By: Jennifer Ngcobo (Clinical Advisor)
Since 20 April 2020 a team of clinical advisors from HST's Unfinished Business for Adolescent and Paediatric HIV project joined the eThekwini district COVID-19 screening and testing teams to assist with testing activities in the field. Following a half-day's training on the testing protocol l, we were allocated to different field teams covering various parts of the district. These teams had already been at work in the field and were comprised of various stakeholders, such as Department of Health and municipality nursing staff, partners supporting health services, metro police and community leaders from surrounding communities.
On a typical day in the field each team meets at a specified location in the morning for a briefing. During this meeting the team leaders provide a directive on what the day will look like, including an allocation of testing sites for the teams. The briefing meeting also involves a reflection on the previous day's work and reporting on the total number of tests conducted by the team. A complete testing and screening team consists of a driver mobilizer, outreach nurses and metro police.
The briefing session is also used to replenish supplies, such as test kits and stationery, in preparation for the field work. This task is not allocated to a single individual to complete, rather all team members contribute to ensuring that the team is prepared and ready. After the briefing teams travel to the field to conduct testing as per the schedule. The current strategy is to provide testing for all clients, with the aim of reaching a specified testing target every day.
Normally, the day before testing is to be conducted in a residential area a mobiliser will visit the area to get buy-in from the community leaders, in preparation for the testing activities. However, when teams are allocated to malls and shopping centres mobilization in the area happens on the day of the testing. When testing is done in complexes one team member — normally the person leading the team — asks for permission to enter the building.
Once in the specified area the team sets up stations in preparation for the day's work. Often this includes setting up the mobile health units and gazebos. The team lead then assigns each member a task: one member is allocated to testing, another assists the tester and others are responsible for completing the relevant forms that are part of the screening and testing process.
At the end of each day the team lead checks the specimen cooler boxes to see if the specimens and lab forms match, before taking the specimens to the NHLS mobile unit and ensuring that any waste is discarded properly.
Although this is how a typical day is structured, one soon learns that field work is often unpredictable. In the two weeks that I've spent on a COVID-19 community screening and testing team I have learnt the following:
- The importance of having a back-up plan for when you run out of supplies during a session: we have had to keep people waiting whilst we request additional testing kits, as it is difficult to predict the turnout at each service point.
- The importance of working as a multi-disciplinary team. This is evident by the daily need to work with law enforcement, as in some areas there are concerns for the field teams' safety.
- The need to work closely with communities when providing services, as their level of buy-in has an impact on how testing is perceived.
- The continued need for education on COVID-19 as most communities we visited know very little about the use of protective clothing and general hand hygiene.
Below are some photos from the field.
One of HST's testing teams outside a mobile unit, dressed in their PPE
A closer look at the PPE that our field staff are required to wear