From Hospital To Home, On The Virus Front Line With Medics Around The World

From the hospital ward and the distress of patients dying, to the home front full of fear of infecting their own families, medical workers face gut-wrenching daily decisions more than ever in the fight against the coronavirus.

AFPTV journalists followed doctors, nurses, ambulance staff and caregivers on the front line of the virus in Paris, Beirut, Stockholm, Sao Paulo, Los Angeles, Dakar and Daegu at the end of April.

Here are snapshots of four of them in action:

Soon after Axel Hirwe's shift begins at 8:30 am, an alarm goes off in the intensive care unit at Argenteuil hospital, 20 kilometres (12 miles) north of Paris.

Someone has gone into cardiac arrest, the team scrambles and a pulse is found but the brain has been severely damaged and the patient isn't expected to last the night.

"Unfortunately or fortunately, we get attached to patients," says intern Hirwe, 29, his eyes full of concern from behind his round glasses.

Before having to go on to a ventilator, the patient in question, he says, was breathing by himself, meaning he'd talked and they had got to know a bit about him.

"So, it's very hard after having known the patient, to realise that, in the end, he's going to die," he says.

Next, five staff are needed to position another patient, one of 40 in the unit, on his stomach to ease his breathing.

And then, there are the phone calls to families...

"We have to reassure them, but not too much, because they do remain in a serious condition, they're in intensive care, they're still intubated.

"But sometimes they need a bit of hope," the young masked medic says.

Ending the afternoon on a positive note: a diabetic patient has improved and was able to get out of bed.

At home, in Clichy, about 10 km from the hospital, Hirwe attempts to relax, not talk shop with his five housemates and rings his worried mum.

"I try to reassure her," he says. At the other end of the line, she holds up the phone so he can hear the day's 8:00 pm applause for caregivers.

Two ambulances pull up outside the coronavirus emergency department at Rafik Hariri University Hospital in the Lebanese capital.

Nurse Ali Awerke, 34, takes charge of one patient while talking to another near the entrance. "I'm coming, just let me get this patient settled and I will come and help you, OK?"

All day long, he is racing. From collecting equipment, bagging up swabs and blood samples, to answering the phone as well as looking after patients.

Awerke volunteered for the coronavirus team at the start of the crisis.

"I didn't have clothes with me, I didn't have anything. I joined the team and called my wife and told her, 'I'm going to stay here and unfortunately, I won't be able to see you all for a while'," he says.

Since then, he's been living at his parents' house in Beirut, isolated.

But this evening, after testing himself first for the disease, he's going home to his wife and daughters for the first time in two months.

As the call to prayer marking the end of the day's Ramadan fast rings out, he drives in to his village, Es Saksakiye, to surprise his family.

The reunion is emotional. Bringing flowers, he kisses his wife; his youngest throws herself into his arms.

As a family, they enjoy the evening iftar meal celebrating the end of the day's fasting.

"We're all going to sleep in the same room, we're all so happy," he says.

"I missed the house and sitting here on the veranda. It's been a long time... two months. Maybe for some people it's not that long, but for me it was ages."

Places at the ECMO (extracorporeal membrane oxygenation) unit at Stockholm's Karolinska University Hospital are few and the demand among patients in severe respiratory distress is high.

The equipment used is invasive and the treatment arduous but it can make all the difference.

"Hopefully the patients that we bring in here will survive thanks to ECMO treatment which they wouldn't do with regular ICU (intensive care unit) treatment," says its head, Lars Falk.

But every day demands difficult choices.

"We need to really select the right patients and during that selection of course we also select people away from ECMO and those are very tough decisions to make," he says.

Once home, the doctor, now sporting a two-day stubble look, recharges the batteries a bit around his family.

Often he has a sense of achievement, he says, though it can be hard to really switch off.

"I think it's more that you can dwell on some of the decisions that you've made during the day, was it correct or not correct to put this patient on ECMO," he adds.

A death a day is the average at the Emilio Ribas Infectious Disease Institute in Brazil's biggest city, Sao Paulo.

Its intensive care unit has been full since mid-April with seriously ill coronavirus patients.

And every day since the start of the crisis, doctor Jaques Sztajnbok, 55, has been at work.

Because the disease is new and no established protocols exist, he says that staff have to take it on a day-by-day basis, talking about every case, every day, and testing to see if what works for one patient, will also help another.

As head of the unit, he feels he has to set an example, but the doctor with dark circles under his eyes is worried all the time -- for his patients, but also for colleagues, several of whom have become ill.

"And that's a worry we've never had before, even in other epidemics," he says.

He and his wife, Fabiane Sztajnbok, 47, an infectious disease specialist at the hospital's emergency room, also worry about the risk of bringing something home with them and about their children.

Once home, they remove everything in the hallway, shower and wash their clothes.

Nevertheless COVID-19 is still present. "At dinner we always talk about what happened during their shifts," says their 10-year-old son Daniel.

But on this day, it's Jaques' 55th birthday.

As he blows out his candles and looks at the cards from his children, he says: "Brave, I think that's an adjective they didn't use to write on earlier birthday cards."