With only 12,000 nurses at the opening ceremony and 7,000 registered delegates, numbers were lower than expected at the recent International Council of Nurses (ICN) conference in Seoul, South Korea.
This was due to an outbreak of MERS (Middle East Respiratory Syndrome Coronavirus) and as a consequence, many that were registered to attend elected not to travel to Korea to participate. At the conference the large Korean delegation were kept at a distance from the other participants attending.
Despite this, the World Health Organization (WHO) advised it was safe to travel to the Republic of Korea. WHO Director General, Dr Margaret Chan, who gave the opening keynote address to the nurse delegates from 130 countries representing the 16 million nurses worldwide, spoke about the disease.
Dr Chan talked about the conference theme of global challenges to global health with reference to MERS, stating that “diseases don’t need visas when we travel”. She also urged the public to “support the health professionals who have worked tirelessly to control the outbreak”.
MERS CoV, is a disease caused by a new virus that has a rapid onset of severe respiratory disease. Camels are suspected to be the primary source of infection, but the exact means of transmission to humans is not known and further research is needed. Transmission in healthcare settings has been a feature of the outbreak. Most of the severe cases have occurred in people with underlying health conditions that increase susceptibility to respiratory infections. All cases of MERS have occurred in people who have lived in, or travelled to the Middle East, mainly Saudi Arabia, have had close contact with people who acquired the infection in the Middle East, or can be linked to an initial imported case. There have been no cases in Australia to date.
As of 1 July 2015, WHO has reported 182 confirmed cases of MERS in South Korea, including more than 30 health workers. Thirty three people have died - a case fatality rate of 16%.
According to Dr Chan, early prevention must be the cornerstone of any future successful health systems. For this to succeed, nursing, as the most accessible and abundant member of the health workforce internationally, must become more central in planning, policy and decision making at all levels of healthcare and community. This requires tertiary educated nurses who practice autonomously, implement treatments and analyse investigations, otherwise global health will not improve.
We couldn’t agree with her more. That is exactly what is needed at this very moment in Seoul. However, the reality there is quite different.
In Korea, we had the opportunity to meet with our nursing colleagues representing Public Services International and two Korean Public Service and Health Worker unions.
We shared stories of healthcare in our countries with a particular focus on the MERS epidemic. The Koreans felt it was most important nurses and healthcare workers around the world were made aware of the root causes of the MERS outbreak in Korea, in order to learn the key lessons.
Initial confirmation of the outbreak in Korea by the Korean government was slow and important information kept from the public. Hospitals were not adequately staffed, equipped or prepared for such a crisis. This led to widespread infection inside hospitals.
According to our Korean colleagues, more than 10,000 people have been quarantined due to the risk of infection. The number of infected nurses, health professionals and hospital workers is high and continues to grow. Although difficult to ascertain, nurse: patient ratios seem to be somewhere between 1:30 and 1:50 depending on the hospital. Due to inadequate staffing, patients and their families hire informal care workers. These subcontracted workers have not been provided with proper safety equipment or training as they aren’t permanent hospital employees. There are no restrictions to visiting and it is customary to have many visitors or family members staying in the room to assist with caring for the patient; so more people are exposed to infection with no proper safety equipment or training.
There is an acute shortage of nursing staff at small hospitals, mainly due to low wage levels. There is no standard wage rate for nurses or assistants in nursing. All healthcare is provided in hospitals as there is no community care in South Korea. When unwell, people have no choice but to present to an emergency department. And, as was the case for the first person with MERS in Seoul, people often seek care at multiple hospitals due to crowded emergency departments.
This experience in South Korea provides a salient lesson to us in Australia, that such infectious outbreaks can easily run rampant when there are inadequate numbers of qualified nurses and insufficient resources.
As Dr Chan told us, we should speak up and push back about the importance of nursing in keeping the world healthy. “Why are you so quiet,” she asked in her address.
So we aren’t being quiet! We’re sharing our Korean nursing colleagues’ story with Australian nurses.
Julianne Bryce, Elizabeth Foley and Julie Reeves
Federal Professional Officers