to disinfect everything within the cabin. The cabin air also is cycled through multiple HEPA filters every five minutes.

PRECAUTIONS IN TEL AVIV, ISRAEL

Girard’s last trip to pick up medical supplies in Tel Aviv required flight staff to print international worker documents. If stopped by police during the quarantine lockdown, this proves flight staff are essential workers and marks the date of arrival and departure. In Israel, flight staff can stray no more than 300 meters from the hotel, almost a football field’s distance, and only to pick up food.

“If you didn’t have a bag of food, they’d stop you and fine you USD$1500,” Girard says. “The beaches were completely empty, and authorities would stop joggers.”

PRECAUTIONS IN TOKYO, JAPAN

Japan takes passengers disembarking further by removing international travelers off flights ten at a time. Greeters meet airplanes in full Haz-Mat suits and give travelers a full health screen including completing a four-page questionnaire. Anyone with a borderline high-temperature gets an immediate blood draw for anti-bodies. Japanese citizens are entirely compliant with what authorities dictate and no one bucks the system, according to Girard.

He says, “Tokyo is bigger than New York City. There was no one on the streets and anyone walking between buildings wore a mask. There was 100 percent absolute compliance, I’ve never seen anything like that in any society.” Comparing how countries have handled the pandemic amongst New Zealand, Japan, France, and Israel, Girard felt Japan dealt with it the best. With a population larger than New York City and high income earning citizens translating to a lot of travel, they had only seen 82 deaths, compared to New York City’s 290 deaths in late April.

“That’s the difference between compliance with what authority tells you and noncompliance, and that is a social issue. The death rate proves how effective that is,” says Girard.

Elaborating on what Western cultures could learn from Eastern cultures in a pandemic, Girard opines that everybody in Western cultures loves their freedoms, thinking of themselves as the ultimate authority and questioning the credibility of anything external to themselves. “Everyone thinks they know more. Eastern culture respects authority and does what’s told,” Girard says.

THEN CAME ALBERTA, CANADA

Chris Helios* works for the Alberta Health Region as a service one worker in a Canadian hospital — this means that he is part of the support staff that keeps hospitals running. Helios moves patients, beds, equipment, blood, stem cells and other essential errands for the hospital.

When the hospital received its first COVID-19 patient, tensions grew and policies began to change. Within four days, the staff started emptying the hospital. If patients could be sent home and return for surgery or treatments at a later date, that became the new protocol. According to Helios, as COVID-19 patient numbers increased, some staff stopped showing up for work, out of fear.

The emergency room began sealing curtains around beds and pinning contamination signs reading “contact droplets,” “contact precautions,” or “airborne precautions.” Nurses started peering at patients through curtains trepidatiously.

As sections and doors were closed within the hospital, nurses donned full protective gear to screen patients. Support staff such as housekeepers, porters, assistants, security, and food staff were given a new set of rules that differed from what had been mandated for years prior.

They became more lax. According to Helios, as support staff began asking for masks and gloves for protection, they were denied. Later PPE was provided but rationed, given only with permission of supervising nurses. Leaders allegedly told staff PPE wasn’t required even when dealing with patients who were suspected or confirmed with COVID-19. Support staff was required to move or work around patients with no gloves or masks. This exposed staff to patients who were coughing, disrobing, being transported in elevators, or in enclosed proximities.

Before COVID-19, when patients were labeled contaminated, there would be an isolation cart outside the patient’s room. This cart was loaded with gowns, face shields, gloves, and whichever mask is designated for that patient’s sickness.

That was no longer available. Support staff was required to ask for permission for any PPE. Some nurses still showed some trusted staffers where the stash of PPE supplies was held, but not all, out of fear of theft or hoarding. According to Helios, Alberta Health Service (AHS) gave nurses full control of supplies, and they ultimately decided if support and hospital staff received protective gear.

“If people only knew that they were next to somebody that spent the last seven days — eight hours a day — exposed to COVID-19 patients, people would be livid. We’re not protected,” Helios asserts.

Since the international run on PPE, the need to ration — and even hoard — has become an issue in most countries. Under the circumstance, the front liner gets priority on PPE, yet Helios says protection shouldn’t fall across class lines. He reminds us that denying essential protection support staff may cost lives.

“Our lives are no less important than anyone else’s,” he says. “To send us into a situation in which they would not go in fully covered is saying that my life is not worth as much as their life. I deserve an equal opportunity to be safe, to come home to my kids.”

The pandemic hit just before scheduled provincial workers strike in April. The Alberta government, under Premier Jason Kenney, planned to make it illegal for workers to strike. Kenney’s attempts to privatize and slash hospital wages follows a long legacy of cutting salaries, eliminating work differentials, and creating anti-union laws to maintain these initiatives. In many cases, workers are reliant on this differential to maintain their rent and house payments. Especially for low-income workers, single parents, and workers with no family support, aging parents, or family members with health issues. The differentials to minimum wages can mean workers’ ability to survive; yet if they become sick, who will care for their children and aging parents? For them, there is no plan B.

According to Helios, union protection and representatives have been passive at best. The last time reps got involved with the support staff was when they were about to strike before the pandemic hit. Helios says the union representative never appeared when AHS sent a notice to the distribution department to deny staff PPE. Culturs made multiple contacts to Alberta Union of Provincial Employee (AUPE) to garner a statement on this issue and as of publication, did not receive a reply.

A statement released by Senior Communications Advisor Melissa Ballantyne of the Alberta Health Service (AHS) states, On March 26th, AHS the Alberta Union of Provincial Employees (AUPE), Covenant Health (CH), the Health Sciences Association of Alberta (HSAA), and United Nurses of Alberta (UNA) reached a joint agreement on the safe and effective use of personal protection equipment (PPE) in our collective response to the COVID-19 pandemic.

"We are aware of the concerns being expressed by our frontline care providers regarding some of the personal protective equipment that has recently been distributed. We thank them for raising concerns. Their feedback is valuable. We are taking it seriously, and we are working to ensure they continue to have safe, reliable, and comfortable PPE. In response to their concerns, AHS is creating a worker-led focus group to review and advise on new PPE products. That is being purchased and address appropriate utilization.”

Helios admits social distancing can still be hard even without protective gear when patients are scared and in such need, citing one particular interaction:

“Last night one patient was like, ‘You’re so kind, nobody else has been that kind. You took the time to listen.’ And I’m sitting there so close, thinking oh my God I’m so unprotected. Still, I can’t walk away because she’s scared shitless and just wants someone to listen to her for five God damn minutes. She is an old lady.”

Helios understands why doctors and nurses on the frontline get paid so much money. Still, hospitals aren’t supposed to be in the business of creating more patients. Helios simply wants a safe work environment to do the job well. Without fear, these workers may come home one day and make their family sick, all-the-while knowing their employer doesn’t think they were important enough to keep alive.

*Please note, names were changed to protect our source’s identity.