Daisy Azmi

Albania: My Journey to Tirana and What I Did There

It was a long journey from Cinque Terra in Italy to Tirana, the capital of Albania. A two and a half hour train trip, a forty minute delay on the train, a half hour change over time (which I was grateful for given the delay to the trains), another few hours on the train and I’d made it to Milan. Once finally at Milan’s main station, it was another half hour train to the airport.

The slight catch at Milano Malpensa Airport was that there were no food shops once you went through the security gate. Normally this wouldn’t have been an issue except that my flight was delayed for three hours. My experience with Wizz Air was a dream compared to that with of other budget airlines I’ve previously flown on. No one yelling no the plane for starters.

Given my flight was delayed and now arrived at around 0030hrs, I was worried about getting to the hostel given that it closed reception at 2300hrs. I messaged and emailed from Milan with no reply. I called on WhatsApp on the airport wifi and to my relief someone was there waiting for me.

Negotiating a taxi price at 0030hrs in the morning is tricky. I was a bit worried as the taxi driver took me to a random car and told me his price was three times what I knew it should have been from online research before getting there. But with no other taxi’s insight, what choice did I have? At least someone knew I was supposed to arrive to the hostel soon.

The hostel was fabulous to my relief! I kind of felt that I’d been transported into the 70s! It was a place for alternative and creative people to gather. I’m in no way creative or alternative but the people there was so friendly, I felt right at home (and the bathroom was a thousand time better than it had been in Italy!).

After getting over my initial shock at arriving in the middle of the night to an unfamiliar place, I woke up the next morning to explore Albania. Several people from the hostel were going on a walking tour of the city and this was one of the best things I did while in Tirana! I had never done a free walking tour before but I learnt so much about the history of Albania and got a good feel for the surrounding area. Eri (I think his name was) was a fabulous guide!

Eri told us that once the end of communism came about in 1991, the first thing introduced to the people of Albania was Coca Cola. People supposedly put their empty cans on their mantle pieces. The other great thing that they discovered was bananas! Eri’s grandfather didn’t know what name was for banana and so would ask Eri and his father for Coca Cola. When they arrived back with the Coke, his grandfather was confused about why they hadn’t brought him back a banana.

Tymmi restaurant, 80s themed music and great food! This restaurant was always packed.

Some of the other top activities I did included Bunk Art 1 and 2 (although you probably don’t need to go both), the cable car with a great panoramic view of the city and the ocean and venturing to some of Albania’s second hand clothes markets. I can thank a couple from Melbourne that I met for this experience: Eugenie and Felix! Felix ran a business selling vintage clothes and was on the hunt for some vintage clothes. I invited myself along and learnt a lot about vintage caps!

A bunker placed in the city during communist times. The city had planned to build around 170,000 bunkers though only a small portion of that goal was ever reached.

The National Historical Museum was great. It helped me solidify my understanding of some of the social history of Albania that I learnt during the walking tour. The tribal history, the ancient Roman history and the modern history, from a democracy to a monarchy, to fascism, to communism and then an open democracy. Albania had seen a lot of change especially in the last one hundred and twenty years.

A few things that I didn’t see that I would love to see next time I am in Tirana are the Archaeological Museum which was sadly closed when I was there and the House of Leaves Museum, a museum dedicated to the history of surveillance during the communist era.

So many people that I met on my trip in Tirana were keen to leave and see the country side. I got the impression that some people weren’t too impressed with what the city had to offer but I found that the people were all very friendly and willing to help, the food was great, there was a lot to see and a lot to learn. Albania and the hostel were a great place to meet people and make friends which made the experience all the more worth while, especially when travelling by myself. I hope that I can come back to Albania to see all the things I didn’t see this time!

Second hand clothes market: on the hunt for some vintage goods with Felix.

The Expectations vs. The Realities of Rural Nursing

I’ve been working as a new grad nurse in a rural/remote hospital for three months now. While I’m finding my feet as a new nurse, I’m discovering that my expectations and the reality of living and working as nurse in rural Australia haven’t quite aligned. This week, in an attempt to get back into blogging, I’m reflecting on the experiences I’ve had so far.

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In all honesty, I came out here with the idea that I would conquer my chosen profession of nursing and gain valuable experience to help me conquer the world – saving lives, improving the state in which people live. It’s my dream to one day work for something like MSF or the Red Cross. Quite the fantasy. This is one area in which rural nursing has met my expectations. It seems to be the kind of place where many people come to ‘up-skill’. The need for nurses out here lends opportunity to those willing to venture out.

What I didn’t expect was the amount of aged-care work we would doing. Rural Australia has an ageing population (surprise, surprise – much like the rest of the western world), with younger people moving to cities and a low birth rate. Having already worked in aged care for two years now, I had thought I’d be leaving home for something a little more exciting.

However, building (professional) relationships with my oldies has been one of the best parts of my job here. The positive in having aged-care here is that the residents can stay in their home town as they get older and it is actually quite a fast-paced working environment. From what I have seen so far, if there were only acute patients or emergency patients, my days might be more… dare I say it? The ‘Q’ word. We have been able to help with BBQs and Easter morning teas, as well as social events for the residents and their families and sundae treats organised by the lovely activities coordinator. One resident sometimes sings us songs as we help her to get ready for bed in the evenings.

There have also been instances where we needed something particular for a patient like a dressing or a specific medication which we haven’t had. I’d previously thought that these kinds of things would be readily available. Luckily are easily able to order anything we need, it’s just a matter of time to get it. The local pharmacy has also been an incredible asset to the town and the hospital.

In a larger metro hospital we could just call a doctor or any allied health and there they’d be but things are a little different here. It’s very lucky that we have a doctor here. There is one GP who services the whole town and is also the treating physician for any patients or residents of the hospital. He is basically permanently on-call and attends to any emergencies where the nurses might require more consistent and immediate assistance from a doctor. When he goes away on holiday or sick leave we use the Royal Flying Doctor Service (RFDS) which has been great!

