In Fear of the Unknown, Thirty-six-year old Dr Joji Vakadiwaiwai Rokomalokalou is the first surgeon to operate on COVID positive patients with underlying medical conditions.

He has been part of the Colonial War Memorial Hospital (CWMH) surgical team for seven years.

During any normal emergency operations, he would have one of his superiors present.

This time it’s different. Inside the operating theatre, he’s the lone surgeon. He’s assisted by a team of two anaesthetists, and four nurses.

They are the first team to operate on COVID positive patients.

The two anaesthetists put the COVID positive patient to sleep, while Dr Joji conducts the operation.

He’s assisted by the nurses when operating on the patient.

Dr Joji has to be more cautious when operating on the patient. He must ensure a successful operation.

But also, that he doesn’t contract the virus during the surgical process.

He’s placed under immense and unprecedented pressure.

This second wave of the COVID-19 outbreak has not spared the CWM Hospital.

Initially, the Ministry of Health and Medical Services was strategically focused to protect the country’s main hospital.

Unfortunately, on June 1, 2021, Permanent Secretary Dr James Fong announced two new cases at the hospital.

Dr Joji had just completed his one-week shift work when he was recalled to work.

It was painful. Just the thought of not seeing his two young children was overwhelming.

He knew that the 14-day exposure period could lead to more than just two weeks away from home.

Last week, Dr Joji had just completed his 14-day quarantine period and was reunited with his family.

He had been away for more than a month.

Like other frontliners, Dr Joji and his team have observed how the second wave of the outbreak has really tested the resilience of our health system.

It has stretched them to their limits.

As the numbers increase, with daily case records hitting three digits, these frontliners fear that the country will overwhelm its health resources.

Questions seeking comments from Dr Fong were not answered when this edition went to press.

40 more lifesaving oxygen machines arrived in #Fiji this week to help hospitals treat patients in the fight against #COVID19. #NZ made, the airvo hiflow oxygen machines have been a game changer in treating COVID & respiratory illness around the world & keep people off ventilators pic.twitter.com/Gxf8uTV0K4

— Jonathan Curr (@JCurrNZ) June 24, 2021

COVID PATIENTS ARE MY FAMILY
Dr Joji left behind his two children – age eight and six – to attend to COVID-19 positive patients at the CWM hospital.

Without hesitance, he packed his clothes enough to last him more than a month. His wife is an ophthalmologist (doctor who specialises in vision and eye care).

His task within a 14-day exposure period was to operate on 10 positive patients who had underlying medical conditions.

After a successful operation, two patients had recovered and were on life support. Then their health started to deteriorate. Both passed away.

They were admitted at the COVID Intensive Care Unit at the CWM Hospital. “It was difficult to receive the news while in quarantine,” he said.

“But at the end of the day, we can’t play God.”

The first surgical operation was carried out on Thursday, June 3, 2021.

Inside the operating theatre, Dr Joji was the first surgeon to undertake surgical operations on COVID patients in the country.

He had a team of four nurses and two anesthetists. Anesthetists are specialised doctors who administer anesthesia to patients undergoing procedures that require numbing or sleep.

The normal routine for Dr Joji is to have a supervisor present in the operation theatre.

But this time around it was different. “The only difference now is COVID-19 is here and everything is changing, you have Personal Protective Equipment (PPEs), masks, things that we could easily do before are not the same now.

“I’m glad that the nurses are there, they really help.”

Most of those undergoing surgeries were elderly patients.

“A pregnant mother had also required a caesarean at the Bhanabhai Makoi Health Centre maternity ward”

“It was the first time for all of us to operate on COVID positive cases, it’s a humbling experience.”

“And to see our patients happy and being discharged it’s a relief to all of us,” he said.

“Despite the fear, the anxiety, to see our patients happy gives us peace.”

His family is his main motivation. He treats every positive patient as a family member.

Dr Joji carried out the last surgical operation on his birthday. He had turned 36.

