Special Report: Indian-American nurses on frontlines of COVID-19 patient care

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When the 28-year old patient was to be intubated because the ventilator was not doing much for him, and his sister was told to leave the ICU, he became uncontrollable. The terror in his eyes as he looked at Marina Bijoy, an Indian-American registered nurse in a Florida hospital, and others caring for him, was stark to behold.

“It’s a very terrible situation and heartbreaking – when you don’t know if you will ever see your family, whether you will live or die,” Bijoy says with a break in her voice to control her emotions.

Though this young man was on the road to recovery in a period of ten days, that moment when he lost control, was game-changing for the caregivers, veteran nurses so dedicated to their jobs that they decided to take turns sitting in his room to reassure him even though staying away and out of his room was more advisable, for their own health.

Nurse Bijoy’s hospital was declared a ‘Corona Center’ April 8, 2020, and began getting all COVID-19 patients instead of only the ICU and emergency cases before.

When Vani Sudheesh, a registered nurse in Miami, was taking care of a 76-year old patient who was admitted with all the COVID-19 symptoms but no co-morbidity (underlying immunodeficiency), he held Sudheesh’s hand and told her solemnly in words that she recalled to News India Times.”The whole world is talking about me (corona patient), but it’s about you. You are the angels in this world. You have to take care of yourselves,” he said,

“He was holding my hands and telling me not to worry, I started tearing up,” Sudheesh said. That was two weeks ago by April 9, but that patient remained in a bad way and intubated.

As Agnes Therady, president of the National Association of Indian Nurses in America, NAINA, drove out of the hospital garage on her way home April 9, 2020, she saw a huge number of cars in the roundabout driveway, and lots of security personnel. As Vice President of Patient Care Services and Chief Nursing Officer in charge of 1,500 nurses at her hospital in Indianapolis, Indiana, Therady wanted to find out what it was all about. When she stopped to find out what was happening, she heard the clapping and cheering that broke out in support of the healthcare workers.

Johns Hopkins University nursing ethics expert Cynda Rushton, interviewed on the hub.jhu.edu website, correctly said, “It’s a time of great stress and uncertainty, and nurses are rising to the challenge.” A few weeks ago, she helped create the Frontline Nurses Wikiwisdom Forum, a virtual safe space where nurses can share their challenges and experiences during COVID-19, the news report said.

Rushton sums up the role of today’s nurses in these words in her interview -“Nurses are often the last thread of compassion for patients. They’re the ones doing the screenings, taking care of the critically ill, implementing triage protocols, communicating to families, and attending to the dying.   Nurses in every role are impacted. They’re being asked to work in areas of the hospital that aren’t their normal specialty.”

“Yes, I haven’t been sleeping well,” Therady said as she worries about her nurses not just at the hospital where she works but also members of NAINA. One NAINA member, nurse  Aleyamma John passed away on the East Coast on Sunday (April 5) she said. She has heard of one other death but has yet to confirm it.

Helping The Helpers

The umbrella organization NAINA, has close to 20 chapters around the country (nainausa.com). In addition, there are also Indian Nurses Associations around the country. News India Times spoke to some of the leaders of various chapters. While no exact estimate of how many Indian-origin nurses work in the U.S. was available, each of them said their branches had hundreds of members.

Professor Bobby Varghese, president of the Indian Nurses Association in South Florida, a sister organization to NAINA, says there are some 5,000 Indian nurses in the four counties that include Broward, Palm Beach, Miami and Dade make up his South Florida region. And altogether he estimates some 30,000 Indian-origin families live in the region, but cautions he may not be giving the correct count. His organization, INA, has around 500 members. Various Indian-American task forces that he is part of are holding weekly zoom meetings, brainstorming about which hospitals around the U.S. to adopt and channel resources to meet the needs of nurses.

A week ago, a webinar for nurses on stress reduction attracted around 100 nurses who were shown techniques such as breathing, mindful meditation, mindful hand-washing, etc, “We are also calling all local presidents of nurses organizations to see what nurses in each region need. Some may need counseling, or money, or PPEs, so that we can serve them,” Varghese said.

