Reflections on COVID-19 from a polio nurse

Nursing manager who worked through Kenyan polio epidemic reflects on COVID-19

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IN THEIR SHOES: After working to fight the polio epidemic in Kenya in 1960, Alison Worrell knows how hard our health professionals are working to help people with COVID-19.

IN THEIR SHOES: After working to fight the polio epidemic in Kenya in 1960, Alison Worrell knows how hard our health professionals are working to help people with COVID-19.

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Alison Worrell reflects on her experiences working to fight polio in 1960s Kenya.

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ALISON Worrell had no real experience when she was thrown into the deep end during Kenya's polio epidemic in the 1960s.

She faced many challenges, from treatments which required incredible amounts of mental and physical dedication, to challenges associated with her inexperience and the disapproval of nurses.

Ultimately, through hard work and dedication, her team was able to help make a huge difference, from recoveries to helping patients deal with their paralysis.

Now, over half a century later, Alison reflects on the hard work and dedication of health professionals during the COVID-19 pandemic.

IT was the 60's in Kenya, I was just back from the UK having completed my midwifery training and nationalism was at its peak following Independence in 1956.

As I was classified as Kenyan, I was promoted to the position of nurse manager of a newly set up ICU converted in a cottage, despite having no experience.

First of its kind

The ICU had been converted from a cottage complex near King George VI Hospital, now known as Kenyatta Hospital.

The 1000 bed hospital - located in Nairobi, was the main general referral hospital for Africans in Kenya.

Because of British colonial rule, hospitals were divided by race - European, Indian and African. This unit was the first of its kind to admit all races.

The treatment process

The unit housed long, portable, tubular metal tanks, fixed over a single trolley on wheels.

There were glass slots in the tank which enabled some visual assistance when nursing the patient.

The patient was laid down in the tank and bolted firmly with no other air allowed to enter, allowing mechanical air compression to inflate the lungs and get them to work.

Nursing the patient had to be meticulous - the tank had portals we placed our arms through, making sure there was no other air entry to affect the machine's pressure . This required two nurses.

We also had heavy and cumbersome respirators that were developed and put together by the anaesthetist and his team.

Hands on work

Respirators required thorough manual sterilisation and were personally checked by the anaesthetist to make sure they ran as smoothly as possible.

Air bags were frequently used when the machines broke down, or there was a power cut.

The suctions used were manual and operated by foot pressure. This apparatus had to be constantly checked as it blocked up easily.

All equipment was recycled, there were no disposables, we used sterilizers and autoclaves.

We had to pack drums with everything we used, including swabs made from rolls of cotton wool, gauze, instruments, syringes, needles, gowns, gloves, masks, dressing towels etc.

This was the only unit that dealt with the bulbar epidemic in all of Kenya, all patients were airlifted to Nairobi.

Patients enjoyed a large verandah which surrounded the building, offering fresh air and lovely views.

I had a well-staffed team of British expat registered nurses (RNs) under me - one or two per patient. They did not take to their new inexperienced leader kindly.

What is polio?

The old synonym of Infantile Paralysis was used when referring to the disease then.

Bulbar poliomyelitis (polio) is an acute, highly contagious disease which is spread through secretions from the mouth and feces. Man is its only natural host.

This virus invades and destroys the nerves within the bulbar region of the brain stem, preventing muscles from receiving messages from the brain or spinal cord.

The intercostal muscles, diaphragm, speech, swallowing, taste and other involuntary muscles are affected.

Sensation is not affected, so there is a lot of pain and discomfort, with the patient unable to speak.

Patients also require a tracheotomy or an endotracheal tube.

Eventually the muscles atrophy, limbs become weak, floppy and poorly controlled and this can eventually lead to complete paralysis.

This epidemic affected young men of all races.

Hypothermia therapy

Besides the respirators we used hypothermia therapy, using water mattresses and iced bags to bring the temperature down below 35 degrees and induce coma.

Lowering the body temperature or induced hypothermia - now called targeted temperature management, works on the cerebral metabolism.

The patient requires less oxygen, less glucose or energy consumption.

The treatment decreases oedema, prevents cell death, reduces lactate accumulation and acidosis.

Patient's temperatures and their central nervous systems had to be very closely monitored.

The process was very labour intensive, with two hourly turns to prevent bed sores.

All observations were done manually and rewarming the body had to be very efficient. Brain necrosis could occur if poorly managed.

Helping hands

I was extremely fortunate to have the Chief Anaesthetist Dr Lawes running the show.

He took me under his wing and gave me a crash course on clinical requirements and I was a quick learner.

The staff and the relatives all wore PPE, which consisted of gowns, masks, gloves, and a hair cap and practiced frequent hand washing.

I overcame the attitude from the RNs as Dr Laws gave me his full support.

We were all provided with delicious cooked meals and snacks by the health department, which helped to keep our nutrition, spirits and wellbeing up.

The aftermath

I ran this unit for one year and as far as I know, none of us, or our relatives contracted the disease.

This was the utmost test in human endurance for desperate young working men and their families and a dedicated health team.

We had a recovery of around 30-40 per cent.

A few patients were paralysed for life and learnt to use their mouths to write and paint and learnt to manually get air into their lungs without a ventilator for short periods so they could talk.

Reflections on the COVID-19 pandemic

Seeing how our current frontline health teams all around the world are working through this pandemic and their dedication brought this unforgettable nursing experience back to me.

All health personnel put their hands up in disasters such as this as it is what we are trained for.

There is no time to think about personal matters, as all the mental and physical energy one possesses is required for every shift one undertakes.

The vaccine

Thanks to Albert Sabin who developed the current oral vaccine which helped curb the epidemic that I experienced.

In 1988 the World Health Organisation adopted a policy to eradicate polio from the world which unfortunately, has not been achieved yet.

There has been no cure developed for poliomyelitis, but there is an effective vaccine.

For more information about polio, click here.

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