During my second month here, there was a town-wide Telstra outage (one of the major telecom companies in Australia) for almost three days. Most people living in places like this use Telstra as it provides the best coverage in rural Australia, so when we ran out of phone coverage it was a big deal. It wasn’t just the mobiles either – it was the landlines too. Each of us as new grads were cut off from the outside world without any phone service. There was about half a day in the middle somewhere that the phones began to work again and then just like that *snapping fingers*, the phones were dead again. During the night shift, an emergency came in and one of the nurses had to go to his house to get him so that he could attend and provide medication orders.

Starting as a new nurse has been challenging. When I decided to become a nurse I knew that it wouldn’t be easy – it would be challenging in a way that starting any new job is but I didn’t expect to make so many mistakes so early on. They were nothing major but it definitely knocked my confidence a little. So something which I learnt quite early on, was to own it – mistakes are going to be made and it’s better if you can learn from it. I have done incident reports on myself to make sure that even though something has happened, I can provide safe care for my patients and myself.

While I’m not in the most remote of places, this experience so far has definitely left my expectations of rural nursing misaligned with the reality. I hope that being out here will help me to become a better nurse but more importantly, I hope that I don’t fail rural Australia and that rural Australia can survive the healthcare challenges it faces.

Next week in Part Two of The Expectations vs. The Realities, I write on what it’s like living in a rural town!

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Getting Tested for COVID-19 in Australia

Tucked away on the island of Australia we have remained fairly safe from COVID-19, though today I’ll be sharing my experiences of being tested for COVID-19 in Australia. NOTE: Do NOT attempt to swab yourself! Swabbing/testing for COVID-19 should only be done by a qualified healthcare professional.

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This week, I’ve had my wisdom teeth removed. I’ve been slightly out of it but I’m committed to the blog this year! So here is just a short post for this week.

For those of you who know me, a sore throat is a Daisy Specialty – a regular occurrence. I might be a hypochondriac. Since the beginning of this pandemic, I have been tested for COVID-19 four times. Currently, the testing criteria for a COVID-19 test in the ACT are: displaying any signs and/or symptoms of COVID-19. It may also be recommended by ACT Health that you get tested if you have been in close contact with a confirmed case of COVID-19 or have returned from any COVID-19 hot-spots in the last 14 days.

You can find information about whether you should get tested for COVID-19 and testing criteria in the ACT here: https://www.covid19.act.gov.au/stay-safe-and-healthy/symptoms-and-getting-tested . For information about testing criteria in other areas, please visit your local government health website or contact your GP.

For peace of mind and the safety of everyone, when I got a sore throat I went to get a COVID test (and also because that’s what we have been directed to do by our government). There are a few ways which you can get swabbed here: one is a clinic and another is a drive-through testing site. I attended a clinic as it was the one closest to my house each time I got a COVID swab.

When I first entered the clinic, I was directed to do my hand hygiene and apply a mask before approaching the reception desk. Once at the reception desk, the nurse confirmed with me why I was attending the clinic and which symptoms I had, as well as took my details down.

During the busiest times, the nurse asked me to wait in my car and would send me a text when it was my turn for a test, though usually I was just directed to a take a socially-distanced seat in the waiting room. The waiting time varied but I always took a book and some earphones with me. Highly recommend a good book for the wait!

The nurse would then call me for my swab! The nurses were always dressed in full PPE and there was a HUGE sign on the door to the waiting room that said ‘DO NOT ENTER THIS AREA WITHOUT APPROPRIATE PPE’ in giant red letters.

I was then asked to sit in a chair while two healthcare professionals (I’ve had a nurse and a doctor as well as two nurses before, so I think it varies) go through my information. They explained the procedure to me before asking me to remove my mask (into a bin) and lean my head back, against the wall. Then that lovey, long q-tip-looking thing called a swab goes down your throat but only for a few seconds. Then immediately after, the swab makes it’s way into what feels like your brain! Only kidding! The swab doesn’t go past your nasal cavity but it does feel slightly uncomfortable for a few seconds and it always makes my eyes water.

The lovely staff then asked me to do my hand hygiene, put a mask on and re-do my hand hygiene again. They gave me some information about self-isolating while I waited for my test results, as well a certificate of attendance (in place of a sick certificate). I then headed back to the car and received my test results via text in the next few days. If your test is positive for COVID-19, currently you would receive a phone call with your result.

I have heard about some varied methods and have been wondering about the efficacy of these different methods. For example, swabs only being taken from the nasal cavity, swabs being taken from one nostril v. two nostrils or whether the swab must be taken from the back of the nasal cavity v. just the nasal passage. I will have to do some reading on this.

I’d love to hear your thoughts and experiences if you’ve been tested for COVID-19 or if you’ve done some reading on which is the most effective form of swab in testing for COVID-19. Until next week, lovely people!

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New Year, New Plans?

Welcome to 2021! I hope that this year brings bigger, better things (as well as safer)! This week, I’m writing about my plans for the upcoming year. This year I’m moving the equivalent of three countries away for work and I’m not even leaving the state! Australia is a big place. I’m super excited and I wanted to share some of that excitement with you! This week I also talk about my lack of New Year’s resolutions and why.

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New year, more consistent blog posts already? I’m really writing this blog post to remind my family where I’m going to be throughout this year as I’ll be moving around quite a bit but also as a little reminder to myself that this is what I want to do. I also wanted to have a chat with myself about making New Years resolutions (or rather, not making them). NOTE: This blog post doesn’t relate to any hospital or health service in particular.

The Plan

For the next 12 months, I’ll be doing a graduate nurse program in far western NSW. This will be based in Broken Hill, 934kms from my home in Canberra. For context, that’s the equivalent of driving from London to Zurich. On another continent, I would be moving three countries away for a job. I think it’s safe to say that I won’t be popping home for the weekend. When I travelled to Broken Hill for my interview, it took two days to get there though I would say that it’s been worth it as I got the job!

