Iowa physicians are on the frontlines of our state’s response to COVID-19. Amid the day-to-day challenges of navigating this evolving public health crisis, it can be easy to forget that you’re not alone in confronting this stressful situation. Physicians on the Frontline is a new IMS initiative to showcase the stories of local physicians as they work through the challenges of the pandemic. It is an opportunity to celebrate the successes of Iowa physicians, find strength in our common experiences, and ensure Iowa patients understand that Iowa’s medical community is rising to meet the shared challenges of COVID-19.
Every week, the Iowa Medical Society will highlight members of the healthcare community who have shared their story of continuing to care for Iowa patients during the pandemic. These brief member-submitted narratives will seek to showcase the diversity of experiences and the common themes being experienced by physicians across our state. To submit your brief story or nominate a peer to share their story, please send us an email.
In these trying times, the Iowa Medical Society wants our members to know how much we appreciate the hard work being done within the healthcare community. Additional resources are available on our Physician Wellness Page. Thank you for helping to keep the state of Iowa safe and healthy.
Douglas Martin, MD, Occupational Medicine, Sioux City
Occupational medicine physicians concentrate on the health and safety of the workforce. COVID-19 has redirected our focus in occupational medicine to establishing a preventive mindset. This involves screening and mitigating strategies. I was involved, for example, in crafting measures that can be used in the meatpacking industry. Think about how you physically distance a 5,000-employee facility. It is not easy. Staggered entry in the plant, staggering breaks and meals are just some of the examples.
We continued to maintain an active clinic during the pandemic. Work-related injuries don’t magically disappear in a pandemic and people need to get cared for. An occ med clinic is the appropriate place. You cannot shut down your clinic and send these folks to the ER or urgent care because that is where the sick people are with COVID. It is all about prevention and prioritization.
The most challenging aspect of occupational medicine during the pandemic: Working within a hospital structure that had mandatory layoffs across the board. No department was spared. At a time when we needed all hands on deck, we had a reduction in nursing and support staff. This was tough.
We are now back to normal staffing, but right now my primary nurse is out with COVID-19. It seems like there is a new COVID-19-related issue that we must deal with every single day. Many of us in occ med also are public health docs. I am a county public health superintendent, so there have been obvious challenges with testing resources, appropriate implementation of guidelines, trying to help schools, etc.
The long-term impact the pandemic will have on occupational medicine: I would hope that there will be an increased focus and emphasis on our specialty and our importance in total worker health and safety. Occupational medicine docs have the training to deal with mass effects on employees, whether that is infectious disease, exposure, mass casualty, etc. As we always preach, prevention is important.
As is often the case, there is not much public attention paid to the preventive medicine specialties until something happens and then we are sorely needed. We do need to significantly improve the public health infrastructure of our nation. I hope this pandemic experience makes that a realization, so that we can do better the next time around.
David Krupp, MD, Emergency Medicine, Iowa City
The emotions were raw and deep in the beginning of the pandemic. As an Emergency Physician of 20 years, I was going to be needed on the front line. As healthcare providers we all had a roller coaster of emotions, all different in our own way. Fear and Duty resonates when looking back to earlier this year. To deepen the impact upon the psyche, my 19 year-old son became rather ill. He was placed in isolation with fever and Covid-like symptoms for 9 days. This was at a time when the only test was the State Hygienic Lab, and he did not fit the criteria. Statistically, it was unlikely he would die, but he was so sick and I could not help him. This personal impact spurned action. I fought feverishly to help prepare our hospital for the potential incoming wave. The reports of hospitals were overrun in Europe. In addition, I spent time creating videos for public service announcements that were shared around the community in an effort to help slow the exponential spread of the virus. The only solution was to get society involved to bring about the change that was necessary.
In the early days of the first wave, through my patients and others, I was intimate with the profound impact upon wellness, not just physically but emotionally, socially, and economically. I wanted to bring about change, but was uncertain how. Fear and duty can often empower us to action. I reached out to some community leaders in the restaurant industry to help bring about change through mitigation efforts including mask-wearing. This was prior to the time the CDC had released its public mask recommendation. One response I received was “masks represent illness and will scare away customers”. This was the mindset at the time. I decided we can change the pandemic's impact upon the health, wealth, and well-being of our communities by acting upon the interface of the business and the consumer. There was sufficient fear that consumers would seek out businesses that were ‘Covid-conscious’. This is when I coordinated with a pharmacist and a small group of five volunteers and started ‘Mask of Wellness’. Through countless hours, we brought about change in my community and others across the state.
‘Mask of Wellness’ is a grassroots movement to promote 'Covid-Conscious’ Businesses for free with a positive empowered method to improve the health and wealth of communities through three basic impactful measures:
I knew many consumers would seek out ‘Covid-Conscious' Businesses, in turn benefiting the Health, Wealth, and Wellness of Individuals and Businesses in all of OUR communities.
