‘Mullingar hospital rose to the challenge’

The early days of the Covid-19 pandemic were “very, very scary” for the staff at the Midlands Regional Hospital Mullingar, but they “rose to the challenge”, says general manager Anita Brennan.

Reflecting on the first six months of the Covid-19 era, Ms Brennan says that early weeks were a steep learning curve for every member of the 1,000 strong staff.

“We were like every other hospital in the country. We have our experts in infectious diseases but because this is a pandemic you are asking people who don’t normally work in the area of infectious diseases and respiratory conditions to drop what they are used to doing and do something else.

“I suppose the unfortunate part of the pandemic was that life as we knew it in the hospital had to change completely because we had to respond to numbers that were surging quickly. I am happy to say that Mullingar did rise to the challenge. There was a lot of infrastructural work done quickly on site to create a hospital within a hospital.

“A lot of hospitals will be an acute adult or children service – we have both, in addition to maternity services as well. We are tri-located, almost, as a hospital.

“We had to be able to cope with emergencies that were non-Covid and we also had to cope with the pandemic. We had two EDs. We had a respiratory ED and the normal ED, and you had to separate them. We also have our paediatric ED, so we also had to have a double fold on that as well.

“We also had to get grips with what we were going to do with outpatients. We quickly got to learn about virtual clinics. That was a challenge, then there was the social distancing with staff and staff cocooning or who were vulnerable. We had to try to make the best of our resources. A lot of staff worked from home when they could and we tried to create social distancing in our offices. There was a raft of challenges which kept us busy.”

Mullingar is one of the only hospitals of its size to have its own Covid testing hub for staff and patients, which “really helped” in the early days of the crisis, Ms Brennan says.

'Shared purpose'

Another positive has been the attitude of the staff, something their general manager greatly appreciates.

“It’s like every business and organisation – you have your own territory and people will vie for their service, but with this there was a feeling of shared purpose and togetherness and looking out for each other and our patients and doing the best we could. I think that we rose to the challenge.

“We have a terrific nursing cohort here and our lead anaesthetist at the time, Anne Bergin, and our medical leads for Covid, Senan Glynn and Mark Sheehy – I have never been so reliant on clinical staff to steer me in the right direction. It was a beautiful thing in one way to see clinical staff stepping up and taking the lead for this unknown phenomenon.

“In addition to the nurses and the doctors , cleaners and catering staff – particularly during a pandemic it’s even more important. The ferocity and concentration around cleaning a space where you are dealing with an infectious disease is difficult. The cleaning staff have to put on the same PPE as nurses and doctors. It was a really scary time for them as well. They did a phenomenal jobs.

“In addition to that our catering staff [were great]. No patient can leave hospital or get better unless they are nourished. Our food service is critical. You had people as well on the clerical and administration side who were used to coming in and doing a job and they all stepped up, were retrained, redeployed. The whole collegiate, shared purpose type of environment was really lovely to work in, albeit we had our challenges. People got very ill with this.”

104 Covid-19 cases treated

To date, the hospital has treated 104 members of the public diagnosed with Covid-19, 79 of whom were admitted. Nine members of staff who contracted the virus were hospitalised.

Ms Brennan, who declined to say how many confirmed cases were among staff, says most of hospital workers that contracted the disease did so in the early months of the crisis and might have contracted it outside of work. The initial phase of the pandemic, when little was known about the virus, was particularly challenging, she says.

“It was scary for everybody. I will say for the clinical staff when you come into work and you are an expert in your area and you’ve dealt with heart attacks and strokes and flus, you know what the therapies and treatments are and what to expect. You can predict and plan. But with Covid-19, it was an evolving situation in terms of how the disease presented itself, what we knew about it, in terms of the impact, and in how it is contracted. For a period we didn’t exactly know what we were dealing with.

“Not only were you grappling with not trying to catch the disease yourself and trying to the best for your patients, you were also going through a learning period. That was evolving quickly and in a constant manner. One day you don’t have face masks, the next you do. Policies were changing and you had to keep up with that. Not alone did you have to contend with this huge change of keeping yourself safe and keeping your patients safe, and we had difficulties with staff getting the correct PPE. All that came in time.”

Maternity Unit restrictions

In order to limit the risk of staff and patients contracting the virus, the hospital had to implement visitor restrictions. Those imposed in the maternity unit were criticised by many expectant mothers and their partners.

Ms Brennan acknowledges that the total visitor ban at the start of the crisis was difficult for patients and staff. In addition to partners missing out on the birth of children, families were also prevented from visiting dying loved ones.