This program isn’t just based in Broken Hill though. I was lucky enough to get a place in the remote facilities program! Over the next year, I will be spending three months each in four rotations. I will begin working as a registered nurse (RN) for the first time in a small town of 1,200 people at a small Multi-Purpose Service (MPS) which includes a small ED, an acute ward as well as aged care. As far as I know, accommodation will be provided and there are two other girls starting there with me at the same time!

Then I’ll be heading to Broken Hill for three months before going to another smaller town to work in another MPS (I don’t have much information about this at the moment but I’ll keep you updated). For my final three months, I’ll be going back to Broken Hill.

It’ll be a little bit of moving around but I’m very excited to go! I think that this may just be the perfect opportunity to help me gain experience in areas of nursing which will help me to achieve my longer-term career goal which is to travel Australia and the world as a nurse. It’s such a good way to help others and see the world and I think that makes me feel better; like I’m making a difference, even if it’s small. Well that was cheesy…

2021 New Year’s Resolutions

Other than the move, I’m not making any New Years resolutions. I never achieve my resolutions and to tell you the truth, I don’t actually ever feel bad about not achieving them. They’re usually important but meaningless things to me, like drink more water or exercise more. So I’ve decided to take a new approach to resolutions this year: I’m thinking about what has helped or worked the best for me during 2020 to bring into 2021 with me.

Journaling: Everyone always told me to journal. ‘It’s so good for your wellbeing’. I never did. I could never do it consistently or in a way where I felt good about it. All that ended up on the page was verbal diarrhoea of complaints and negativity. Anyway, last year I started just writing one thing that I’m thankful for every evening. From there I started to write slightly more and more each evening. It’ been a very positive experience so far and I think that I’ll keep doing that more in 2021.

Reading: During 2020, I read at least five books that I can think of off the top of my head. This may not seem like a lot but I have been on a reading hiatus for many years. When I was younger, I read so many books! Ask my mum about the time she banned me from reading. I’m making a slow return to reading and I love it. I’ve already finished two books this year and I think it’s also helping me to break up with my phone.

Lowering my exercise expectations: I hate exercise. I don’t enjoy it however, in 2020 I found my exercise groove. I got into yoga and swimming, both of which I really enjoy though they’re not cheap. I just decided that I couldn’t force myself to workout cause I didn’t like it. Hopefully I’ll get to keep doing some kind of similar exercise wherever I end up! Yesterday I swam 1.25kms and I’m a little bit proud of myself.

Eating more vegetarian meals: gotta do what you’ve gotta do for the planet and the animals… you don’t need the spiel but last year my family became ‘at home vegetarians’. Yep, I couldn’t give it up completely but it’s a step in the right direction.

I think 2021 is going to be better than last year for a number of reasons; hopefully we and the rest of the world will get COVID under control with the introduction of the COVID vaccines though I think we have all learnt a lot during 2020 that we can bring with us into 2021! Things like supporting each other and taking time for ourselves (slightly contradictory, I know but you can do both!), as well as doing what we can for the greater good. Happy New Year Everyone!

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My Nursing Graduation During the COVID-19 Pandemic

2020 has been a rough one for some more than others. I think it’s safe to say that we have have fared very well here in Australia. During this year, I also graduated from my Bachelor of Nursing degree but it wasn’t your typical graduation ceremony.

Surprise! I’m back! I feel like this is how every blog post starts from now on… yes, I’ve been MIA. Here’s a bit about where I’ve been and what’s happened since we last spoke (figuratively): I was due to finish my degree in July but as I wrote in my last post, I got a cold and had to do some extra placement hours. In Australia the Australia Health Practitioner Regulation Agency (AHPRA) requires Bachelor of Nursing students to complete a minimum of 800 hours of clinical placement. Once I finished all my placement hours it was August!

I’m not sure why I thought it was a good idea but I decided to get four jobs? Like what? I continued working with the nursing agency that I had been working with before, I started working with a private client (which was actually the best thing I’ve done) and I started teaching skills labs at the uni one day a week. After I started working with my private client, another lovely family reached out to me to ask if I could help out with their daughter (which I didn’t really have the days in the week for but I said yes anyway) and so I gained another private client. Hey presto! Four jobs! That definitely wasn’t sustainable but I’m kind of using it as an excuse for my absence on here.

In the midst of this job craziness, the uni cancelled our graduation which wasn’t really a surprise to anyone. Firstly, they offered for us to attend the graduation ceremony in March of 2021. I was totally fine with this as I hadn’t intended to finish uni this early anyway – I only fast-tracked my degree because I was bored in lock down and at the time we’d been told that it may take some time to gain our placement hours because of COVID restrictions in hospitals. This idea to ‘walk’ in March was scrapped pretty soon.

For graduation we got a ‘photoshoot’ – yes, that’s what it was called. When October came around we were able to book a time where you could go into uni with your family and collect your testamur, dress up in the gown and get your photo taken. It actually turned out really well! I was able to book the same time as a few friends so that together we very unceremoniously collected our testamurs from a nice lady at the COVID check-in station and took our photos!

Two thirds of the support crew at the graduation

We were lucky enough to be able to take four guests with us so I took my parents and sister. The most supportive bunch ever! Couldn’t have done it without them! On the day of the ‘photo shoot’ I decided to wear these stupid shoes – high heels of course. My support crew dropped me right at the door in my stupid shoes and then went to park the car – huge thanks for that! By the afternoon I could barely walk, so I treated myself to a Pepsi and a sausage roll #healthy. I can safely say that I have good nursing shoe judgement though – super sexy (or not), black leather, memory foam, slip proof, lace-ups.

RN Amy, RN Anna and myself at graduation on the 15th of October 2020

I can’t lie – I was feeling quite proud of myself and my other nursing sisters (and everyone else as well) for finishing our degrees in this moment! It had literally taken blood, sweat, tears and poop to get to this point. I was feeling quite grateful that we had been able to celebrate it together during this time and due to the restrictions that we had. The mum of a close friend of mine told me that the ‘photo shoot’ was the perfect way to celebrate your graduation as you got to do all the fun things without sitting through the boring speeches and 300 other people also receiving their testamurs.

