Typically, a patient spends three hours at most in the emergency room of any given hospital in the Philippines. That changed, said Dr. Faye Garcia, 31, chief resident of Emergency Medicine at The Medical City after the Department of Health (DOH) announced the first local transmission of COVID-19 in early March.
Suddenly hundreds of patients were flooding the ER. The Medical City is at the heart of one of Metro Manila’s pandemic hotspots. Isolation tents were put up outside the hospital. They overflowed. Patients sent home with mild symptoms returned to the ER unable to breathe.
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“I have patients who have been [in the ER] for seven days,” Garcia said. “Now I know [the patients’] names. I talk to their families.”
She remembered a man asking her to deliver a letter to his wife in isolation. Garcia couldn’t tell him that his intubated wife was in no condition to read.
“So I started reading it to her. It said, in Filipino, ‘How are you. I’m just here outside. Don’t worry about money.’ I just started crying. I was like, I’ve done this so many times, what the hell.” Garcia’s voice choked and her eyes glistened during a Viber video call with VICE.
“As an EM physician, I don’t cry…but I couldn’t finish reading it.” Exhausted as she was, her eyebrows remained totally on point.
Today, Garcia spends her shifts resuscitating patients only to watch them die. “And it’s not getting any better. We’ve exceeded our capacities for doctors, for equipment, everything.”
Like many other healthcare workers, Garcia can’t go home, for fear of infecting her loved ones.
“My family calls me every day. I don’t tell them these things. I’m trying to be strong for them.” Some nights, in her dormitory room, she talks to a psychiatrist on the messaging app, Viber.
“My family calls me every day. I don’t tell them these things. I’m trying to be strong for them.”
Many of the country’s health workers migrate abroad for better work opportunities — in a six-year period, experts estimate that more than 3,500 doctors left the Philippines as nurses. With only one doctor for every 33,000 Filipinos, Philippine healthcare cannot adequately take care of its citizens, even in ordinary times. Given that female health workers make up a significant portion of the country’s brain drain, the women who stay are under extraordinary pressure in the fight to keep the Filipino people healthy during these unprecedented times.
“Bring your own PPE (Personal Protection Equipment),” Maria, 26, recounted the policy of the government-run hospital she works in. She wished to only be identified by her first name to protect her identity.
During a break in her shift, she told VICE that she’s relying solely on PPEs donated by family and friends. Anaesthesiology residents like Maria are the ones intubating patients in need of respiratory support or in preparation for surgery. Even in non-COVID-19 cases, the simplest procedures have become arduous and dangerous. It can take two hours to get a PPE on and off. Every patient is assumed positive for the novel virus.
“As of now, we’re in the dark. The medical director isn’t releasing [the numbers of suspected cases] in our institution.” Excluding intubations, Maria’s team sees on average 30 patients a day.
“We make do with what we have.” Masks are reused, she said through Facebook Messenger. “We’ve [also] been using yellow bags as PPEs.” Yellow garbage bags are designated for infectious waste. Maria sends sad-face emojis with her messages.
Inadequate protection means more healthcare workers will get quarantined for at least 14 days. As of this writing, at least 12 doctors have died in the fight against COVID-19 in the Philippines.
The New Normal
“It’s frustrating to read news from late January and February, when the DOH kept on saying they were capable of handling this disease — that our facilities were enough, that we weren’t a third-world country,” shared Dr. Binky Ortiz, 37, who works as an Emergency Medicine consultant at several private and public hospitals around Quezon City. “Their statements didn’t age well, did they?”
On social media, stories circulated about health workers with nowhere to sleep, or refused public transportation and forced to walk to work. Within days, volunteer groups made of school alumni and housewives stepped in to provide PPEs, hot meals, carpools, even toiletries. Establishments including a motel chain serve as dormitories. “The support we’ve been getting from the private sector is boosting our morale,” affirmed Ortiz. As demonstrated with Typhoon Ketsana in 2009, Filipinos use their love for social media to help each other in times of catastrophe.
“I haven’t been this paranoid in my life…We are fighting an invisible enemy and it has already surrounded us,” continued Ortiz. “We don PPEs [instead of] white coats. We have industrial face shields lining our shelves; before, they were full of charts.”
“I haven’t been this paranoid in my life…We are fighting an invisible enemy and it has already surrounded us.”
In order to survive, she said, “I’ve learned to accept that this is the new normal. [My colleagues and I] talk, share stories, and most of all, share our fears. I’ve taken up cross-stitching again after 20 years to calm my mind.”
“Who would’ve thought I would go into training in the middle of a pandemic?” wondered Dr. Therese Anne Suñe, 33, who moved to Manila from Bacolod, a city in the Visayas, for an Infectious Disease fellowship at the Research Institute of Tropical Medicine (RITM).
