100 days of self-isolation: the experience of a Brazilian Palliative Care hospital to prevent the COVID-19 contagion

Categories: Care, Featured, and Policy.

Between March 25th and July 2nd, 2020, the Premier Hospital in the city of Sao Paulo-Brazil, self-isolated to prevent the spread of COVID-19 among its patients, family members, and employees. The so-called Solidary Quarantine was established after the World Health Organization declared state of emergency and pandemic due to the new coronavirus.

The experience of countries like China, Italy, and Spain alerted us to the challenge and responsibility to develop effective preventive measures. The social isolation measures were gradually taken. Visits by family members were suspended, as well as visits by religious volunteers who weekly comforted patients of that belief. Musicians no longer filled the hospital corridors with their art. Undergraduate and graduate students from several partner educational institutions interrupted their activities. Regular events to promote quality of life for patients and their caregivers gave way to empty rooms. The elderly in the neighborhood stopped their health prevention activities inside the hospital facilities.

This introduction gave a sense of Premier Hospital’s usual atmosphere. Founded in 2004 and guided by the principles of Palliative Care.  The Premier Hospital is a private secondary-level organization, with 70 beds, specialized in chronic disease patients with high dependency. Our goal has been to take care of our patients and the entire team, valuing individual beauty and complexity. Through the practice of compassionate care, we encourage people to look at each other in the eye and recognize themselves in the face of the structural psychosocial difficulties that our society imposes.  The values ​​that govern our coexistence are signaled with the community, and there is a continuous exercise to develop this attentive look.

We were aware that the pandemic scenario could be even more aggravating given the social inequalities and limited access to Brazil’s health services. When considering the high risk of complications of patients in Palliative Care; employees living in conditions of vulnerability, agglomerations and the municipal public transport with an increased risk of contamination on the way to and from work; the Premier Hospital opted for the strategy of self-isolation / Solidary Quarantine.

We offered employees the voluntary possibility of permanently staying within hospital facilities from March 25th. Around 40% of our professionals agreed to participate in the Quarantine; they signed a voluntary adhesion term and knew they could leave anytime. The hospital provided personal protective equipment (PPE), beds, bed and bath linen, work clothes, washing clothes, personal hygiene products, and food for all employees who voluntarily accepted to participate in the Quarantine. The work schedules were readjusted, ensuring rest times. The Solidary Quarantine had the written support of about 80% of inpatient´s families.

For employees in the Solidarity Quarantine, it was not an easy task. The restrictions, even if voluntary, associated to the distance of the family and their environment, concerns about the family, anxiety, and difficulty in initiating sleep were some of the complaints. The tiredness over the days was apparent. A routine of physical activities and relaxation was organized based on professionals’ needs. Structure for family videoconferences, religious rituals and psychological consultations were made available online. Meetings with dynamics and philosophical reflections, allowing space for sharing experiences and collective construction of meaning for work, occurred regularly. Training of the health and support teams on COVID-19 management and prevention through class-based teaching and active learning was carried out, maintaining the usual methodology of participatory education centered on the individual.

Aiming to guarantee the necessary distance and minimize social isolation, videoconferences between patients and family members, and visits through the reception window, called “Window of Meetings”, were promoted. In July 2020, we started the gradual easing of the Solidarity Quarantine. In-person family visits monitored by the team are carried out as often as possible and with all precautionary measures against COVID-19 recommended by competent international bodies.

Mirrored in international experiences and following WHO recommendations, we maintain our contingency plan with the maximum possible humanization, convinced that we also avoided potential health professionals and families’ infections.

We reached 2021, having fulfilled many of our goals. The main one is having zero cases of COVID-19 in our patients, something we are proud of. We cannot deny that this pandemic moment puts us in a state of alert, and as a team, we are working hard never to loosen our commitment to taking care of our patients, our family and ourselves too. 2020 showed acts of bravery and dedication that will never be forgotten, like those presented during the Solidary Quarantine. Not in our history nor our hearts.

We welcome 2021 committed to rebuilding, regenerate, and replenishing ourselves from this crisis. The first COVID-19 vaccines arrived at Premier Hospital in the last week, and part of our clinical staff has already received the first dose. Prevention, protection and care are still the most important things we seek in 2021. We share our experience with the community with the hope that these difficult times will make us better people and with the potential to stimulate broader thinking about the dynamics of health services, solidarity, and crisis response.

Written by Amirah Salman, Manuela Salman, Monira Kallas





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