OF HEALTHCARE LEARNINGS, MUSINGS IN A PANDEMIC
WHEN the Philippine government reported the first confirmed Covid-19 case in the country back on January 30, 2019, the country’s health-care system immediately started preparations to manage the expected increase in Covid-19 cases.
While they were able to put in place the necessary infection and patient safety protocols not only to protect their patients but their healthcare workers as well, two doctors had many learnings and realizations to share as they battled this invisible disease for over a year. Another doctor, who managed to be part of the government’s efforts, had to leave prematurely to find another platform to push for his beliefs.
Dr. Gerardo D. Legaspi, Director of the University of the Philippines-philippine General
Hospital (PGH), recalled that when enhanced community quarantine (ECQ) was imposed on March 15, 2020, he was summoned by Health Secretary Francisco T. Duque III and was informed that PGH would be designated as one of the three Covid-19 referral hospitals in the National Capital Region. The other two hospitals were the Dr. Jose M. Rodriguez Memorial Hospital in Caloocan City and the Lung Center of the Philippines in Quezon City.
When he spoke during the recent
Philippines Graphic organized webinar titled “Hospital Best Practices in Handling Covid-19 Patients,” Dr. Legaspi shared lessons he and his team learned from operating a referral hospital. At that time, PGH was already down to around 70 to 75 Covid-19 patients with 20 percent in the ICU, down from 220 to 140 during the peak months of July and August.
“All that we have done is based on using Science as the base of our decision,” he said. “it is not only enough to follow Science but you have to choose the right Science and I am happy that our experts here guided us well with the safety protocols and interventions for our patients.”
Fear management
THIS also helped him and his team to manage their fear, which, Dr. Legaspi said, “was a hindrance to the effective management of a Covid referral hospital.” He noted that “fear was evident in everyone’s faces, including ours probably at the start. But when we believe in real Science, our fear started to melt away.”
One of the things that Science also proved, according to Dr. Legaspi, is that the RT-PCR “is not the end game to Covid.”
“It is a point in time and the reliance on it will should be well-tempered because you know the assurance of negativity is brief or only during the time of testing,” he explained. “Still, whether you are positive or negative, precautions still need to be observed.”
Dr. Legaspi related that PGH did one mass testing of 4,700 employees, “and we promised ourselves that we will never do it again although we got a lot of information from that.” Instead, he said he would recommend targeted testing as a more efficient way to make use of RT-PCR.
Surprisingly, PGH’S surveillance showed that those who were assigned in the Covid wards actually had a lower rate of infection than the support staff who were helping them or those working in non-covid wards.
“This proves that if you have hospital health protocols well in place, even in a hospital like PGH with high-risk patients, Covid infection can be brought to a minimum,” Dr. Legaspi said.
Caring for the health-care worker
When it came to their healthcare workers, Dr. Legaspi made sure that they were housed in nearby hotels, had shuttle services and that they were mentally and spiritually supported to deal with the situation.
“The staff enjoyed the food from donors and they were given one week off after serving in the Covid ward,” he said. “I think all of these gestures of support somehow made them feel less stressed at work.”
Dr. Legaspi recalled that whenever PGH was sought for comment on any issue, he would call Health Undersecretary Maria Rosario Vergeire to ask if his statements would not counter the messages that DOH wants to impart.
“This is to prevent a lot of miscommunication from people working in the Covid crisis,” he said. “People should be able to identify with the messages to be sent so we made them attractive, easy to understand and of course, informative.”
For Dr. Karl Henson R. evans, Director of the Hospital Infection Control and epidemiology Center of The Medical City (TMC), one of the critical lessons he learned from this pandemic is that preparation is key.
“The preparations at TMC were not comparable with that of Singapore, but I think we were prepared because our preparations for global communicable diseases were not entirely zero and we started on the correct footing,” he said.
Crisis leadership
RAPID diagnostics, he added, holds the key as there is really a difference between the early response to the pandemic “when we were getting the tests very late versus when there were more tests and we were diagnosing patients faster.”
Crisis leadership, Dr. Henson added, is critically important not only for the hospital but at the local government unit and national levels.
“Whatever your politics, I think we can all agree that our national healthcare system needs an upgrade and I think that this pandemic has defined everyone, especially our leaders, what the next things are and what next steps are required by the nation.”
The declaration of ECQ was also a turning point for Dr. Anthony Leachon, a noted cardiologist who practices at the Manila Doctors Hospital. He recalled getting a call from Malacanang summoning him to support and advise Secretary Carlito Galvez who was tapped as the Chief Implementor of the national Action Plan against Covid-19. He would report to Camp Aguinaldo which served as the Command Center.
“My role is to give medical advice to Secretary Galvez. In fact, on my second and third day, I presented a blue print on how they would carry out the plan,” he related. “After that, I was also involved in the delivery of major services, meeting with governors and mayors on their needs. It’s an action team really.”
However, Dr. Leachon was forced to resign after only three months because of “some differences in the policy as well as in the communication process.” For one, he noted that the data that the Department of Health had been disseminating was not updated because of the delay in its collection.
“I demanded transparency and openness rather than the propaganda system so that is what happened,” he said. “They should report what is happening and if there are deaths and not stone wall any communications.”
No sense of urgency
He added that there was no sense of urgency “so that people will be informed and will be able to make the appropriate sacrifices” given the information.
“It is important that the people know the extent of the problem so that they will realize the need to stay at home and to observe the minimum health standards of wearing face masks and face shields, frequent handwashing, social distancing when they need to step outside.”
If he had his way, Dr. Leachon said he would form a coalition of stakeholders in order to fight the Covid-19 pandemic. He related his experience when he was invited to be part of the group that helped formulate the sin tax law. This group was composed of doctors, economists and members of the Cabinet.
“The problem here is that the opinions of medical experts are overruled by our economic experts so when our medical experts make certain recommendations, they are overpowered,” Dr. Leahcon said. “This is a global pandemic; this is a medical pandemic. Why should the economy be prioritized?”
“This is the reason why there have been delays in the vaccines because their priority is how to open the economy without realizing that the problem is that the economy will never recover until the virus is controlled,” he added.
Leachon had recommended that once the vaccination program is finally rolled out, the National Capital Region be prioritized since 50 to 70 percent of the business and major academic institutions are based here.
“If I want to change their game plan, the National Capital Region should be vaccinated first so that you can open the airports and the businesses freely,” he said. “The other regions to follow are Region 4A and Region 3 because these are the regions that will bring you business.”
Ready for next pandemic?
ASKED if the country is ready for the next pandemic, Dr. Leachon declared that the country is not ready because the government has not invested in health-care for the past 40 years.
“In the 1960s, because of the Vietnam War, there was an exodus of the doctors and nurses to America. And in the 1970s and 1980s, there was a time that even doctors became nurses just to go abroad because of higher pay,” he said. “So we are the number one exporters of doctors and nurses abroad.”
There is also a need, he said, to revitalize Philhealth by reducing the corruption and appointing competent people. It would be best that the Philhealth setup be made similar to that of the Bangko Sentral ng Pilipinas where the Governor is given a set term of six years.
To be fully prepared for the next pandemic, he also recommended that the country have more PGHS built in the countryside.
“If there are 14 regions, you have to build 14 PGHS so that not everyone will need to go to PGH in Manila,” he said. “So we need to build infrastructure in the countryside so that the doctors, after being rained in Manila, they would be willing to go back to be deployed in the regions and with every hospital, there will be economic development.”
“We are really not ready for the pandemic. Why? We don’t have the human resources, we don’t have a stable Philhealth and we don’t have the infrastructure,” Dr. Leachon stressed.