I was also feeling quite sad for a lot of others in Canberra, as well as around the world, who wouldn’t get to celebrate their graduation or other milestones. As far as I know, a lot of people have been offered the opportunity to ‘walk’ in future graduation ceremonies or alternatives such as ‘photo shoots’ or virtual ceremonies. I think that it will be hard for those in university and school this year but I’ve got my fingers crossed for everyone!

This has been a long one, sorry! If you this far – well done!

Part 2. Being on Placement During the COVID-19 Pandemic: Diaries

In the second part of my series Being on Placement During the COVID-19 Pandemic, I take on a three week placement in paediatrics in a rural hospital and a week in ophthalmology. I also face a lack of PPE and a COVID-19 scare.

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I’m baaaaaack! Yes, I have been MIA but I’m hoping to get back into the blog! I wrote this post a long time ago and was deciding whether to post it or not but I think it’s important for me to reflect on my practice and for others to gain a little insight into what it’s been like to be on placement during the COVID-19 pandemic as a nursing student.

This blog post contains general entries from my time on placement and any information regarding a particular hospital or patient has been omitted or changed for privacy reasons.

02 July 2020

I was expecting to go to the Coronary Care Unit for my last block of placement but I’m very excited to be in paeds! I had it as one of my placement preferences but had never gotten it. I can’t lie, I’m a little bit disheartened that I hadn’t gotten a critical care area for my last placement but I’m trying to stay positive about it. Paeds is very different to adult nursing. I feel like a little bit of a fraud because everything is done so differently; the med checks are the same in principle but completely different to what I’m used to in practice.

I’m way out of my depth. I had to take out an IVC [intravenous catheter] from a four year old. I’m sure she won’t even remember it but I felt awful. She cried the whole time – not because taking out a cannula hurts but because it hurt her to have the bandaid taken off which secured it. I feel like all I do is make these tiny tots cry when I’m trying to help them.

1o July 2020

I have been in paediatrics for two weeks now. I feel like I have been here long enough now to say with confidence that this is the situation: we are severely lacking PPE [personal protective equipment] and just about every second patient is ?COVID [nurse short-hand for suspected of COVID-19]. When those patients do come in, I want to be able to protect myself and everyone else by wearing the appropriate PPE. But the reality is that we don’t have the PPE we need because other people are panic buying and the hospitals themselves are stockpiling [this is not isolated and is widely reported].

I am really conflicted about this because if the worst does happen, I want the stockpiled PPE to be there but I’m also interacting with patients who could have COVID-19 without the right masks and gowns. It’s a complicated situation and definitely not a safe one. Despite my concerns, thankfully none of our ?COVID patients have returned positive results.

EDIT: Since writing this post there has now been a new confirmed case of COVID-19 in this rural town.

17 July 2020

I’m coming to the end of my placement in paeds. I have really enjoyed working with this team of fabulous nurses and learnt a lot. I feel like this placement has taught me so much about medications that I wouldn’t even have thought about nursing on an adult ward.

I have also learnt a lot about resilience and standing up for myself – I will not be bullied by six year olds (or anyone). This week I looked after one patient who had broken their leg. They had a full leg plaster cast. I felt bad for them of course, I wouldn’t want anyone in that situation, but they were the rudest, cognitively intact patient I have ever cared for. They were rude to me and their mother and demanded constant attention from the nursing staff. They even kicked me one day when I was helping them into their wheelchair (I’m really hoping it was an accident). I love kids but I’m not sure that paeds is for me.

What I have loved about working in a rural hospital is the relationship between the staff, from the doctors and nurses to the ward cleaner (who is a legend by the way and helped me out in so many ways). It was nice to be respected as a nurse by everyone in the team even though I was a student. If they had a concern about a patient I was looking after, they came and spoke to me directly (with my supervising nurse there for support of course!) and I felt confident enough to approach them myself with patient concerns. On nights when it was quiet, we all had dinner together – even the doctors (socially distanced with all rules followed – it was a small ward with few staff).

22 July 2020

I was supposed to begin my last week of placement EVER this week. That didn’t happen. I developed a sore throat over the weekend and couldn’t attend placement. The likelihood of it being COVID-19 was minimal but that’s just not a risk you take. Two days ago I got my second COVID test and let me tell you… it’s nasty.

They performed a nasopharangeal swab. They told me that they don’t put it all the way into your nasal cavity anymore but it sure felt like something was going up my brain! I understand though – better to make sure you get all you can for the test.

For now I’m waiting for my test results to come back.

30 July 2020

My test came back negative so I am back to placement. Although I was slightly delayed, tomorrow marks 800 hours of placement. It took a lot of blood, sweat, tears and pooh (literally) to get here. My CLN [clinical liason nurse – preceptor] gave me a lot of encouragement and feedback to get through this last month. And while I’m super proud of myself for finishing my degree, I still think I know nothing. Not quite sure I’m ready to be a nurse but I’m sure the confidence will come with experience.

As for ophthalmology, the hours were great. I finished work everyday at 5pm and was consistently home for dinner. I learnt a lot about eyes, which I hadn’t thought about since we studied anatomy and physiology in the first year of our degree. It was good to refresh my knowledge and add to it! I feel like I didn’t use my clinical nursing skills too much but it was a nice change of pace and everyone was super accommodating even though I was only there for a week. I also learnt that I definitely need to get my eyes tested.

Now the ‘second wave’ is picking up. Everyone is becoming more cautious once again. Only time will tell how this will play out.

In the words of Doctor Mike, once again, ‘Stay alert, not anxious’.

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Part 2. How COVID-19 Has Impacted Healthcare Students Across The World: Australia and Tonga

I’m back! I’ve spent the last few months trying to finish my degree, which put the blogging on pause but I’m glad to be back and venting into the chasm of the internet. Over the last few months, I have been speaking to nursing and medicine students from around the world about how their lives have changed because of COVID-19. This week, Mahdid, a medical student from Newcastle shares his story and I recap my conversations with Angela, a recently graduated nurse from the Kingdom of Tonga.