“We have appropriated considerable amount of money and we are dividing the country into three parts – East Coast, Midwest and West Coast,” to render the help. “We are starting with the East Coast as the most important right now,” he said.

Tara Shajan who is in the thick of the crisis knows about that as the director of nursing at a medical center in New York. When the number of COVID-19 patients surged in the second week, her hospital moved to convert a whole floor dedicated to those patients. “Now 98 percent of the 400-bed population is COVID patients,” she said. “We have a good number recovering,” she said reassuringly, but less among those with underlying conditions. Retired nurses are being called upon to help, and new graduate nurses are being hired on a permanent basis. The PPE supplies have stabilized. “That way staff feels more comforted,” she said.

Some nurses on the frontlines also made time to talk about their experiences in the midst of busy schedules. Professors of nursing like Varghese in Florida, and Harkirat Bal in California, who teach Nursing Practice at colleges and universities, also gave of their time willingly, even as their workloads had increased with switching to online courses and managing their organizations, listening to the concerns of frontline nurses, and organizing webinars to keep their members informed and updated.

Bal, president of the California chapter of NAINA, who also manages a rehab center in Fresno, noted he had the most vulnerable and high risk patients in his establishment, all of them with co-morbidity conditions like heart disease, diabetes, cancer etc.

But Bal moved quickly to establish strict protocols for patients, staff and visitors so that to date there have been no deaths. His early measures were considered an overreaction by some, but that did not deter him.

Taking Initiative

An Advanced Family Nurse Practitioner with a doctorate in nursing, Bal teaches at two local universities, and despite being sleep-deprived, he is optimistic. “The good news is I do have some suspected but not confirmed cases,” who are in isolation, but his nurses and other staff are checked daily when they come for work. Those with any signs of temperature are told to go home. It was an expensive move to come down heavy with strict regulations, but it has paid off, he said. “We do not have many sick patients, we have very well prepared staff,” he said, And he is there at everyone’s beck and call.

A similar situation has unfolded in Aney Abraham’s institution in far away Chicago, where she is the associate vice president at a hospital and oversees some 600 full-time staff and several hundred temporary ones.

By end of March, her institution launched a Command Center which ensured enough supplies and staff resources were available to meet a bigger crisis, prepared to cancel elective surgeries, and create new intensive care units. “We are watching the data closely – from China to New York to California and other places,” Abraham, whose mother was also a nurse when the family came to America in the 1970s, says her Indian colleagues from around the country are not in such good standing as her hospital is at the moment. “I’m hearing stories from them on shortage of materials etc.,” she said.  Her Command Center is open 24/7. A total of 7,000 nurses work in this large hospital, she estimated.

“We know that nurses are the backbone of American health care, and often its heart and soul,” says the Johns Hopkins site the Frontline Nurses Wikiwisdom Forum, site created for nurses to share their experiences, says.

“I want people to be aware that the patient is a real individual person who has same feelings, emotions and is scared as anyone else. If we give them the mental support at this time, it helps them a lot, No amount of social networking can replace the human touch,” says Nurse Bijoy. She returns after her nightshifts and does her best not to bring COVID-19 home.

“I have told my kids who usually hug me when I return from night duty, to wait till I have showered,” Bijoy described. Her mom and her younger son have underlying conditions,

“I’m happy to do whatever is needed so long as I am healthy,” says Nurse Sudheesh, whose two year old toddler gurgled in her arms as she gave the interview. The child’s birthday fell on the same day, April 9, 2020. “They are preparing us (at the hospital) for the peak in two weeks,” around April 21, she said.

Faith Community Nurse (FCN) Pauline Alookaran of the Central Florida chapter of NAINA, is currently at home but busy organizing help for nurses, many of whom call her to tell her its’ extremely hard, “Like going to war.” They are worried about what they are going to face daily, whether they are going to be back from work whole, who is going to take care of their family, and are they going to spread the virus to family members.

As an FCN, Alookaran tends to the needs of some 250 families, all of Indian origin from Kerala. She offers them spiritual guidance as well.

“For me this is the time when we are really needed.” Nurse Bijoy emphasizes. “It is what it is — if they are sick we have to look after them. We’ve got the talent, we are educated (trained) for this. This is the time and with God’s grace we should overcome it.”