“The Covid-19 experience of this past year has inspired courage from all our staff. The North Central Regional Health Authority (NCRHA) under the direction of the Minister of Health, Terrence Deyalsingh and Prime Minister Dr Keith Rowley has taken the challenge as an opportunity to further develop and create ground-breaking ways and methods to provide its patients with the highest possible quality of healthcare.”

In a climate such as this, it was imperative that we were able and willing to adapt, innovate and even expand our capacities to treat with any challenges that may present themselves now and in the near future,” says NCRHA CEO, Davlin Thomas.

“This is evidenced in the number of projects that were implemented within the last few months... the successes of which are testament to the fact that we care about the citizens of this country and are committed to bettering their lives, daily.”

The Covid Executive Wellness Clinic services at the Arima General Hospital is a good example of this. The recently piloted centre targets post-Covid patients who were critically ill and hospitalised in Intensive/High Dependency Care Units, but have remained negative for at least three months subsequently. The initiative, which provides a comprehensive executive level assessment, offers diagnostic examinations and specialist services in cardiology, physiotherapy, nephrology, pulmonology, social work and nutrition, among other things.

Dr Ravi Lalla, Medical Chief of Staff, explained that the service follows a solution trap model that serves as a one stop shop, where all facets of the service are conducted during one visit, though it is split into two rotations, one in the morning and the other in the evening.

“During the morning rotation, clinical assessments such as echocardiograms, chest x-rays, ECGs and blood investigations, focus directly on areas susceptible to compromise by the virus. Additionally, counselling services such as psychiatry and social work forms part of the second rotation, with compounded services from our team of specialists, which includes cardiologists, nephrologists, pulmonologists, physiotherapists, dieticians, and nutritionists. It is really a concentrated multi-faceted team effort, but it is in the coming together of each part as a whole that we are able to ensure improvements in the quality of life for every single one of our patients.” Lalla added.

“Of equal importance to treating with those patients currently diagnosed with Covid-19 who are entrusted into our care, the North Central Health Authority has placed great emphasis on ensuring that optimum health care service and consultation continues in post-Covid stages as well for every single one of our patients and their families,” CEO Thomas stated emphatically.

The sentiment was echoed by Thoracic Medical Director at the Caura Hospital, Dr Michelle Trotman who informed that the clinic was conceived on the premise that post-Covid patients have been found to experience post traumatic issues like lung failure, renal failure and life threatening conditions. She added that the North-Central Regional Health Authority, along with Ministry of Health, has an inherent concern due to the novelty and uncertainty of the disease, and its possible lingering effects on the body.

These examinations have been proven to lend insight into scar tissue and organ damage, supply data for research and development and will even advise possible health management approaches in the future.

In a systematic innovation response, the NCRHA has engaged Covid-19 by taking a multidisciplinary approach to engage affected members of our public and their families. Through the combination of specialist services, the NCRHA have strategically orchestrated a method of engagement that has already proven successful, even in these early stages.

CEO Thomas commended the diligence of the medical staff on the front line, highlighting their commitment to do whatever is necessary to ensuring that the patient always benefits.

“Patients are no longer required to seek out and attend clinic sessions with varying doctors, but are afforded the value of having each doctor attend to them in seamless collaborative effort. The implications for which, as you would imagine, are tremendous, as patients have consistent access to a cross-section of interdisciplinary specialists providing them with the necessary medical interventions – simultaneously. These doctors and nurses do not work in isolation, but are committed to working in tandem to ensure continued improvement in the health and lives of the citizens of Trinidad and Tobago.” Thomas stated.

Physiotherapy is also offered, as it has been found to assist in strengthening breathing performance. It is well documented that breathing deficiency are a common symptom among Covid-19 cases – presenting itself in early stages and even later, in recovery stages.

Respiratory Therapy Services

To engage and to improve patient comfort & well-being, the NCRHA introduced into its services respiratory physiotherapy by employing specialist therapists at its Covid centres. Under the guidance of specialist physician Dr Gerard Antoine, who has ten years experience in respiratory care in the US, and pulmonologist Dr Michelle Trotman, a three-tier respiratory care programme was instated to educate and equip medical staff at the NCRHA, more specifically patient care assistants, enrolled nursing assistants and registered nurses.

Initially, Covid centres were assigned specialists on rotation, but upon seeing the need for expansion, more specialists were assigned and additional medical staff were trained to increase capacity.

Dr Antoine indicated that the training, which is ongoing, covers basic and immediate level care for patients who require minimal respiratory care, oxygen management, pharmacology, nebulisation therapy (tier 2) and also training in incentive spirometry.

An incentive spirometer is a respiratory device used to help lungs recover after surgery or an illness.

At present, nurses at the NCRHA are being trained in the usage of the device, and in turn are teaching patients to self-administer in the absence of medical professionals. The latter training was employed for more stable patients and those in less critical conditions, on the wards or those in home quarantine.

This is all part of the NCRHA’s thrust to engage Covid-19 and not just equip ourselves but arm our citizens, as well so we can fight together to improve the lives of every member of society.

Beyond Covid-19, however, according to Dr Antoine, the overarching goal is to increase capacity not just in response to the pandemic, but to develop and improve our medical capacity to treat with respiratory diseases, on the whole.

“Dr Trotman and myself, in collaboration with the Training Unit, and our dedicated physical therapists who are committed to the success of our training sessions have taken directives from the Board of Directors and the CEO to orient staff to world class health care practices, specific to the needs of those patients suffering with respiratory illnesses,” he informed.

At present, Dr Antoine indicated, there were no specialist respiratory care programmes existing in Trinidad and Tobago, and consequently, credited the vision of the NCRHA management for taking bold initiatives to champion this cause in the midst of challenging times.

Plans are also in place to commence a nine-month respiratory technician programme, which would allow for further advancement in the field, positioning the NCRHA to bolster its capacity even more.

“Metrics have shown that there are already significant improvements post-training from the first round of participants. This is evidenced, not solely in the retention of information and completion of classes, but we are seeing it, in real terms, in the application of healthcare and in the feedback received from our patients,” he concluded.

The influx of testimonials from patients who have migrated through the process has been extremely positive, with many relatives and patients in high praise of the work and sacrifice of the medical staff. The introduction of the Patient Liaison Unit has also allowed for the NCRHA to establish another point of contact with patients and their families, this time communicatively – a unit designed to call and engage patients and enquire of their needs and provide real time intervention or direct their concerns to respective clinical heads for assessment and assistance.

“The reality is that, for many patients warded at the Couva Medical and Multifunctional Facility (CMMF) and Caura Hospital, their Covid-19 experience has been frightful, stressful and extremely distressing. We cannot begin to imagine, but we were deeply moved to put as many mechanisms in place to ensure that the impact of the ordeal for each patient was subject to the impact of the intervention. These mechanisms could only happen through the efforts of our staff… dedicated members of the NCRHA team who willingly put themselves on the front line time and time again,” said Thomas.

The CEO went on to state that the services are an extension of the NCRHA’s commitment to strategically combat any threat to the health and lifestyle of our clients. He added that the NCRHA is keeping abreast with all developments regarding the virus and taking every precaution to prevent the proliferation of the disease.

He maintained that the NCRHA remains committed to meeting the needs of nation’s citizenry, adapting and innovating new ways to improve the health of the population, and ultimately creating a thriving health system of premium status, consistent with the mandate given by Minister of Health Terrence Deyalsingh, under the guidance of Prime Minister Dr Keith Rowley.

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