I went to college (Australian year 11 and 12) with Mahdid and we both chose to go into healthcare fields. Since then, we’ve been chatting about the different challenges we’ve been facing as healthcare profession students, especially during this crazy time. Australia has had 23,035 confirmed cases of COVID-19 and 379 deaths. While our numbers are much lower than other countries, there’s no doubt that this has been difficult for everyone. I asked Mahdid to share his story:

“Before SARS-CoV-2 hit, my weekly schedule began on a Thursday morning with an anatomy lecture and lab, where we learnt the anatomical foundations for the medical topic we were about to learn for the week. We were fortunate enough to do so through hands-on examinations of cadavers thanks to the brilliant individuals who decided to donate their bodies to science and learning. The rest of the week was filled with numerous lectures; tutorials based on real patient cases and investigations; research focused modules; as well as hands-on clinical skills labs where we would learn how to actually physically perform certain examinations from real doctors and clinicians to supplement the textbooks we read. Atop of all of these classes, every so often we would have patient forums, where a patient diagnosed with a condition we had been learning about speaks to all of us about themselves – not only about their condition but their entire, holistic experience which I found to be incredibly important and a genuinely invaluable experience for a young medical professional.

“Once social distancing came into effect my classes went online and being a medical faculty, we were especially vigilant. Although the problem-based tutorials and research were reasonably unaffected, the anatomy and clinical labs were difficult to do online. Being unable to see the anatomical structures in an actual three-dimensional specimen and how it relates to other nearby structures was a huge disadvantage since it’s often an important foundation to learning the following physiology. The hardest part about performing the clinical labs online is the difficulty of actually being able to conceptualise the skills through a screen or words [on paper] since it’s one thing to know how to practice these skills in theory, but actually knowing how to perform them is a completely different ball game. One of the more upsetting implications of social distancing has been the lack of our patient-centred forums. Our planned forums were cancelled which really sucked, since interacting and learning from an actual human with a condition is poles apart from learning it in a textbook, often devoid of real human feelings and experiences.

“Initially, being a pretty social person, it was a little tricky being so socially isolated. It was lovely being back home with family but it’s hard having your routine shaken up so drastically and rapidly. Despite this, I had kept busy with a bunch of projects. An exciting personal project I took on was keeping 3 pet pekin ducklings and renovating their coop in my backyard. I also took part in a uni project with the help of two of my peers; we convened the Vampire Cup blood drive for the University of Newcastle’s medical society throughout the pandemic. The Vampire Cup is a competition run every year between medical schools from different universities across Australia of which school can get the most blood donations. The competition began in March, near the Easter period where there’s always a shortage of blood donations and ended in May. Our uni did an amazing job this year despite the circumstances and we had 290 donations which smashed our previous records by more than 100 donations.”

You can check out Mahdid’s efforts on their Vampire Cup Facebook page: https://www.facebook.com/groups/UNMSVampires.

I met Angela while on placement in Tonga at Vaiola Hospital. She was still a nursing student at the time but has since graduated and become a fully fledged nurse! When I spoke to Angela, there were luckily no confirmed cases of COVID-19! She explained that things had remained running as normal but the small Kingdom had closed its borders to overseas travel to limit the possibility of transmission into the country.

The borders weren’t the only change that Tonga faced. The country had implemented a curfew between 9pm and 5am to limit the possibility of community interaction, just in case. More than 3,000 swabs for the purpose of COVID-19 testing have been sent to Tonga and will soon (if they aren’t already!) arrive in the country. Angela said that despite the declared state of emergency, her life hadn’t changed much at all. It seemed that the isolation of the Pacific had saved Tonga from what could have been disaster in this part of the world. Unfortunately, this hasn’t been the case for all Pacific island countries.

If we continue to stay alert and safe, we can still prevent further spread of COVID-19.

For more information about terminology surrounding COVID-19, such as Mahdid’s use of ‘SARS-CoV-2’, you can check out my last post where we explore terminology and the spread of COVID-19: https://daisyazmi.com/2020/06/07/the-spread-of-covid-19-and-how-contact-tracing-works/

Sources

International situation report 16 August 2020: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200816-covid-19-sitrep-209.pdf?sfvrsn=5dde1ca2_2

Pacific situation report 12 June 2020: https://www.who.int/docs/default-source/wpro—documents/dps/outbreaks-and-emergencies/covid-19/covid-19-external-situation-report-19.pdf?sfvrsn=ea24f9e7_2

The Spread of COVID-19 and How Contact Tracing Works

With lock-down restrictions starting to ease and a number of large gatherings taking place, I thought now would be a good time to take a look at how COVID-19 spreads and how contact tracing works.

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Some of you might have been expecting part two of my articles on How COVID-19 Has Impacted Healthcare Students Across The World but truth be told, I was a little bit stressed this week and had a mini meltdown (I was stressed about literally nothing… drama queen!). Part two has taken me a little bit longer than I expected but will definitely be up next week and explores the experiences of a medical student from Newcastle (the Australian Newcastle) and a recently qualified nurse from the Kingdom of Tonga!

I’ll try not to make it too scientific or boring, so I’ll keep it short and do my best not to sound like a journal article. The information in this post is correct at the time of posting (on the 06 June 2020) and sourced mainly from the article Features, Evaluation and Treatment Coronavirus (COVID-19), published on the 18 May 2020. A link to this article can be found at the end of the post!

SARS-CoV-2 is the official name of the virus wreaking havoc across the world today by causing the disease known as COVID-19. SARS stands for Severe Acute Respiratory Syndrome. The SARS outbreak of 2002-3 was caused by a different form of virus. CoV is an abbreviation for Corona Virus, the family of viruses which SARS-CoV-2 comes from. The ‘2’ is the number used to differentiate it from the virus that the caused the SARS outbreak in 2002-3 as these are different (though similar in very basic terms) viruses.There are no currently known cures for COVID-19 and the treatment for COVID-19 is therapeutic measures. This includes things such as oxygen therapy and anti-emetics (temperature-lowering medications).

