On the frontlines:
Celebrating nurses and midwives

The World Health Assembly has named 2020 as the International Year of the Nurse and the Midwife to honour these unsung heroes who often work in difficult conditions to deliver healthcare. In this series, five IAS Members share their experiences from the frontlines of the response to HIV and now also COVID-19.

Allan RiveraCosta Rica

Allan Rivera, 36, from Costa Rica, was 14 when he was diagnosed with Type 1 diabetes and 20 when he was diagnosed with HIV and decided to become a nurse. He has been working as a nurse for 18 years, in the same hospital in which he studied. This is his story...

My motivation to study nursing came when I was diagnosed with HIV in 2004: I knew the needs of people living with HIV and the support we needed in psychological and comprehensive care. I joined an NGO of people living with HIV as a volunteer in 2007. I founded the Network of Positive Young People of Costa Rica and am President of an NGO of HIV called MANU (Asociación MANU). I have also been a member of other networks, NGOs and state agencies working on HIV.

Sixteen years ago, the HIV situation was not well known. Therefore, there was a lot of stigma and discrimination in hospitals. Patients living with HIV were isolated and, when they died, they were wrapped in black bags marked as infectious. Their clinical records were marked as high risk. There was not much scientific, medical and knowledge advancement for people.

There has been a lot of change. As nursing professionals, we have more tools to support people living with HIV and great knowledge on the subject. This has greatly reduced the stigma and discrimination against people living with HIV in healthcare settings.

I feel proud every time I can help, explain or offer my support, knowledge or guidance to people who have just found out they have HIV. This is as a nurse and also as a peer who has been in that situation.

The most challenging thing in my career is being accepted by my colleagues – to educate them with the HIV knowledge that I have acquired and thus not feel discriminated against or stigmatized by older colleagues who do not have the same knowledge and experience.

The only similarity I see between COVID-19 and HIV is that they are both widespread pandemics. The national response to HIV has taken place over a long time and depends on the few people who are involved and their political or economic interests. For COVID-19, it is an immediate political, social, economic response that involves all people.

 

On a professional level, COVID-19 has created a health crisis that demands more work to help people living with HIV. This is so that they receive their medication at the right time and maintain their adherence to treatment. Many people, such as those who do not have jobs or have lost their jobs during lockdowns, need help in finding basics like food and they need psychosocial support.

On a personal level, it has been difficult. I have worked with fear of contracting COVID-19, not had restful moments, not stopped to see friends and been more distant from my boyfriend and family. However, I consider myself a very resilient person.

The best contribution that nurses can offer in the HIV response is to raise awareness about early and timely control and adherence to treatment. We can carry out conscientious work, stand up for the right things, not discriminate or stigmatize any person and defend human rights. And we can act with the commitment to help all people who need us.

Daren Paul Katigbak Philippines

Daren Paul Katigbak was born and raised in the Philippines and now lives in the Netherlands. He believes nurses should be valued at all times, not just during the COVID-19 pandemic. This is his story...

I have a Master of Science in Public Health from Royal Tropical Institute in Amsterdam and am doing a second Masters at the International Institute of Social Studies – Erasmus University Rotterdam in the Hague (ISS-EUR). In the Philippines, I worked in the intensive care unit and emergency room before moving to a faith-based NGO. I am involved with HIV advocacy and youth networks internationally, such as Y+ Global, of which I am the Deputy Chair.

I wanted to be a doctor, but due to financial constraints, it was difficult to go to medical school. So I decided to be an assistant to a doctor – a nurse. I got a partial scholarship at college and studied nursing. I started seeing that nurses play an important role in medicine. Doctors usually do the initial session, but nurses are there throughout the process. My motivation to become a nurse was also linked to the fact that when I got diagnosed with HIV, I wanted to help others in a similar situation. I wanted to work on community initiatives on HIV or other public health concerns in the Philippines, such as TB and malaria, which is also a major burden to the community.

I started working in the hospital immediately after graduating and passing the board exam in the Philippines. In my three years there, I felt that I was not growing in my career. There was a lot of work to do and clients to see in the eight-hour nursing shift. I was very tired. Usually, you leave two hours after your shift ends and we were not compensated for that overtime. The burden was huge and the salary was not sufficient.

So I moved to where I felt I could be more useful and empowered – working for the community and managing programmes and activities. During my time with the NGO, the Catholic Bishops’ Conference of the Philippines – Episcopal Commission on Health Care (CBCP-ECHC), we set up a one-stop clinic, the Woodwater Center for Healing. We provided health promotional activities and counselling to key affected populations, people living with HIV and people affected by TB. We provided health services, including HIV treatment and medication for TB. Despite bureaucracy and funding issues, the clinic was seen as a role model and other denominations of Christians were inspired to set up clinics. We were able to change the narrative in HIV programming, especially coming from the church. I was very proud of this.

