Running into COVID-19 chaos

Starting a new job is always somewhat stressful. Starting a new job in emergency medicine on the brink of a pandemic? Well, that’s a different kettle of fish entirely. For the University of Cape Town’s (UCT) Dr Lauren Lai King, however, stepping into the role of course convenor for the Master of Medicine (MMed) in Emergency Medicine registrar programme at this particularly challenging time has been an unexpected opportunity to show her mettle.

Lai King started her new role as course convenor for Emergency Medicine Cape Town (EMCT) in March this year, just as South Africa started getting wind of the coming COVID-19 crisis.

“In many ways, this kind of public health pandemic is what we’ve been trained for,” she said. “So, this is an opportunity to run front and centre into the chaos. There’s no way around this; we have to go through it to come out on the other side.”

Melting pot of medicine

A joint venture between UCT, Stellenbosch University and the Western Cape Government, EMCT hosts the largest emergency medicine school in Africa.

The MMed Emergency Medicine programme is a four-year postgraduate specialisation, which includes both research and clinical components.

“The programme is really like a melting pot of diverse teams and projects,” said Lai King, who was among the 2019 graduate cohort. “We are fortunate to have EMCT as an umbrella organisation, which encompasses the full spectrum of emergency services in the Western Cape.”

Because Emergency Medicine runs the gamut of clinical disciplines, it’s well placed to coordinate the spectrum of services on the health platform. Graduates of the registrar programme are sought after for both clinical work – such as heading up emergency units – and management positions, where their broad perspective on the health system is deeply valued.

“It was definitely a case of being at the right place at the right time with the right kind of interests and skillset.”

Her ability to step into the role of convenor is, no doubt, also testament to the well-rounded nature of the programme, as well as her dedication to lifelong learning and keen interest in blended learning.

She said that being appointed in this role came down to a good mix of luck and creating opportunities for herself.

“It was definitely a case of being at the right place at the right time with the right kind of interests and skillset.”

Little did she know – when applying – that the job would come with the added challenge-cum-opportunity of a global healthcare crisis.

“I joined the role, but I definitely didn’t sign up for what I’m doing right now,” Lai King said. “I’ve had to do a lot of learning on the fly.”

Unavoidable surge

With gaining clinical competence and proficiency being central to the registrar programme, and emergency clinicians leading the charge in any acute health response, Lai King and her colleagues anticipated a wave of healthcare worker COVID-19 infections and braced themselves accordingly.

“We had our first faculty infection in late April,” she recalled. “Subsequent to that, we experienced a surge in cases.”

Since April, the programme has been hit with 12 infections out of a group of 70 registrars and faculty. Fortunately, all these individuals were able to self-isolate and have fully recovered.

As Lai King pointed out, 12 out of 70 is not an insignificant infection rate. It also closely approximates the higher range of the percentage of healthcare worker infections being reported by the National Department of Health. As of 17 July, the department reports that the national infection rate of healthcare workers stands at 5% and the World Health Organization reported that healthcare workers accounted for 10% of global infections.

“It’s been quite stressful, but in many ways [it] has actually been a way for us to pull together and unite and to really strengthen the relationships and the bonds that we’ve forged in the programme.”

A moving target

Of course, as a newly minted course convenor with the heavy burden of coordination and administration on her shoulders, the stress and challenges could easily have overwhelmed Lai King. However, she decided early on that the only way to approach planning was to see it as a moving target.

“Once we realised that it was impossible to create the most perfect solution, it freed us up in many ways to think creatively and to just adapt, move and adjust as things happened,” she said. “That really gave us perspective and prevented us from being too overwhelmed and having our morale obliterated to pieces.”

“It freed us up in many ways to think creatively and to just adapt, move and adjust as things happened.”

On the topic of morale, Lai King said that the emotional impact of COVID-19 – especially on the registrars – has been much greater than that of any other infectious diseases they’ve worked with in the past. This has required a more intensive approach to communication and support, as well as a pivot toward COVID-19 content in the academic sessions to empower the registrars with knowledge.

“Fortunately, we’ve also been able to be vulnerable with one another,” she said. “It has helped a lot to be able to share experiences, to chat about the challenges and debrief with one another. There really is no substitute for having a willing and understanding ear and shoulder to lean on.”

Furthermore, she cited the support of the Western Cape Government – especially in making mental healthcare services available – as well as the collaboration, coordination and advice with and from the team advising the National Institute for Communicable Diseases and the teams at Groote Schuur Hospital and Tygerberg Hospital.

Pillar of strength

While Lai King is proud of the collective resilience of her MMed Emergency Medicine colleagues and registrars during this time, her colleagues have experienced her as a pillar of strength throughout.

Having worked together during this time, Dr Colleen Saunders, lecturer and research manager in UCT’s Division of Emergency Medicine, witnessed Lai King stepping into her role, adapting to circumstances and supporting the registrars, as well as the Western Cape Government’s disaster response with “remarkable resilience”.

“I’ve been standing on the shoulders of the giants who have come before me.”

“[She] has had to hit the ground running without much time to figure out her new position,” Saunders said. “She has very quickly become a pillar of support for our registrars in helping them navigate both the professional and personal implications of this pandemic.”

Unsurprisingly, Lai King is quick to shrug off any praise that singles her out.

“I’m in the company of strong and motivated and experienced leaders. More often than not, I’ve been standing on the shoulders of the giants who have come before me,” she said.

Ultimately, she believes it is a privilege to be among those who have a role to play in the COVID-19 response.

“We’re not going to come out unscathed, but we’ll come out together,” she said. “The strength of the united collective is underestimated, and I think we’re definitely seeing the value of that now.”