Almost overnight, it all changed
When the coronavirus pandemic hit, Jenny Hall was employed as a speech language therapist working on the medical wards at Middlemore hospital in New Zealand. As well as helping those with communication disorders, Jenny worked with people who had difficulties swallowing (‘dysphagia’), due to disease or trauma affecting the brain, throat or mouth. Safe swallowing is important for good health, because if food or drink or saliva goes into the lungs, pneumonia and other serious health conditions can result.
Jenny’s work involved examining people’s mouths and evaluating the level of control they had over their lips, tongue, palate and throat. She also carried out cough reflex testing to evaluate whether a person was likely to cough if food or drink went ‘down the wrong way’. Then Jenny might give them small trials of drinks and food and observe their response. Instrumental swallowing assessments known as ‘flexible endoscopic evaluation of swallowing’ (FEES) were carried out when needed. In FEES, a tiny camera is passed through the nose and into the person’s upper airway. Dyed food and drink is then given to the person to swallow, and the camera reveals what happens when it is swallowed. These assessments are carried out by a specially trained speech language therapist, and Jenny was trained to assist with them.
Then Covid 19 hit, and Jenny says, “almost overnight, it all changed as the country locked down.” The speech language therapists had to stop cough reflex testing and all but essential FEES, due to the risk of exposure to patients’ bodily fluids. Without these techniques to help with assessment, it was like going back to the old days. It was a challenging time. Jenny explains, “with information changing almost hourly, we had to adopt new ways of working.” The speech language therapists worked closely with medical and nursing staff, increased their use of a ‘free water protocol’ proven to reduce risk of dehydration without increasing risk of pneumonia, and attempted to increase the number of other swallowing assessment methods they used, such as a ‘videofluoroscopic swallowing study’ which uses x-ray technology to visualise the path of swallowed material through the mouth and throat.
“I became the nominated Covid SLT and spent some time on the Covid wards, seeing patients suspected of having the virus, learning about PPE, how to don and doff correctly and religiously checking online systems for the usual negative results.”
Jenny has recently returned to her home country of Great Britain and to her job in an acute medical team in the NHS. “We already had limited access to technology and instrumental assessments before the pandemic, so I’ve not seen a huge change in the way we work. What has changed is PPE. We wear face masks all day, significantly impairing communication with our patients, many of whom have a pre-existing cognitive or communication impairment or hearing loss. When you add a face shield for assessments, verbal communication is almost impossible. However, speaking with colleagues about their difficulties accessing PPE during the early stages of the pandemic makes me appreciate what I have now.”
Jenny says she has only worked with a handful of patients recovering from coronavirus, none were testing positive at the time she was working with them. She describes the after-effects of the virus on the people she has worked with: “The critical illness weaknesses they face, complicated by tracheostomies and other treatments in the intensive care unit and damage to the respiratory system can have a profound impact on communication and swallowing. These are impairments members of the public do not realise they can suffer as a consequence of the virus.”
According to Jenny, working for the NHS has always felt like being in a ‘special club’. “No doubt the NHS will have been changed beyond recognition once the pandemic has passed, but I’ve found a sense of resilience, teams which are closer, and a real sense of ‘we’re all in this together’”.
Alison Paulin and Jenny Hall.
New Zealand Speech-language Therapists’ Association