During the COVID-19 pandemic, nurses are prioritized mainly because we are on the frontline. The government had put an emphasis on us, creating a safe space, elevating our status in society and giving us importance in policies and guidelines, as well as a better salary. COVID-19 should not be the only driving force behind treating us well.

The pandemic has created a crazy situation for me. I am in the Netherlands and my family is in the Philippines; I feel powerless because I cannot take care of my family. I am immunocompromised, so I cannot go out when I want to. However, I am taking the opportunity to use technology to address issues of COVID-19 and create awareness of the relationship between HIV and COVID-19.

The Philippines recorded a 200% increase in HIV infections in nine years, according to UNAIDS. But there are not enough doctors and facilities. We are in the process of enabling nurses to initiate ART in the Philippines. I believe that the role of nurses will become even more important in managing HIV and controlling the spread of the epidemic.

My message for young nurses is: be strong, put yourself out there and remember that you are an important part of the responses to COVID-19 and HIV. Believe in yourself. Help each other and always put your heart into what you are doing.

Harriet Tambudzai JereMalawi

Harriet Tambudzai Jere, 29, is a registered nurse who works in a paediatric ward in Malawi. She has witnessed stigmatization of nurses working in COVID-19 wards. This is her story...

I started working as a nurse in 2015 after obtaining a Bachelor of Science in nursing and midwifery from the Kamuzu College of Nursing at the University of Malawi.

I was motivated to become a nurse after visiting my late dad in hospital; he was in a ward where one nurse, alone on that shift, was caring for many patients. I started thinking that if I pursued nursing, I would be able to make a difference by reducing the problem of shortage of nurses.

When I started working as a nurse, it was not as easy for me, especially when I worked with chronically ill patients on palliative care, such as those with cancer secondary to HIV. However, I am pleased that I made the good choice to join nursing, knowing that I am trusted with people’s lives and trusted to advocate for them even when they are in a critical state.

It makes me proud when my client gets home and is happy, not only because they are returning home healthy, but also because they are satisfied with the quality nursing care services that I provided.

Seeing a patient die is one of the saddest moments of my life. As a nurse caring for a client, it is my hope and expectation that they will get better and return home. It’s challenging when your patient is not responding to treatment despite much effort.

Malawi has been hit hard by HIV, and now it has been hit hard by the COVID-19 pandemic. I was deployed to work in a COVID-19 ward. My experience there was that we, as healthcare workers caring for COVID-19 patients, were being stigmatized by our fellow healthcare workers and the community. This is a bit different from the HIV response, where stigma is mostly directed towards people living with HIV, rather than the people nursing them.

This pandemic has affected nurses a lot. Many nurses would report for duty at the nurses’ station, instead of the COVID-19 ward, due to the fear of being infected. This led to an increased workload on the nursing team that did report to the ward. We also lost some nurses due to the pandemic, which worsened the shortage of staff. I was distanced from my family while I was working in this ward, and my social life was negatively affected.

There is an increasing amount of HIV research being conducted. This raises hope for nurses working in the response because if there is more accurate information on HIV available, it is easier for nurses to do their job safely.

My message to new nurses in HIV is that providing evidence-based care is one of the most important components of providing quality nursing care. Knowledge is light.

Kinana RahalLebanon

Kinana Rahal, from Lebanon, has worked in roles across the profession and sees many parallels between the HIV and COVID-19 responses. This is her story...

As a teenager, I was greatly influenced by inequality and poverty. Seeing marginalized groups, especially handicapped people, children with disabilities and the elderly, was heartbreaking, so I chose a speciality that serves the well-being of these groups. Nursing was an entry point to this world and not the end.

After graduation, I nursed in the intensive care unit of a university hospital in Beirut. I searched for a speciality that would take me away from death and closed areas – to the community, my world. I decided to obtain my midwifery diploma, followed by a Master of Public Health.

I worked as a nurse and midwife at the hospital, established my own private delivery clinic, consulted as a midwife at a dispensary, and taught nurses and midwives at universities. With experience in both academia and reproductive health, I was recruited by the UN in 2008 as an Associate HIV/AIDS Training Officer and also as an HIV counsellor.

Fear and discrimination against people living with HIV were high in the community and among medical staff. Myths and misconceptions were dominant 25 years ago and some practices did not follow standards. For example, the file of a patient living with HIV was labelled so staff were aware of this, and the patient was put in a single room. If a staff member had a needle prick, we took the patient’s blood sample to test for HIV and hepatitis without their consent. I personally screened pregnant women for HIV without their consent. Much has improved due to NGOs’ efforts and mass media work, but more is needed to change the attitude of the medical and paramedical sector towards the HIV response.

