Peter Hodkinson

The African Journal of Primary Health & Family Medicine welcomes submissions that encourage scholarly exchange between family medicine and primary health care researchers and practitioners across Africa and the developing world, whilst providing a contextual and holistic view of family medicine as practiced across the continent.

Background: The COVID-19 Pandemic had profound effects on healthcare systems around the world. In South Africa, field hospitals, such as the Mitchell’s Plain Field Hospital, managed many COVID patients and deaths, largely without family presence. Communicating with families, preparing them for death and breaking bad news was a challenge for all staff. Aim: This study explores the experiences of healthcare professionals working in a COVID-19 field hospital, specifically around having to break the news of death remotely. Setting: A150-bed Mitchells Plain Field Hospital (MPFH) in Cape Town. Methods: A qualitative exploratory design was utilised using a semi-structured interview guide. Results: Four themes were identified: teamwork, breaking the news of death, communication and lessons learnt. The thread linking the themes was the importance of teamwork, the unpredictability of disease progression in breaking bad news and barriers to effective communication. Key lessons learnt included effective management and leadership. Many families had no access to digital technology and linguo-cultural barriers existed. Conclusion: We found that in the Mitchell’s Plain Field Hospital, communication challenges were exacerbated by the unpredictability of the illness and the impact of restrictions on families visiting in preparing them for bad news. We identified a need for training using different modalities, the importance of a multidisciplinary team approach and for palliative care guidelines to inform practice. Contribution: Breaking the news of death to the family is never easy for healthcare workers. This article unpacks some of the experiences in dealing with an extraordinary number of deaths by a newly formed team in the COVID era.

The South African Journal of Psychiatry publishes topical content in psychiatry for clinical practice and academic pursuits, including work in the subspecialty areas of psychiatry.

Background: The coronavirus pandemic has put extreme pressure on health care services in South Africa. Aim: To describe the design, patients and outcomes of a field hospital during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. Setting: The Cape Town International Convention Centre was the first location in Cape Town to be commissioned as a field hospital that would serve as an intermediate care bed facility. Methods: This was a retrospective descriptive study of patients admitted to this facility between 8th June 2020 and 14th August 2020 using deidentified data extracted from patient records. Results: There were 1502 patients admitted, 56.4% female, with a mean age of 58.6 years (standard deviation [s.d.]: 14.2). The majority of patients (82.9%) had at least one comorbidity, whilst 15.4% had three or more. Nearly 80.0% (79.8%) of patients required oxygen and 63.5% received steroids, and only 5.7% of patients were required to be transferred for escalation of care. The mean length of stay was 6 days (s.d.: 4.8) with an overall mortality of 5.7%. Conclusion: This study highlights the role of a field hospital in providing surge capacity. Its use halved the predicted duration of stay at acute care hospitals, allowing them the capacity to manage more unstable and critical patients. Adaptability and responsivity as well as adequate referral platforms proved to be crucial. Daily communication with the whole health care service platform was a critical success factor. This study provides information to assist future health planning and strategy development in the current pandemic and future disease outbreaks.