As with many respiratory pathogens, SARS-CoV-2 is believed to be transmitted by droplets. This means that anyone coughing, sneezing (or even talking in some cases!) can cause droplets containing the virus to transmit directly to another person or onto surfaces. The virus can also spread through aerosol transmission, though this usually only occurs during certain procedures in a hospital environment.

Current data suggests that SARS-CV-2 can live on certain surfaces for up to 2 days. Though future studies may reveal different results it is important to keep this in mind as it is the information we currently have available. SARS-CoV-2’s current suggested reproduction number is 2.2. This means that it is estimated that every person who contracts SARS-CoV-2 spreads the virus to approximately 2.2 other people. This was seen before lock-down measures were introduced, when numbers of SARS-CoV-2 were doubling every day around the world. The fact that it can live on surfaces for a number of days and spreads to people so quickly freaks me out. But no need for alarm, if we consistently practice our hand hygiene all will be well in the world.

Having said that, the other crucial element to preventing the spread of SARS-CoV-2 is staying home! Although lock-down restrictions are starting to ease, it is still important to remember the virus has not been completely eliminated. If you are out and about you might be interested to know about contact tracing. In Australia contact tracing is carried out separately by each state. Someone will call you from your relevant state department.

Firstly, they’ll confirm you were in contact with a COVID-19 positive person (without identifying the positive patient). The person calling will then ask you a series of questions about your health to assess whether you will need a COVID-19 test. The current test or COVID-19 is a nasopharangeal swab which involves swabbing the back of your throat as well as the back of your nasal passage (do NOT try this at home – only a trained healthcare professional can administer this test). Based on the questions you’ll be directed to self-isolate. Meaning no shops, no school runs or socialising but your contact with your relevant department will provide you with some resources to assist with these challenges. They’ll then keep in contact with you everyday, either via text or phone call.

If your test is positive, you’ll be instructed on how to self-isolate and things you can do to manage your symptoms, as well as what to do if your symptoms worsen. If your test is negative, you will able to go about your business with respect to current lock-down restrictions, or depending on the circumstances of your exposure you may need to stay isolated and continue retesting.

I know there’s some debate about Australia’s COVID-Safe app so I won’t dive into the specifics here but it’s another way of assisting in the contact tracing process if you are going out and about. I have downloaded it!

I hope this hasn’t caused anyone too much distress. I’m sure that as time passes, new knowledge will come to light so please stay up to date with the best current (and tested) information. The journal article where much of this information has been sourced can be found at: https://www.ncbi.nlm.nih.gov/books/NBK554776/?report=classic and contains many more interesting insights. Thanks to my teachers for passing on this article! If yu find any other helpful or more current evidence, I would love to see it! Please send me a message or comment below so we can continue to build our knowledge. ‘Stay alert but not anxious’ and practice your hand hygiene.

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Part 1. How COVID-19 Has Impacted Healthcare Students Across the World: England

This blog has been a way for me to share my experience of how COVID-19 has impacted me as a nursing student but over the last few weeks, I have been speaking to nursing and medicine students from around the world about how their lives have changed because of COVID-19. This week Dr. Andrew Durham, from Leeds, shares his story about how his life has changed because of COVID-19.

I met Andrew while on placement in Tonga last year and we’ve kept in touch. As of the 30th of May, the United Kingdom had 271,226 laboratory confirmed cases of COVID-19 and 38,161 deaths. I can’t begin to imagine how horrific this might be. We have been talking about how COVID-19 has impacted him as a medical student and I asked him to share his story:

“This is a crazy time, isn’t it? I turned 25 last month and had a big party planned for all of my uni mates, which would have coincided with our final day of placement. Sadly a higher power had other ideas.

“I’m a UK-based medical student who met Daisy and her friends while in Tonga last summer (or winter for the Australians/Kiwis reading this). I think it’ll be a while before I’m back down-under again.

“We first heard that there was a new disease in China around late-January. It wasn’t something that we thought much of at the time. My course-mates and I were too busy with placements and preparing for our finals; it seemed like a world away and something that shouldn’t concern us. “Stuff like this doesn’t affect England, it’ll never reach us poms.”

“Then in late February we began seeing the footage from Italy. Initially we were quite dismissive and we laughed at people rushing to go and stock up on toilet paper. An online video of two women fighting was circulating and while the hysteria was comical, it made light of what was going to develop into a serious situation. We just didn’t believe it and believed it was media hype trying to whip up a story.

“The severity and scale of the illness had probably been covered up by the Chinese media, but as more reports came out of Italy, we started to see how bad it was for the first time. We could see patients with severe respiratory distress in their hospitals, how the doctors were struggling to cope with the workload and how the streets were closed to prevent spread. “Oh dear – this is actually quite serious!” Perhaps the media hysteria had some substance to it, and it shouldn’t be disregarded so readily.

“Sporting events began to be cancelled, most notably the last weekend of the 6 Nations. Italy’s final games against Ireland and England were postponed at the request of the latter’s governments, and Ireland began to enforce social distancing within their country. But in spite of this, our borders to Europe were still open and one of the biggest horserace event of the year, the Cheltenham festival, had gone ahead with 250,000 spectators.

“At this point, I was on a respiratory ward, and very close to finishing. Most cases were in London with about a hundred deaths, and infections were beginning to pop up across the country. This was quite a scary time for my two placement buddies and I as we didn’t know when corona was going to reach Leeds on a large scale. Would we be seeing these patients, would we be able to finish our placement, would we be at risk of contracting the virus? The biggest worry was we could potentially spread it among the student population (in Leeds where I study, that’s 100,000 individuals) who would then spread it home to their families all over the country. We medical students would be an ideal vector.

“It seemed that our medical school thought this too. They told all students in the lower years to stop going to placement to minimise exposure, all teaching moved online to prevent the spread, and people were passed into the next academic year based on their placement reports and previous examination scores. I felt most sorry for the 4^th years. While they have the toughest exams to sit (they dodged that bullet), this all meant their finals in year five would be much harder, and they missed out on their electives, the best holiday they would never have.

