Yassine Nhammi, chief physiotherapist at the department of children’s orthopedics at Centre Hospitalier Universitaire (CHU) Rabat, was leading MiracleFeet’s newest program in Morocco, treating clubfoot patients, distributing corrective braces, and overseeing communication and follow-up with families and patients. That is, until COVID-19 swept the globe.
Seemingly overnight everything changed. Nhammi is now treating COVID-19 positive infants and young children in the pediatric ward of CHU Rabat. He was chosen for this position because of his limited risk factors (he’s under 30, unmarried, and healthy) and because of his extensive experience working with kids.
To help slow transmission of the virus only COVID-19 positive children and mothers are allowed in the ward. While most children who contract COVID-19 have mild symptoms, those with underlying conditions can have severe reactions. Last week, Nhammi treated an infant who tested positive and who he suspects is also suffering from an underlying respiratory infection. Nhammi massaged the infant’s chest to coax fluid out of his lungs to send out for testing.
Although he is not currently practicing much of what he specializes in as a physiotherapist, Nhamni has an easy rapport with the children on the ward and tries to keep them occupied and in good spirits and even plays games and colors with them.
Once it was clear that all health systems were shifting their full focus to COVID-19, Nhammi and his team of three other physiotherapists sought to help as many of his patients as possible before the clubfoot clinic in Rabat closed. This included:
Arranging brace delivery. For patients who had already received a tenotomy and were ready for the last stage of treatment (the cast worn for 3 weeks before bracing), Nhammi coordinated delivery of braces to help prevent relapse for patients so near the end of treatment. He was unable to deliver the braces himself due to government-imposed movement restrictions, but, ever resourceful, he enlisted the national courier service to deliver these essential medical devices to families. Nhammi also provided instructions to the families over video calls to ensure they understood how their child should wear the brace and had an opportunity to ask questions.
Educating patients about the importance of brace compliance. Nhammi encouraged patients already in braces to continue to wear their current brace as long as possible to prevent relapse. For parents of patients donning braces for the first time, Nhammi explained how to wear and manipulate the brace over live video calls. He is also devising a plan to deliver the next size up brace to patients who need them.
Instructing pre-tenotomy patients to remove casts from home. Nhammi instructed parents of children who had not yet had a tenotomy to take their cast off at home. To assist with this process, Nhammi provided voice or video instructions (babies should be put in a warm bath for 20 to 30 minutes until the cast develops a paper like consistency and can easily be unwrapped and removed). The process is not difficult, but parents appreciate having specific guidance.
Collecting information from new patients. Although Nhammi is currently unable to initiate treatment for new patients, he is working to ensure that all patients seeking treatment are in contact with the clinic coordinator so they can begin the process as soon the pandemic subsides. Most understand that the priority has shifted to COVID-19 and that it is safer to delay treatment rather than risk infection by visiting a high-volume health facility.
At the beginning of each shift Nhammi’s temperature is taken and then his entire body is disinfected. Inside the COVID ward he wears a mask, shoe covers, a hazmat suit, three gloves worn and disposed of in a specific order, and a photo of himself taped to his suite so the children know what he looks like underneath his protective gear. Nhammi will be working exclusively in the children’s ward of the hospital treating COVID-19 positive patients for the next 30 days. His shifts are six hours long, after which he takes a dedicated vehicle to a hotel reserved exclusively for hospital workers. Once his one-month stint is over he will self-quarantine in the hotel for 15 days. After that, if he shows no symptoms, he’ll return to the hospital for another 30-day shift.
Nhammi worries that after that pandemic subsides the primary focus of most families will be navigating the economic disaster created by the pandemic. The priority for many families will be regaining their livelihoods and they may struggle to prioritize the intensive process of treating their child’s clubfoot. Since treatment is most effective during infancy, this could leave a gap that will be difficult to bridge. He is also thinking ahead to plan for the surge of patients and what the program will need to address the backlog, including new cases and those who were in the middle of treatment (many will suffer a relapse and need to start the process over).
But there is a silver lining to the pandemic. CHU Rabat is already a reference facility for clubfoot treatment, but there is now an increased level of coordination between the maternity ward and the clubfoot clinic in the hospital. Nhammi, now at the hospital consistently, is continually advocating for and educating families about treatment for this common birth defect.
Although the situation is bad and the long-term outlooks uncertain, above all, Nhammi feels his ultimate challenge is to maintain a positive attitude and optimistic outlook—for the kids and for himself as he believes stress and fear can increases vulnerability to the virus.
Nhammi’s ability to quickly shift from clubfoot treatment provider to COVID-19 caretaker speaks to his ultimate skill as a health care worker: he cares. His instincts for care and his creativity around providing it are what make him essential right now.