KUALA LUMPUR, April 7 — Palliative patients increasingly lack medical attention as their drugs run out under a nationwide lockdown, while hospitals cancel surgeries and follow-up appointments for non-coronavirus patients.
Hospis Malaysia CEO Dr Ednin Hamzah said 90 per cent of his patients with serious illness have cancer, who may suffer from significant pain, constipation, breathing difficulties, and nausea, but it’s not very easy for them to be seen at hospitals anymore amid the Covid-19 epidemic.
“They (palliative care patients) are non-Covid-19 patients, but have ailments that need medical attention. It is not easy to go to hospitals now. Many hospitals are becoming Covid-19 hospitals, so these patients are not able to receive their usual attention,” Dr Ednin told CodeBlue in an interview.
The palliative care advocate added that under the Movement Control Order (MCO) — which started on March 18 and has now moved to Phase 2 — the roadblocks now enforced in many places in the country are making it harder for these patients to seek immediate medical attention.
On April 5, the police together with the Malaysian Armed Forces conducted 743 roadblocks nationwide and inspected 293,051 vehicles, Senior Defence Minister Ismail Sabri Yaakob told a press conference yesterday.
New regulations under Phase 2 of the MCO see only one person — the driver — allowed per car, except for emergency cases, disabled people, pregnant women, and for health care purposes, according to the National Security Council’s (NSC) FAQ dated April 2. Even then, Dr Ednin fears it would cost ailing patients precious time to go through roadblocks and reach the hospitals.
“They may go to one hospital and may be told: ‘You can’t come here. You need to go to other place.’ And it takes hours now; people are getting stuck in roadblocks. They may let the patients through, but they may be questioned for some time,” he said.
Under the MCO that is scheduled to end on April 14, people are now generally restricted to travelling a maximum of 10km from their home, while those who need to see their regular doctors for medical treatment further away may be permitted to do so, depending on police discretion.
Seeking Non-Coronavirus Health Care Is A Struggle
Dr Ednin said frontline treatment is not at the hospital as widely perceived, but in the community, as people are asked to stay home so that they don’t have to go to the hospital.
“The hospital should be seen as the last line of defence, as that’s where you know whether you live or die,” he said.
“The nature of the frontline is the community and there are two elements there. One is the healthy people who should stay at home and practice social distancing; and the other is current patients with health care needs who got difficulties getting to hospitals, appointments and surgeries cancelled, running out of medicines, movements are affected. They are the ones that have [a] great deal of difficulties.”
Hospitals are screening high-risk people for Covid-19, like palliative care patients, for coronavirus. But as the focus of the country’s medical sector shifts to handling the deadly virus, Dr Ednin notes that these ailing patients are finding it harder to get their usual medical assistance.
“People and patients that are potentially at risk are getting screened, so there are no issues with them. But in normal day-to-day situations, outpatients of clinics are being reduced, follow-up checkups are being interrupted, patients that have scheduled appointments for surgeries are being diverted. Wounds that need dressing cannot be dressed. People needing nursing care cannot get private nurses. People who need changes in the catheter in the nasogastric tube can’t get it done,” Dr Ednin said.
The hospice team steps up during these times to aid patients via any means they can.
“My palliative case team visits patients at home and keeps them as stable as they can so that they do not load the hospital services. We provide physical care, psychological care (as in counselling and assisting the family in how to cope with the loved ones), or potentially even caring for them when they might be dying,” the Hospis Malaysia head explained.
Health director-general Dr Noor Hisham Abdullah said last month that all elective operations, or surgeries that can be scheduled in advance, have been indefinitely postponed at coronavirus-admitting government hospitals. Patients from Covid-19 hospitals have been transferred to non-coronavirus public hospitals and also to the private sector.
Managing Death, Funerals, And Emotional Anguish During Covid-19
Apart from prohibiting any type of gatherings, including funerals and memorial services, the MCO has also disallowed interstate travel and foreigners from travelling to Malaysia.
This has made dying patients’ reunions with their loved ones not only impossible, but also stressful for everyone involved.
“Funerals are being affected. We have to manage it under current rules; it is how it has to be. It is hard, and that is why we concentrate on the mental health and mental anguish. In many places, Covid-19 patients are dying and they cannot see their loved ones because of risk of infection,” Dr Ednin said.
“We are not involved with the government in getting back these people with their loved ones, both overseas and local. But we are helping the patients in the emotional sense. We say ‘I’m sorry you cannot see your son in UK’ and ‘you probably just need to be okay to talk to them over the phone or using FaceTime’ and something like that.”
According to Dr Ednin, Hospis Malaysia was not included in the government’s recently announced Prihatin economic stimulus package.
Yet, the charitable organisation providing professional community palliative care says it is in dire need of donations, including personal protective equipment (PPE) for its health care workers and cash to purchase medications for patients.
“We need full PPE as we are seeing potential Covid-19 patients, like people who may be at risk or those with close contact with Covid-19 positive people. We had a few situations now where patients and families may have been in contact with people who are at risk. So our team needs to be equipped. This includes face masks, gowns, visors, aprons etc which are in ridiculously short supply,” Dr Ednin said.
“We also need money for medications for many of our patients who don’t have them. We certainly do need donations to keep going.
“How much? As much as possible.”