“Final years were told to keep going to placement. The General Medical Council declared final years were to be made a priority, so that we could qualify quickly and help ease the burden on the NHS. We were practically qualified at this point so were of some use on the wards. We would go and see patients before the consultants, prepare the notes and take the necessary bloods, helping to speed up the ward rounds. It was quite nice to feel as if we were of use.

“Then we started seeing infections in Leeds. When a student who was staying in halls [university accommodation] became infected, the entire university closed its doors, and every course moved to an e-learning platform. You couldn’t go to the libraries, the computer rooms or the on campus gym. In the evenings I’d come home from placement and see students filling their cars or getting picked up by their parents to go home for the inevitable lock-down. It felt like a scene from World War Z with all the cars parked outside and students abandoning their houses.

“Going back into the hospital after those first confirmed cases, the place had turned into a ghost town. Only patients who needed to be there were and on the floor was tape to encourage the two metre distancing. One of the respiratory wards was now exclusively for the COVID patients (along with ITU [intensive treatment unit]), no visitors were coming in and as many beds as possible had been emptied. It was strange being in the MAU [medical admission/assessment unit], which had been turned into the corona overflow unit, and there being no patients. All of these changes to prepare for the sudden spike had taken place in all of 48 hours.

“In spite of the apocalyptic tension, it was mostly business as usual. There was only one patient with a confirmed case and they’d been sectioned off. Staff were adhering to the new hygiene procedures and applying the necessary PPE [personal protective equipment], and it was all done with very little drama. Given what we were seeing in the news I was very surprised at how calm it all felt on the front line. I imagine as time has gone on and the number of cases have increased, this may have changed a bit.

“As previously mentioned, medical students are ideal vectors, and given we were on a respiratory placement, our consultants agreed to sign us off a week earlier than planned. It was a rather anticlimactic way to end six years of studying and placements. I’d imagined a big night out with my mates, and I’d even organised it, but our prime minister had closed all pubs and restaurants. It was completely the right decision by the government, but I hadn’t pictured medical school ending this way. Still, at least I got one for the gram…

“Then on the night of the 23^rd, Boris Johnson gave his television address telling us that we must stay at home. I live with two other student doctors and I remember thinking, as we sat in one of our cluttered bedrooms watching, “This is what wartime Britain must have felt like.”

“When Boris had finished, we looked at each other and asked “What are we doing?” Do we stay in our small flat and only go out once a day, or do we pack our bags and go home to our families? We chose the latter, there was no way we were staying in our cramped flat in the middle of the city, where we’d only be allowed out once a day. If I was at home, I’d have my mother for company, a country park out the back of my house and a more comfortable area to live. Within an hour of Boris’ announcement, I had packed the essentials, and was gone.

“Settling into the new regime took a while. Day-to-day things like shopping, going to the gym, going for a walk and coming home from work had to be planned, as was choosing when and what to eat. My mother is a midwife, and as a frontline worker she was at a greater risk of contracting the virus, given she was meeting patients daily. Our front porch became an airlock; she’d come home, take off her uniform, take it through to the washing machine and go straight for a shower to wash off any virus particles before doing anything else. We came up with a meal plan involving foods with a long shelf life, and we batch cooked a lot of meals in the first week that I was home. If one of us became ill, at least we’d have an ample food supply and wouldn’t have to worry about cooking.

“This was made more difficult when the fridge suddenly broke. We couldn’t order a new one immediately as people’s panic buying had suddenly extended to second fridges, so we had to borrow a small one that a friend lent us, and when a new fridge did arrive, the deliverymen wouldn’t install it because of the risk of infection. Totally understandable, but my mother wouldn’t have been able to install it herself.

“The daily government reports added to the increased tension. We saw the figure of daily deaths rising and wondered if their measures were working. The media were reporting stories of a lack of ventilators, a lack of PPE, a lack of testing and an economic crisis for thousands of people. It was very much a picture of doom and gloom, which got a lot worse when Boris Johnson was taken to hospital after testing positive. The media’s portrayal of it all didn’t help with the country’s mood.

“You can only control the controllables however. So I got myself into a mental headspace where I would focus on the few things that I had some form of control over, mainly keeping the house tidy and revising for my exams, and would adapt to whatever was to come. We were told that we’d be doing an online assessment, and that our practical OSCEs [objective structured clinical examination] had been cancelled, so I spent most of my day knuckling down. Then about a week into lockdown, once we hit early April, the health secretary Matt Hancock announced that he was going to get final year medical students to start working early, to help on the front line. The medical school responded and told us that they were going to cancel exams, and pass people who met the list of criteria below:

Passed fourth year the first time around
Passed the National Prescribing Safety Assessment
Passed all placements with no concerns
Had signed off all skills

“I had met this criteria, but what did it mean? After over ten years hard work, was I finally a doctor? The confirmation email came through a few days later. “Dear Dr. Durham, congratulations on becoming a doctor!” Dear Dr. Durham? Bloody hell I’m going to have to get used to that.

“It was a bizarre way to finish medical school. Normally there’s a barbecue immediately after your final exam and you have a graduation ball when you’re done. It’s certainly not the ending that I’d imagined. The big positive of the current situation is that I don’t have to sit exams, and I can start earning some money straight away (which I’m very much looking forward to), and in the time it has taken to organise everything, it’ll be during the period after everything has peaked.

“What have I learned over the last 6 or so weeks in lockdown?

I don’t trust the media. The majority of news these days is designed to be clickbait, to spark outrage and does little to really inform people in my humble opinion. It’s as if journalists have a hidden agenda that they are promoting; their careers, the political preferences. It makes for a very biased and uneven view, which doesn’t allow for intelligent discussion and at the time of an international crisis, undermining the government’s every decision in the hope of getting a reaction is dangerous and counter-productive.
When there is a crisis, the British people come together. So many medical and healthcare students have volunteered to work as ward clerks, cleaners or doctors assistants in the hospitals near their medical schools (if they’re not in their final year). When the government asked for people to volunteers to deliver goods to the vulnerable 750,000 people stepped up. Captain Tom Moore (who celebrated his 100^th birthday a few days ago), raised over £30 million for the NHS by doing 100 laps of his care home’s garden on a Zimmer frame, and every Thursday people have been clapping outside their front doors for all of the NHS workers.
Society will be different for a long time. Until a vaccine is found and we know more about how this virus works, I think social distancing will be in place for a very long time.

