Khanya’s predecessor: Quintin the robot. (Damien Schumann)
An iPad-carrying robot is alleviating the loneliness of critically ill and isolated Covid-19 patients at Cape Town’s Tygerberg Academic Hospital’s intensive care units (ICUs). The robot enables patients to talk face-to-face with their loved ones without risk of infection. Fondly called Khanya, the robot also helps end-stage patients say goodbye to their loved ones or receive succour from a spiritual counsellor, something that was previously impossible during high bed occupancies at infection peaks, and rarely achieved even at less pressured times.
The family is first briefed on what to expect by the ICU staffer and then dialled into a second tablet that is attached to the robot facing their loved one. The tablet-driven device manoeuvres itself around other high-tech ICU monitors to the patient’s bedside before a healthcare worker outside connects it with the relatives or spiritual counsellor, enabling a completely private connection. If at any time the patient’s oxygen saturation levels drop too low, the call is terminated.
Tygerberg Hospital ICU head Dr Usha Lalla told the Mail & Guardian that it has been challenging to meet the emotional needs of patients and relatives.
“The patients were completely cut off — and with so many of them needing care and with the staff levels of fatigue so high, it was distressing for everyone. During the first wave, we had 10 to 12 patient deaths a day. It was very hard. There was simply no time for the ICU patients to see all the relatives or for us to provide meaningful emotional support,” she says.
Enter Quintin, Khanya’s predecessor, a robot long used in the university’s hands-on teaching laboratory where interns, registrars and junior consultants hone their skills, often with outside experts conducting tutorials remotely.
Quintin’s laboratory skills application morphed into an emotional support role within weeks of the first Covid-19 wave. The more sophisticated upgraded and sensor-driven Khanya took over by the time the third wave began.
One woman, whose husband was admitted to the ICU with Covid-19 pneumonia 45 days previously, said: “The doctor called me to say my husband’s heart was failing. We spoke and it was so comforting – but he survived. I was so grateful.”
Dr Kerry-Ann Louw, a psychiatrist and senior lecturer at Stellenbosch University, said that while most Covid-19 units did not allow family visits, other “amazing and simple” innovations had been developed, including a latex glove filled with warm water simulating the experience of holding a human hand, and bringing in aromas, textures, objects and pictures that were comfortingly familiar to the patient.
Salisha Maharaj, a senior clinical psychologist in the Child, Family and Adolescent Unit at Tygerberg Hospital, told how she treated a mother and her 12-year-old son after losing a five-year-old family member to a non-Covid condition. The mother subsequently contracted Covid-19 and died in the Tygerberg ICU.
“The mum was about to be intubated and all she could do was blow kisses via Khanya to her husband and 12-year-old,” she recalls.
Louw told the M&G that versions of Khanya were not being used in general Covid-19 wards because patients in general wards were more able-bodied.
“They can hold an iPad or cell phone, whereas it’s tiring holding one up for an ICU patient, besides which you have to be fully kitted up in personal protective clothing,” she explained.
Whole system healing
Louw, whose specialised field of practice is delivering mental health care to medical patients, said stress and emotions impact the immune system, inflammation and recovery from surgery or illness.
“By reducing stress, we help them recover. For example, stress is associated with cancer, infections or skin conditions. The simplest illustration of the mind-body connection is a person blushing because they’re embarrassed. Covid has made it extra difficult because there’s no real human contact. Healthcare workers wear this outlandish protective gear and masks – you can’t see a smile, and even the other patients look foreign,” she explained.
Louw said where families did not have access to cell phones or data or stable internet access, the hospital helped, often securing family videos or audio tracks to play to patients.
A tsunami of grief
Khanya is not only helping patients but healthcare providers as well. Early in the pandemic, it became clear that the departments of psychiatry and psychology needed to offer support to frontline healthcare workers, especially preventative interventions focussed on resilience.
Maharaj describes the mental health pandemic and tsunami of grief currently in society as the soft underbelly of Covid-19. She and her team had, by the beginning of the third wave, developed a critical containment model where healthcare workers were redeployed to support hospital staff, patients, and families.
“It grew out of a need to relieve the burden on healthcare workers in keeping families up to date,” says Maharaj.
Her team dealt with between 30 and 40 patients per day, each call taking five to 15 minutes, using a guideline developed by Louw.
“It took time for families to switch from just being given the oxygen saturation levels and medical information, but now they’ve come to expect support and [space to] talk about their fears. They often ask for practical advice like how to break the news to the children. We engage with powerful primitive feelings like fear, rage and grief. It’s like psychological first aid,” she says.
Louw said that by 3 September, Covid-19 bed occupancy had begun dropping at Tygerberg Hospital, but the high care and ICU wards were still running at full capacity, mirroring the trend of previous waves.
Professor Soraya Seedat, who is the executive head of the department of psychiatry at Stellenbosch University, said she was unaware of ICU robots being used in any other South African public or private sector health facilities, although it was common practice in overseas ICU settings.
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