His family had to cancel his birthday celebration plans. He wouldn’t have it any other way. He’s thankful to God for his team.

Dr Joji has been a surgeon for seven years.  He hails from Nabouva in Wainibuka.        

COVID HAS ONLY MADE ME RESILIENT
A father of two young children said COVID-19 has taught him many things, but to never lose hope.

He is a frontliner nurse at the CWM. He had just completed his shift when he was recalled to work, two days after parts of the hospital were cordoned off.

He spoke to Shine a Light on the condition of not being identified.

“We were just told when you come in, go to the Emergency Department, get your swabs done and bring enough clothes to last 14 days,” he said.

He was anxious about contracting the virus.

But, he treated all COVID-19 positive patients as any normal patient, reassuring them that everything will be OK.

“Most of them get scared and alarmed when they see us wearing our PPEs,” he said.

Apart from the fear of contracting the virus, there were challenges with medical consumables not arriving on time.

“But as frontliners, we had to learn quickly how to improvise.

“For example, if we had to put in a drain into the abdomen, and then we didn’t have proper drains, then we’ve had to use the feeding tubes that usually have to go through the nose,” he said.

“Or if we had to a vacuum dressing, we don’t have the proper vacuum dressing stuff, so we’d use sponges, glad wrap and other things.”

“Sometimes we use stocking nets, we cut it up and roll it up as bandages.”

As a frontliner, he fears that conspiracy theorists will delay their target to reach herd immunity at a scheduled date.

He fears being in a position where frontliners will have to decide who gets a ventilator and who doesn’t. Fiji has only 120 ventilators.

He said frontliners were not only treating COVID patients, but non-COVID patients as well, who may also need ventilators.

Be it increasing a theatre nurse for a little more than eight years, he believes that the worst is yet to come.

“COVID-19 is really stressing our manpower. I think if the number of positive cases keeps , it will really overwhelm our manpower.”

He suggests that a salary increase is the best possible way to boost the morale of these frontliners.      

BLESSED TO BE BACK HOME WITH FAMILY… Colonial War Memorial Hospital senior surgeon Dr Joji Vakadiwaiwai Rokomalokalou with son Vetaia Vakadiwaiwai, 8 (left), and daughter Joelene Vakadiwaiwai, 6, at their family home in Davuilevu. Photo: Leon Lord

FATHER AND SON BOND
The fear of the unknown or what will happen next is the most haunting and recurring thought for a father of one.

“We were not mentally prepared, especially when leaving our family behind,” he said on the condition of not being named.

His wife is also a nurse. Most times they are away from their family. His wife had just returned from quarantine when he was called to work.

He has been away from his family for more than a month.

“I was worried about what will happen if I become positive, already we were leaving our son behind because of work commitments.”

“When this COVID-19 outbreak happened, we were told we’d be away from home for four to five weeks.”

Family time is the most challenging for him and his wife.

COVID-19 has meant him sacrificing his father and son time to save Fiji.

“Every time I make a phone call home, my four-year-old son would ask ‘when will you come home? You’ve been gone too long’.

What also saddens him is that people are still treating COVID-19 as a joke. He said they saw everyday the deadly reality of the virus.

“We are doing so much from our side, trying to treat COVID-19 cases as any normal patient, trying to make them feel loved and cared.”

“This is someone’s mother, dad and we don’t want our citizens to come here.”

“You don’t know the pain these patients go through because you cannot have your family with you.”

As a family-centered man, he feels hurt to see the pain COVID-19 positive patients have to go through.

The increase in daily case numbers signifies the need for more manpower.

Frontliners are tired and work is overloaded, he said. He encourages his wife to carry out her duties with a good heart.

“Look at Dr Fong, he is just tired, and that reflects all of us, because we are just human beings, we need to rest, recover, reconnect with our families,” he said.

“To see so much we are sacrificing, and the public still roaming around, it really disappoints us.”

“Some frontliners have been away from home for six weeks, eight weeks, it’s sad.”

He said nurses and doctors need a pay increment, to avoid rapid brain drain.      