“When Covid began we had a total visitor restriction ban until we knew what we were dealing with and we were more comfortable. I think the maternity one has been difficult. Both for mums, babies and partners but also for our maternity staff, Sam Thomas and Marie Corbett and their team. They are so dedicated to what they do and the live, breathe, eat and sleep the maternity services and women’s health in general here in the hospital. They are really expert at what they do.

“We are small hospital with a small maternity unit. We don’t have the comfort here that they would have in the bigger hospitals. So if there was a cluster of Covid among the maternity staff, the maternity service would close. In as much our new mums suffered during that period, and I know they did, and it was difficult and for expectant dads, we tried to keep the service safe for all future mums could continue to use the service. That’s the reality for us.

“We have a small cohort of staff that look after the maternity unit and we could not afford to lose those staff to Covid.

“The other thing people need to understand is that we are not just dealing with maternity services on site. We have a large elderly cohort of patients that are vulnerable to this disease. In addition to that we have a special care baby unit and we also have a paediatric unit. We had to make a decision to try to protect everybody.

“We have reviewed our policy and expectant partners and mums are now together maybe for a shorter period during labour than they would like. They are also present at birth and for a very short period post birth. We will continue to review that as time goes on. We are where we are at the moment and we have to make the best decisions of everybody in Mullingar. The staff do their absolute best to try and compensate for the fact that mums don’t have their partners with them. They are a terrific team. They are so good at what they do.”

Backlog

A number of organisations such as the Irish Cancer Society and the Irish Patients Association have expressed concerns about the backlog of procedures such as cancer screenings and elective surgeries due to Covid-19.

Ms Brennan says that while procedures had to cancelled, services resumed “once our figures became manageable on site”.

“We still have our two separate EDs and we have to keep that going. We have reopened our outpatients department, albeit there are not as many people visiting because of social distancing, and we try to use as much virtual technology as we can. Our doctors are getting good at that.

“Mullingar isn’t a cancer treatment centre but there is that fear that diagnostics may have been missed. All I can say is that we have resumed services here in Mullingar and our theatres are back up working to full capacity.”

Living with Covid

With a Covid-19 vaccine not expected for at least a year, the world will have to learn to live with the virus. The hospital is preparing for the first winter of the Covid-19 era and a surge of cases.

“At the start we had no idea what to expect,” Ms Brennan says, “now we do in terms of Covid, we are living it. Winter is different because we expect flus and colds.

There are different strands of flu and flu kills a certain percentage of people every year. It is going to be difficult in winter when people are presenting with respiratory complaints through ED, to know whether it is flu or a chest infection, normal cold or Covid, because the presentation of symptoms is similar. That is going to be difficult.”

The hospital’s efforts will be boosted by a trio of new projects that will be finished by the end of the year. In addition to a new lab, a new 10-bed isolation ward will increase capacity, while the ventilation system in the ICU is being upgraded so it can have negative pressure [negative pressure rooms have lower air pressure, which traps and keeps potentially harmful particles within the room]. Ms Brennan also revealed that early next year the hospital is also hoping to “streamline” its ED and acute floor to “make them work better for us”.

“These new additions will significantly improve how the hospital works day to day. It’s not before time for Mullingar. It will inject some life into the building. People are getting ideas about how services can be tweaked. It’s all patient orientated, about how we can make life for patients in Mullingar better. We have a wonderful staff here in Mullingar and we have a good hospital, but it needs the improvements that we are going to get.”

Public's role

While the new investment will help the hospital and its staff deal with the next phase of the crisis, the public also has a role in ensuring the number of Covid-19 cases remains at a manageable level.

“The asymptomatic, invisible aspect of this disease is challenging. I suppose people should just be really aware of that, in particular with our children. Just because you appear well and feel well, doesn’t mean you don’t have Covid.

“What I would also be saying to people is that if they are unwell at home and don’t have an underlying condition, they should be visiting their GP and chemist, a thermometer is always hand to have at home. Also continue to social distance, to do what we are doing. The hope would be this winter that because our elderly and vulnerable members of the population with underlying condition have been cocooning, there won’t be the surge of our normal winter bugs. I am hopeful of that, but we just don’t know.

“The other thing I would say to people is get your flu vaccination. If you are over a certain age, if your are vulnerable and if you don’t want to end up in hospital, you need to get out and get your flu vaccination. I am the first in the queue for that every year. I cannot over0emphasise that. It is perfectly safe.”