As an HIV trainer and counsellor, I understood that HIV was like any other chronic disease: no longer a death sentence, but still battling with stigma and discrimination. I understood HIV from its diverse dimensions: medical, psychological, social and mental. The first time I met a person living with HIV was a lesson in empathy, compassion and acceptance, and I felt that I passed the exam with distinction.

I am very proud of being a nurse. This profession has given me a significant tool for continuous reflection on life, health and death. Gratitude is my best lesson learned. I want to tell you about a mother who lost her baby two days after birth and after many attempts to get pregnant. The paediatrician called me to assist in delivering the news to the mother and assist her in her grieving – I am known for my skill in compassionately approaching such situations. Working with sick children has been my biggest challenge.

There are many similarities between the HIV and COVID-19 responses. Both are viruses and require a vaccine; ignorance leads to fear, anxiety and panic in communities and leadership; and both are linked to stigma and discrimination. For both, we need to enhance the sense of individual and collective responsibility and concern. Preventive measures are well known for both, but attitude and behaviour change are missing.

We must learn from the HIV response to better manage the COVID-19 response.

The impact of the COVID-19 pandemic on the professional and personal levels is huge. We had to create new ways to work. For example, I shifted to online training and sometimes online counselling. Fear, confinement and uncertainty increased our anxiety. In Lebanon, the breakdown of the medical system due to the economic collapse that coincided with the outbreak of the pandemic complicated the situation and amplified stress.

To young nurses, I say that nursing is not just a profession; it is a vocation and a mission. We should do it with passion and devotion. Otherwise, we may not be able to handle the stress.

Shaun WatsonUnited Kingdom

Shaun Watson has worked as a qualified nurse in England since 1989, mostly in terminal and palliative care and HIV. His passion is for death and dying, sex and sexuality – the taboo subjects that traditionally we find difficult to talk about. This is his story...

I trained in Hull and moved to London in 1997. I have managed wards in a generic hospice and a specialist HIV unit and taught general nurse and HIV modules at three London universities. I have been a community HIV specialist nurse since 2005, managing people with complex HIV in their homes.

My family lived in a village and I thought about joining the police. But at a “careers” event at school, I was told to look at nursing and I volunteered at a hospital. Although I had dull tasks, such as making tea, I enjoyed talking to patients about their lives. I did a pre-nursing course and then studied at Hull District School of Nursing. I had an interest in terminal care, having lost my grandparents and father within seven years.

I can pinpoint the start of my interest in HIV to a lecture in nursing school about AIDS. The lecturer did a session about safer sex, which bordered on homophobia. I became a volunteer at an HIV charity and joined its counselling team. At this time, I knew I was gay, and I devoured anything about being gay; most, unfortunately, was around HIV and AIDS, which was not the most positive coming-out experience.

For me, basic nursing hasn’t changed. We have more administration and pressures, but day-to-day care and support and our interaction with people who are ill and their families is the same. Systems have changed and seem to be less supportive. In the 1990s, you would never discharge a patient until services at their home were set up for a safe discharge. Now, there is pressure to move patients as soon as possible.

My proudest moment was becoming a ward manager in a hospice. It was my first management role: I liked to think that I could shape nursing by recognizing that caring for the same patient every day could be tiring, allowing nurses to choose who they cared for, giving them a break and focusing on the family and how we supported them.

My biggest challenge is fighting for nurses to be who they want to be as “nurses”. I don’t have a degree … I do have 30 years of experience, and this has been a battle to develop as I want to develop, not as my manager feels I should. The pressure to grow through academia is immense, but does not suit all nurses. Some of the best nurses are those who learned from their history, patients and work, those who can reflect and support nurses from their own experience, not through a textbook. I learned from observing good and bad managers; you cannot teach a nurse to be a “good” listener, empathetic, to comfort and support, to effectively break bad news.

I have been redeployed to the COVID-19 frontline. In my hospital, most redeployed nurses were from sexual health and HIV. One is working there full time, some flourished, and some despised every shift. I was in the middle: scared but skilled. I see a similarity to what we do now in HIV. We had to adapt the way we worked with HIV over the years.

The world is a strange, alien place. I have half an eye on making sure that my patients are supported and safe and the other on my emails, awaiting redeployment. It is quieter now, but there is still the fear that long days and nights in critical care are around the corner. I feel that I need more balance. My flat is on the market and I’m looking for a place nearer the coast to enjoy my days off more. I still feel unmotivated, distracted and anxious.

I hope that I will see nurses being the future of HIV care and the COVID-19 response. We are leading HIV clinics, prescribing medications and dealing with complex care coordination issues. We have proven our worth, flexibility, adaptability and resilience. I hope that nurses can see their power and remain strong.