Paramedics on the frontline

Kareem al-Suwaify, a 32-year-old paramedic from Beni Suef, is riding with a COVID-19 patient in the back of an ambulance. He is exhausted, but there is still a long way to go until they reach the designated hospital in a faraway city. It is in these moments, as he sits in his protective gear for a four-hour drive, that the fear that he may have contracted the virus creeps in. 

The most important challenge for paramedics in the Egyptian Ambulance Organization is to transport patients safely.  But in the back of an ambulance, rushing along the highway or a domestic street, bedside manner can be equally important. 

“The most difficult thing is for a patient to sense that you are scared of them or that they have become estranged from people,” Suwaify says. “It is my role to change that and make the patient feel safe.”

Suwaify and his colleagues, who have been working with confirmed and suspected COVID-19 cases, must strike a balance between managing their own fears and anxieties and providing medical and emotional support to patients, a calculus that goes beyond their functional training in disease prevention. The hours are grueling, and they often go with little sleep on long drives to and from hospitals — without the compensatory hazard pay other medical professionals receive. All of this takes a toll, paramedics Mada Masr spoke to say, on everything from their family lives to their mental health and financial wellbeing. 

The challenges go beyond interacting with patients; the mere task of driving a suspected COVID-19 patient weighs quite heavily on paramedics. 

“On my way there, I feel so anxious about everything. I feel so scared, and I start feeling all the symptoms of corona before I even get to the patient,” says Mohamed Amgad,* a 26-year-old paramedic in Cairo. “Everything that we learned in the training sessions on infection control, everything we read in the books and at school, we feel all of that. I get a migraine and a dry throat. I panic too.” 

Suwaify was satisfied with the infection control measures, which included the provision of protective gowns, goggles, N95 masks, white rubber boots, and gloves. Once he arrives at the hospital, Suwaify discards his mask and gloves. Then, he disinfects his goggles, suit, boots, and the ambulance car. Suwaifi explains that the yellow suit he wears is safer because it has never been used except in extreme cases, such as attending to clinical ulcers and amputation procedures.

According to Wael Sarhan, the chief of the Egyptian Ambulance Organization Employee Syndicate, paramedics received two COVID-19-related training courses. One was focused on preventing infection while dealing with a COVID-19 patient. The other was focused on infection control at large, how the virus is transmitted, and how to disinfect oneself and the ambulance car. 

Sarhan explains that paramedics are typically trained to handle usual tasks like traffic accidents and non-epidemic diseases. They have also gained more experience in dealing with injuries from protests or militant attacks. But dealing with COVID-19 is drastically different, as a pandemic like this has not happened in a century. 

Sarhan adds that the pandemic has put a tremendous strain on paramedics, both financially and mentally. “For the first time, we’ve had paramedics fainting due to work stress,” he says. In addition to transporting confirmed and suspected cases, the subsection of ambulance staff designated to handle COVID-19 cases is now tasked with transporting those who have recovered back to their houses as well as those who died from the virus. 

In mid April, Health Minister Hala Zayed stated that there are more than 500 ambulance cars that transport confirmed and suspected COVID-19 patients, with more than 2,200 paramedics and 820 logistical support members. 

The Egyptian Ambulance Organization was established by a presidential decree in 2009, employing 17,000 with a nationwide fleet of 3,200 ambulances.

“There are times when we don’t have time to sleep. A positive test result comes back from Cairo at 4 am. We have to move the case to the quarantine hospital closest to Beni Suef, which is in Assiut, which means four hours to the hospital and four hours back. I’m wearing the protective suit and cannot eat or drink or use the toilet while wearing it,” Suwaify tells Mada Masr.

COVID-19 has also affected the personal lives of paramedics. 

“When I get out of the vehicle taking me home, my heart races. I’m scared of contracting the virus and transmitting it to my children,” Suwaify says. “I’m used to coming back home to my kid running toward me and hugging me, but I stopped this. He noticed and has been saying things like ‘Dad does not love me anymore.’”

As for Amgad, he describes what he went through as a “social crisis.” He decided to isolate himself from the rest of his household since the crisis began. He stays in his room and never comes out, and food is passed to him through an opening at the bottom of the door, much like what happens in the quarantine hospital. He is scared of transmitting the virus. 

Amgad says that his friends have also been treating him differently. “Some of them know that I work as a paramedic. All of a sudden, you start to notice that one member of the group is avoiding you,” he says.