We cannot have freedom without responsibility. Unfortunately there is misinformation and many individuals will utilize confirmation bias to only see information to support their view. The concept of mask-wearing is sufficiently supported and we all need to take action in our communities to bring about the necessary change. If we all assume we have Covid-19 at all times and take the necessary steps, we can shut down this pandemic. We are fortunate to have the support and partnership of the Iowa Medical Society. ‘Mask of Wellness’ changes the perspective to choice which is resonating with the communities resisting mitigating measures. A member of the Mason City Chamber of Commerce reports that ‘Mask of Wellness’ normalized mask-wearing and brought about rapid change in their community. Cognitively reframing society to a ‘Covid-Conscious’ mindset will shift the pandemic and will improve the wellness of all of our communities.
My name is Joyce Wahba and I am a 4th year medical student at the University of Iowa Carver College of Medicine and am applying for Emergency Medicine residency this year. I am one of the executive chairs for the University of Iowa Mobile Clinic, an interdisciplinary student-run free clinic that offers free basic healthcare services to anyone who needs it. As a first generation immigrant myself, I understand first-hand the importance of having access to healthcare. As an organization, we are proud to serve a wide range of patients: low income families, individuals returning from incarceration, elderly folks, immigrants and refugees, people experiencing homelessness, and more.
Before COVID-19, all of our clinics were conducted in-person inside community centers, churches, and other organizations. At every clinic, we ran vitals, basic labs, and offered medical appointments. Depending on the clinic we also were able to offer in-person translators, flu shots, general health education, HIV/HCV testing, social work services, physical therapy sessions, and dental assessments.
When COVID-19 first started to ramp up in the US, we had to shut down our in-person operations in accordance with University policies. As medical students, we were devastated that we could no longer work in the hospital and work with/learn from patients. We quickly pivoted to offering our Mobile Clinic services over telehealth so that we could continue to support and care for patients. Many people lost their jobs and insurance coverage, which was particularly devastating considering the increased need for medical and mental health care during a pandemic. With the help of our community partners, we were able to reach out to uninsured/ and underserved families across the entire state of Iowa. We have been helping with acute minor medical illnesses, chronic disease management, mental healthcare, and connections to social services.
Now we are able to offer both our in-person services as well as telehealth. We hope to continue to reach out to the most vulnerable populations across the state and to try and help out with whatever we can. I have been so impressed and lucky to work with such a passionate team which is made up of almost every single individual college within the University of Iowa. We are excited to continue expanding services and outreach efforts. Feel free to call or email UI Mobile Clinic with any questions or comments. (319)535-2684 firstname.lastname@example.org
I have been practicing Osteopathic Family Medicine in Chariton since 1994. I practice primarily in the Medical clinic, but I still see patients in two nursing homes. I take calls and man the ER every Wednesday night, and one Sunday every month. I still fill in occasionally as the hospitalist. I gave up full obstetrics (including C-Sections) almost two years ago after 24 years and over 700 deliveries. When the COVID Pandemic started, I felt the same spectrum of emotions everyone else did. The initial fear for my community, my patients, my family and for myself. So much was unknown, and with close family in New York, I had a very different perspective of this than most rural Iowans. I got to see just how dangerous this disease really was. I continued to work every day as so many others were sent home to shelter in place.
My patient-load dropped drastically. I remember a day when I only saw three or four patients. Unlike many clinics, we continued to see sick patients. We were given surgical masks and safety glasses and a few N-95 masks and told to make them last because replacements were just about impossible to obtain. We were told that N-95 masks could be used for 40 hours and were only necessary for aerosolizing procedures. We were told that we could only test patients that were sick enough to be hospitalized and had a history of significant travel, fever and exposure to someone with known COVID-19. There were weeks when our hospital had less than ten of the swabs necessary for testing and sending to the State Hygienics lab. There was no way to know who had it and who did not. I worked closely with my hospital leadership to share perspectives and information and try to solve problems.
We ran simulation outbreaks. Eventually some of the restrictions eased, but the hospital controlled who could be tested and who could not. Our first COVID patient who tested positive was in May. He was admitted to our hospital and rapidly deteriorated until he needed to be transferred to a Des Moines Hospital. I was not the hospitalist, but I was the ER doc that weekend. My paramedics asked if I would go with them to help prepare the patient for transfer and possible intubation, and of course I did. I also went through how to properly get into and safely out of the PPE supplied. (N-95 mask with surgical mask over it, double gloving, gown and face shield). I began requiring all of my patients to wear a mask. Since then, we have had ever increasing waves of new cases.
Our county has now had more than 150 cases from young children to seniors of 97 years. Nearly all have been symptomatic and most have been diagnosed in our clinic. We have had 6 deaths. Our nursing homes have thankfully been spared so far. I spend my days trying to educate my patients, neighbors, friends, and coworkers. Trying to cut through all the misinformation, mistrust, and political divisions that have so damaged our Country's response to this Pandemic, and of course trying to give my patients the best care and advice possible. I have learned how to practice telemedicine for my Nursing Home patients and for those who cannot or will not come to the office. Thankfully, I have not had to experience some of the horrors that some of my friends in Tertiary care hospitals live with each day, and I have not had to endure the massive cuts and layoffs that some of my rural friends have experienced. Nevertheless, I am very proud of my coworkers and fellow healthcare providers at Lucas County Health Center, and our fight to continue to provide the best possible care to our community in extraordinarily challenging and uncertain times.