PROVIDENCE – There are many, many angels persevering on the front lines of health care in Rhode Island, endeavoring to take good care of patients in a risky time of pandemic. Hearing their stories, or rather, having their voices heard about the difficult conditions they are encountering on the job, is not an easy task.

As some doctors, nurses, and even the commander of a U.S. aircraft carrier have learned, the risks of speaking out and telling the truth, honestly, about the conditions they are facing can result in immediate termination from your job. As in war, truth is also always the first casualty in a time a pandemic.

The tendency is for the higher ups to be given ample opportunities to speak in front of the news media – such CEOs, top medical department heads, and agency directors – rather than hearing from the worker bees.

Who speaks up for the hard-working people?
Last week, at one of the daily news briefing held by Gov. Raimondo, Convergence RI posed a pre-screened question that remarkably got asked – and answered.

The virtual exchange on Facebook, as reported by Steve Ahlquist of UpRise RI, went like this:

Towards the end of the press conference Richard Asinof of ConvergenceRI asked a similar question, focusing on the low-wage front line health care workers.

Question: “Would you be willing to make an emergency funding request through Commerce RI to increase the hourly wages of CNA (certified nursing assistant) workers in nursing homes, hospitals, and the home health agencies.”

Governor Raimondo’s answer, as Ahlquist reported, was to say that she put her trust in the market and the health care executives in charge of our local health care institutions to make the right decision as to whether CNAs might deserve higher pay. There was no admonition to businesses “to do the right thing.”

ANSWER: “So, at this time, what we are doing is, I’m in very good contact with hospitals, nursing homes, and the labor unions that represent the CNAs, nurses and social workers,” the Governor said. “Soon the federal stimulus money will be made available to hospitals and other health care providers. And then, at that point, I would say that the individual institutions – health care institutions – will have to figure out how to use that additional capital to keep the lights on and keep folks employed and to have the PPE necessary. And I would just encourage each institution to do what they think is in the best interest of their employees and their patients.”

Translated, the Governor is content to let the hospitals and the nursing homes and health care providers divvy up the promised federal stimulus money in the way that want to do so.

Would that equation change if the voice of CNAs, the ones providing most of the care in the nursing homes and in many health care settings, could be heard in public and featured at a news conference? Good question.

Speaking out
Speaking out to the news media in a time of pandemic can be seen as a violation of their employment contract, according to a number of sources contacted by ConvergenceRI. Yes, there are daily briefings by the Governor and her agency directors; the news media gets to ask questions, pre-screened, with no follow-ups allowed, in a tightly constricted process. As a result, the news flow often tends to resemble repeated messages as pronounced through a megaphone.

Still, some folks are willing to talk, but only anonymously, out of fear of losing their jobs.

Here is one such interview with a provider, let’s call him “Florence Nightingale.” He has been serving on the front lines in Rhode Island as the coronavirus pandemic took hold.

[In history, Florence Nightingale was a nurse who served during the Crimean War, who advocated a common-sense approach to health care, talking about the importance of hygiene – fresh air and water, cleanliness, proper drainage, and ample light – as well as ongoing consideration for patients’ feelings in the design of hospitals.]

ConvergenceRI: How have your responsibilities in your job changed as a result of the coronavirus pandemic? What kinds of innovations in the delivery of care have happened as a result of the current situation?
NIGHTINGALE: My work responsibilities have been changed, though we have not yet been asked to work in a specialty other than those we are trained in.

We have moved almost all outpatient visits to be conducted through telemedicine. I personally am still going in to work, though am only seeing patients in person for sick visits or in the emergency department.

Telemedicine is new for most of us, but it is proving to be quite innovative in the way we can provide care. We are now checking in with patients and families perhaps more frequently than before, and it removes the barrier of transportation for many patients.

ConvergenceRI: What are the kinds of questions you are getting from pediatric patients about the coronavirus?
NIGHTINGALE: Surprisingly, kids haven’t asked me much about the virus. Parents have been asking about healthy and safe ways to keep their kids occupied at home, but the kids themselves seem pretty unfazed.

ConvergenceRI: How are you and your colleagues dealing with what has been reported as a lack of personal protection equipment?
NIGHTINGALE: Unfortunately, we still don’t have enough PPE despite limiting our staffing in the hospitals. It is upsetting, and many providers are worried about the risk to themselves and their patients.

As this is a new virus and the route of transmission continues to be a point of discussion, the ever-changing recommendations are also [creating] a point of anxiety for providers. We continue to care for patients and ourselves in the best ways that we can, with a limited supply of PPE.

ConvergenceRI: How many of your colleagues and fellow health care workers have been tested and found to have been infected with COVID-19?
NIGHTINGALE: I can’t speak to the numbers who have been tested nor to who may have resulted positive tests. But I can say that our occupational health department has opened a 24-hour hotline for us to call and report symptoms to.

They are working alongside the R.I. Department of Health and making recommendations about screening and when it is safe to return to work. Those of us who have required screening have gone to one of the public testing centers.

ConvergenceRI: What kind of collaborations have you been able to engage in with staff, including doctors, nurses and aides and other staff, as you confront the epidemic?
NIGHTINGALE: It has always felt like the various staff [that I work with] are part of a bigger team, but this feeling is even stronger now. Everyone feels overwhelmed, but we are trying to work together to get through everything that needs to be done.

Many local restaurants have donated food to the emergency department, which has been greatly appreciated.

ConvergenceRI: There is some confusion around what kinds of testing are available here in Rhode Island. Are there concerns about the reliability of the results of the new kits bring deployed? If the nasal swabs used in testing for sampling could be produced by 3-D printers, would that be helpful in making more testing available?
NIGHTINGALE: I don’t feel that I can accurately speak to the specific tests nor to 3-D printing as these aren’t areas I’m particularly educated in.