“People who regularly go to the gym (like me) have had to adapt to exercising at home and make do with the equipment at hand. Who knew a bag of sand could be used for squatting and overhead pressing? I’ve become a lot fitter in this time.

“The way we connect to each other with Zoom and Facetime have been invaluable, and for the first time in a while I think that I’m better connected with my cousins than I have been for a long time.

“I’ve also broadened my culinary skills and value the outdoors a lot more than I previously used to.

“This is a very uncertain time for people, both with regards to their finances and their health but for me, there is a lot to look forward to. I’ve finished university and will be starting my first job as a doctor, financially I’ll have a lot more freedom and when this blows over, I can say that I was working at an incredibly testing time, and developed my clinical skillset.

“A positive mental attitude will be key going forward. Stay safe in the meantime.”

Thanks so much to Andrew for sharing your story! Andrew has a YouTube channel where he’s posted some videos of his travels: https://www.youtube.com/channel/UC1ZHHkYkDDiiRc-pF5AaqjQ, you might even find some video of the nursing girls and I swimming with the whales (thanks for preserving the memories Andrew)! Andrew talked about how the front of his house had become an ‘airlock’ for decontaminating before coming into the house. If you’d like to read up more on how I decontaminate coming home from work you can read about that here: https://daisyazmi.com/2020/04/17/cominghomefromworkdecontaminating/.

It’s been so interesting to hear about students from all over the world and catch up with friends. Next week’s post features Mahdid, a medical student in Newcastle and Angela, a recently graduated nursing student from Tonga!

For the WHO situation report where the statistics were gathered from please visit: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200530-covid-19-sitrep-131.pdf?sfvrsn=d31ba4b3_2

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Part 1. Being on Placement During the COVID-19 Pandemic: Diaries

Placement is the time where you put your clinical skills to the test as a nursing student. I put together some entries about my experience on my last placement during the COVID-19 pandemic.

This blog post deals with the death of patients. If this brings up any worries or concerns, please reach out to someone or visit: https://www.lifeline.org.au/.

30 April 2020

It was not long ago that all placements had been cancelled. Thankfully the number of COVID-19 cases have been declining in Australia and some placement areas are now taking students again. I got the email yesterday that I would start placement in five day’s time (but only if certain criteria were met). At first I felt relieved that I had gotten a placement, which brought me one step closer to completing my degree.

Now, it’s sinking in a bit more. I got another email today about protocols for entering and exiting the hospital, and infection control measures that need to be taken. Although I won’t be in an area of the hospital where COVID-19 patients may be, it’s a little worrying to think what I could expose myself, my family and my patients to.

06 May 2020

I’ve been on placement for a few days now. So far, I’m loving working on this ward! I’m feeling a lot less nervous about the COVID-19 pandemic as I’m working on a designated ‘clean ward’ (a ward that doesn’t take any COVID-19 or suspected patients) and there is hand sanitiser everywhere. I’m also feeling a little safer because the number of COVID-19 cases has decreased so much. I’m lucky enough that the area I live in has very (VERY) few cases now.

When we were doing our ward orientation, the CDN warned us students to go straight home. If we needed to go to the shops at all, we should go home and get changed first, not because of the infection risk (because we’re a clean ward and everyone has been being very careful) but because some staff members had been abused by members of public. This was so disheartening.

I’d always felt proud to be a nursing student and to wear my uniform – as if it was saying ‘I’m here to help’. I just couldn’t believe that anyone would be yelling at someone or refusing to help any one of the amazing nurses I have worked with. I can understand that people may be fearful of catching COVID-19 as it can have devastating consequences but I think that we, as healthcare professionals, know that as well as anyone. And that someone would be rude to a nurse that could help them if they were to become ill … I just don’t know how to feel about it.

19th May 2020

I haven’t been writing as regularly as I should – being on placement and trying to study is super tiring. I’m feeling kind of grateful that we haven’t been allowed to work (at other healthcare facilities because of COVID-19) while on placement, otherwise I don’t know if I’d be able to do it. I know it’s not something that I should be complaining about because it’s about to become my new normal. I guess it’s just a matter of adjusting.

I guess placement has been a little bit up and down lately. On Friday there was a MET (medical emergency team or code blue) call and I scribed. The nurses were doing other things for the patient and the doctors were trying to figure out what was going on so I ended up being the scribe. Thankfully there was another student I’d been on placement with who was helping me collect all the information like vital signs and tests being done. I was super nervous but I think I did an okay job, even if it was only for five minutes. I came out of the MET feeling really proud of myself – that I’d contributed in that situation.

Later that same day, my first patient passed away. Over the weekend a second patient I had looked after passed away and on Monday night a third patient I had looked after passed away. They say it happens in threes. The death of my patients wasn’t something that really shocked me or scared me, they were palliative patients and I knew it was going to happen but I was quite sad when they passed away. For my first patient, I was privileged enough to help with her after care and I felt honored (the only way to describe it) to help her in that moment.

22nd May 2020

Today was my last day of placement. Last time I wrote I think I was definitely feeling some stress and sadness – mostly tired, I think [insert crying laughing face]. It’s safe to say I’m feeling much better (thanks to sleep) and more confident in my practice as a baby nurse. I’ve definitely learnt a lot during this placement in terms of clinical skills, my interactions with patients and colleagues. There’s still a lot I need to learn on my final placement but I can’t wait to finally become an RN!

I looked back at my previous entries and how worried I was about going into the hospital environment during this pandemic. I’m still worried with some of the restrictions lifting but I’m so relieved that our numbers have been so low. I can’t imagine how it must be in other countries. If things had been worse, I’m glad that I’m in a position where I could help in some way.

Placement can be hard sometimes. It’s just important to keep the positive experiences in mind during those times. And there are so many positives about nursing.