Nurses at work. Photo: Leon Lord.

SERVICE WITH A SMILE
Looking after COVID positive patients in the Acute Surgical ward, one of the hot spots at CWM Hospital, posed great risk for frontliners.

Many frontliners panicked. In any normal emergency, nurses were aware of what to do, a mother of one said. This time it was different.

“We have to be careful because if we are exposed, then our family will be exposed,” she said.

She spoke to Shine a Light on the condition of not being identified. She looked after five COVID-19 positive patients during her night shifts.

COVID-19 patients are kept in a different ward.

Four of the patients were between the age group of 50 and 70 and the fifth one was in her early 30s.

Part of her daily routine was to help the two elderly positive patients – to sit up, change them, and walk them to the bathroom and back to the ward.

“Nurses in Acute Surgical have to bath patients after operation, dress them, and change their bed sheets,” she said.

She said given the increasing number of cases, there needs to be more space created to avoid the risk of transmission.

A ward at the CWM Hospital can only cater for 30 beds.

“There’s no spacing between those beds so it’s either we reduce the number of patients we take in or we make space.”

“But there is no other way that we can make space in there,” she said.

“The risk of spreading is really high. Maybe if we have more resources for the wards, then we will be able to do the work properly.”

She said the feeling that she can put a smile on COVID-19 patients was the best.

“The feeling that you can put a smile on your patient’s faces and then hearing positive feedback from them after your shift ends is a great feeling and I want my daughter to see that.”  

The 🇦🇺and🇳🇿Medical Assistance Team has hit the ground running in Suva with a visit to the CWM Hospital and meetings with senior staff. Vinaka vakalevu to the CWM Hospital staff for your ongoing efforts to keep Fijians safe and save lives. #StrongerTogether #Vuvale pic.twitter.com/M7FDkGOjeC — John Feakes (@AusHCFJ) June 29, 2021

TEAMWORK
An anaesthetist said the early stage of the outbreak at CWM, resulted in a lot of confusion among the frontliners.

He spoke to Shine a Light on the condition of not being identified.

This was particularly with the implementation of the emergency protocols during the first few days.

The father of one was part of a surgical team that operated on COVID positive patients with pre-existing medical conditions.

He led a team of seven. They operated on two positive cases on the first day.

They would then be isolated and would only come in if another positive patient was due to undergo operation.

“Before every operation, we have a quick discussion on how we will handle the case and the precautionary measures we take,” he said.

“We work in pairs to put on the PPEs. The highest risk was taking off the PPEs after a procedure because we could easily contract the virus.”

After every procedure, the team has to clean the operating theatre at least three times.

An operation would take two to three hours, sometimes longer with the new emergency logistics.

He said two of the cases they operated on were on life support at the COVID ICU for a few days after the operation. There were four ventilators at the COVID ICU.

The COVID ICU is smaller compared to normal ICU.

“At the moment, with the cases coming in, we have enough ventilators because we have the COVID ICU, normal ICU and they have set-up a four-bed ICU at the Queen Elizabeth barrack-based military hospital,” he said. “

The worry is when the number of cases increases, in particular severe cases, and we might just be overwhelmed.”

He said when the outbreak happened at the Lautoka Hospital, CWM Hospital should have been preparing for a possible scenario, rounding up protocols and procedures.

“The initial plan was to prevent COVID cases from entering CWM Hospital because there were some cases that could not be performed in any other hospital in Fiji.”

But despite the challenges, he is thankful for the team. He also thanked the Ministry of Health for providing PPEs for frontliners.

Dr Osea Volavola the Head of Emergency Medicine and his your team of Doctors provide triage and care at the ED at CWM. We support them by abiding by the COVID safe measures of Mask, distancing, not gathering, vaccination #TogetherWeWill pic.twitter.com/ERHPZsAVqQ — Dr I Waqainabete (@Nadokoulu) July 2, 2021

Edited by Rosi Doviverata

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Shine A Light is an Fiji Sun Investigative Project.