It can take Suñe up to 24 hours to find a hospital to take in patients they can’t admit. Way over capacity, RITM is like other hospitals, except for one key difference. “Even though it’s a new disease, RITM is not new to outbreaks,” said Suñe. Specialising in infectious disease, they’ve dealt with SARS, MERSCOV, and HIV, the latter making up the majority of their cases pre-pandemic.
From the subspecialty doctors she consults for each patient’s treatment, to the institutional workers cleaning rooms, Suñe is grateful that everyone is doing their job as best they can. “The work gets done eventually…Panicking or [being] negative wouldn’t help at all.”
She credits her positive, professional composure to the hospital’s rigorous protocols, plus the additional hiring done to help prevent burnout. “The Infection and Prevention Control Committee are very strict on training the employees on [protocols] and protective gear,” she continued, “not just the doctors and nurses, but also the janitors and aids.”
Where to Next?
As for the rest of the Philippines, a suspicious quiet pervades. Lockdown and isolation measures are in effect but, outside of Manila, few municipalities are testing. Christelle Cuevas, 29, doctor to a barrio (village) in Lanuza, Surigao del Sur, and a surfer, thinks it’s only a matter of time before COVID-19 shifts to the provinces, thanks to the mass movements triggered by President Rodrigo Duterte’s Luzon lockdown.
“If you think [Metro Manila] is overwhelmed right now,” she said, “the mortalities will be terrible, here. That’s what I’ve been prepping my local government to realise. We’re starting to detect [cases]…They’re here.”
Provincial hospitals don’t have the capacity to handle complex cases — these are usually sent to major cities like Davao, Cebu, or Metro Manila, all of which are on lockdown. Even in Metro Manila, there are only 23 beds for every 10,000 people; Mindanao, where Lanuza is located, has less than half of that. Lanuza has a population of around 12,600; Cuevas has four oxygen tanks.
Far from the decision-making capital, implementation of government protocols varies widely on a town-to-town basis. “In the province there are so many logistical issues….One of my communities is a two-hour journey up the mountains,” said Cuevas, who’s taking her masters in Public Health at the University of the Philippines. She argued that social distancing and home quarantine are unrealistic in rural areas, where big, extended families often live in one house.
Barrio doctors like Cuevas have to get creative. Thankfully, her local government is on board. She’s turned a government-owned resort into an isolation area. Perhaps a local distillery could produce local disinfectants.
“Poor comprehension is a big obstacle. We need a behavioural change education plan.” She is considering using bandilyos, a provincial announcing system that involves a megaphone attached to the roof of a car, to blast information throughout the town.
“I’ve been crying every night out of worry and fear,” Cuevas admitted, the force of her convictions breaking down for a moment. “Everyone knows everyone in this town. These are my friends. Any death would be personal.”
“I’ve been crying every night out of worry and fear.”
We Are All Frontliners
Ortiz hopes that more local factories will manufacture PPEs, the foremost concern of every frontliner. She hopes that when this is over, the country will develop a concrete action plan, like Singapore did after SARS. She hopes that the salaries of health and service industry workers will be increased. “They’ve proven themselves indispensable during this crisis, yet most of them barely earn above minimum wage.” But without a cure or a vaccine on the horizon, she knows that the end is not yet in sight.
The government has granted hazard pay to its frontliners, but Cuevas quipped that timely pay is a better place to start — the first time her nurses got paid in 2020 was in March. She also urged the central government to consult with their barrio doctors in the provinces. Even before COVID-19, she had been battling a string of outbreaks: measles, polio, then dengue. “Maybe [our public health] isn’t in a good state [if] diseases from 20 years ago are coming back.”
Hospitals can contain outbreaks, but they can also unleash them. Medical officials are calling for mandatory testing for health workers and additional designated COVID-19 hospitals. As of March 20, only 12 in every million have been tested in a country of 109 million people. Currently, there are only five accredited testing centres nationwide, including RITM, with a total capacity of 1,000 tests per day.
“It’s weird that people keep calling us heroes,” mused Garcia with a puzzled smile. “For us, it’s our job.”
Whether you’re a nurse tending to a comatose, contagious patient in an overcrowded ICU, or an anxious twenty-something struggling to stay sane under home quarantine, every one of us has a job to do.
“We are in this fight together,” affirmed Ortiz.
As for Suñe, who prays rosaries with her family on Facebook Messenger, saying goodbye has become a strange, running joke: “I don’t know when I’ll see you but I’ll see you.”
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Correction 04/06/20: This story originally said that Christelle Cuevas was pursuing a doctoral degree. She is actually studying for her masters. We regret the error.
