Corona virus disease 2019 (COVID-19) first reported from Wuhan China on 13 December 2019 and declared “public health emergency of international concern “by World Health Organization on 30 January 2020 and pandemic on march 2020. The Government of Nepal imposed a national wide lock-down since 24 March 2020 till 15 June 2020. And there after some free and then again strict lock down in some more COVID infected area like Chitwan. Public health measures such as social distancing, public vehicle restriction quarantine/ isolation plays major role for patients and people to stay at home without emergency situation arises. Health care providers postponed non urgent cases for treatment.
COVID-19 pandemic has disrupted regular health care services including brachytherapy services . This new pandemic of which we know little of the modes of virus transmission confusing and WHO frequently changing their views confused the health professional on how to restart the on going health services as normal. Routine brachytherapy treatment plays an important role to overcome the symptoms of cervical cancer.
However, the COVID-19 pandemic has interrupted regular Brachytherapy Services. Brachytherapy may not be of a top priority treatment however the external radiation therapy is continuously going on during this pandemc. This article mainly focuses on the impact of Brachytherapy in BP Koirala Memorial Cancer Hospital (BPKMCH) at Radiation Department.
Brachytherapy is a form of radiotherapy where a sealed radiation sources is placed inside or next to the area. It is a type of radiation therapy used to treat cancer.It placed radioactive sources inside the patient to kill cancer cells and shrink tumors.These sources produces gamma-rays which cause the same effect on cancer calls as x-rays. Brachytherapy is important treatment for cervical cancer treatment.
In BPKMCH, we used High -dose rate implants.In this type of brachytherapy the radiation sources is left in place for just 10-20 minutes at a time and then taken out.Treatment may be given twice a day for 2 to 5 days or once a week for 2 to 5 weeks. In BPKMCH, we do brachytherapy vaginal cylinder (VC) for post operative patient once a week for two weeks and non operative patients, intra cavitary radiation therapy (ICR) once a weeks for three weeks depends up on the patients disease condition .
This pandemic has affected the brachytherapy services in BPKMCH during lockdown. Especially far geographic patients are more affected by this situation covid -19 pandemic. BPKMCH has been able to continue external radiation therapy services by taking proper precaution about Covid -19 pandemic during this situation.
Now we resumed the Brachytherapy services by taking proper precaution
- Patients are allowed one visitor with RT PCR report
- Brachytherapy could be done only after RT PCR negative patient
- Temperature is recorded before entry to the hospital
- Hand washing station and sanitization facilities are made available in hospital premises.
- Preparing isolation room for COVID positive patients.
- Only three patients get brachytherapy per day
- Every staff who involved in services should wear face mask and face-shield.
In the previous year 2019, total number of brachytherapy application 806 done as for intracavitary brachytherapy for ca cervix patients.
This year the number was expected to rise as there were increased the number of treatment by External Radiation Therapy of cervical cancer patients . The waiting patients for brachytherapy is also increased in OPD, so we started doing brachytherapy on Saturday since, February 2020 .
But, this pandemic made disturbance to the brachytherapy services since march 2020 .The number of brachytherapy in BPKMCH has decreased significantly during lock-down.
During this emerging situation, urgent care unit, inpatient care unit, emergency operative procedure, different diagnostic procedure is continuously going on. During working condition our many staffs suffering from COVID-19 positive. Some are returned their regular duties and some are in still isolation center.
Many follow up patients are consulted virtually or by phone sine lockdown by providing phone no to concerned doctors in BPKMCH but brachytherapy service cannot be done virtually or by phone. Brachytherapy services need to physical presence of patient and get treatment with the help of brachytherapy implant with the help of machine. So it is difficult to continue brachytherapy service during lockdown.
✍️ Bishnu Maya Adhikari
Register Nurse -BPKMCH
Radiation therapy nurse with 18 years experience in the field of nursing
Secretary-. Nursing Association of Nepal Chitwan Branch