Avoidance can also give way to more extreme responses. Ahmed Sayed, who has worked as a paramedic since 2008, tells Mada Masr his relations with the general public have also become strained. 

“There are those who tell you ‘No, corona!’ or ‘Get away from me. Don’t touch me’ — they are repulsed by us,” he says, highlighting that the social stigma of infection has extended to paramedics. 

Gradually, Sayed  has begun to feel more and more isolated from people, and he has developed conflicting emotions about his job. “I feel like I am doing something that I didn’t want to do. But in the end, we are doing good by helping people arrive at the appropriate place to receive treatment,” he says. 

Sarhan explains that many paramedics felt compelled to rent apartments to stay in instead of going back to their families, while some have been living in their work stations and paying out of their own pockets to eat. Sarhan also adds that some paramedics had side jobs to make up for their low wages, but they have stopped working in those jobs for now. 

The fear of infection is not mitigated by what Sarhan says amounts to trickery on the part of hospitals, which do not always inform paramedics that the patient to be transported is suspected of having COVID-19.  

“When they have a suspected COVID-19 case, they refuse to announce for fear of having their hospital shut down, so they call the ambulance as if it is a normal case. The paramedics then go without taking the appropriate preventative measures, only to find out that it was a COVID-19 case,” he says. 

According to a statement by Sarhan, 19 paramedics from across the country have contracted COVID-19, in addition to 10 of their relatives in Menoufia, Luxor, Fayoum, Cairo, Suhag and Qena. 

Suwaify, Sayed and Amgad say they have felt moral support from society, but they are waiting for financial support and recognition. 

Suwaify denounces the fact that paramedics are excluded from the category of medical professionals. “This is the worst issue really. We are supposed to be part of the medical profession, with doctors and nurses. When we spoke up, it was brought to attention that we are not part of the Medical Professionals Syndicate, which meant that we did not take the  75 percent increase that the president mandated. We weren’t with them. Only nurses, doctors, technicians, radiologists and medical trainees took this money. Paramedics were the only group that was excluded. This was quite difficult. I am on the frontline, and I bear the burden. I am the first one to come in contact with a case, whether suspected or confirmed. And the others come after me,” Suwaify says. 

On March 29, President Abdel Fattah al-Sisi decided to increase hazard pay for medical professionals by 75 percent and establish a hazard fund for medical practitioners, an allocation that would come from the extra-budgetary Tahya Masr Fund. On April 4, Parliament Member Evelyn Botros presented a proposal to extend eligibility for the increase in hazard pay to the Egyptian Ambulance Organization.

In her proposal, Botros highlighted that the ambulance organization and its employees are not subject to the 2014 medical profession law, as well as its amendments issued by a subsequent presidential decree in the same year. The organization is governed by regulations set out in the 2009 presidential decree.

To be eligible to work in the ambulance organization before 2009 required a paramedic diploma from a preparatory school. But this diploma was discontinued. In 2009, former Health Minister Hatem al-Gabaly announced that there would be an open call for hiring paramedics from among candidates who held medium to high level qualifications.  Applicants underwent basic training. According to Amgad, those who finished the courses were hired in assistant positions, while those who enrolled in a two-year paramedical fellowship program organized by the Health Ministry were hired as supervisors. 

According to the medical professionals law passed in 2014, hazard pay was meted out to doctors to the tune of LE 200 and to other emergency room staff at the equivalent of 300 percent of their salaries. Paramedics did not fall under the law’s purview. According to Sarhan, the Medical Professionals Syndicate negotiated at the time with the health minister, who in turn negotiated with the prime minister, to allocate hazard pay for paramedics. “And they agreed to do it,” he says, noting that hazard pay for paramedics comes in at LE 150.

In November  2014, the law was amended, setting minimum hazard pay for medical professionals at LE 400 and a maximum at LE 700. Emergency hazard pay was pushed to 700 percent of the employee’s salary for emergency doctors and 600 percent for the rest of the emergency team. The amendment did not include paramedics. 

According to Sarhan, the Medical Professionals Syndicate submitted a request in mid April to the prime minister’s office for an increase in paramedics’ hazard pay. This request has been sent to the health minister and is still under consideration.

*Mada Masr has used pseudonyms for the paramedics at their request

Mohamed Ashraf Abu Emaira 

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