KUALA LUMPUR, April 9 — Three government clinics and a university hospital in the Covid-19 epicentres of Selangor and Kuala Lumpur have complained about persistent protective clothing shortages forcing rationing.
Doctors from Ministry of Health (MOH) health clinics — who spoke to CodeBlue yesterday on condition of anonymity for fear of disciplinary action — highlighted various personal protective equipment (PPE) items that they were running out of, despite health authorities claiming that the problem has been resolved.
A doctor from a Klinik Kesihatan in Hulu Langat, Selangor, complained that white coveralls have been out of stock for almost a month. Hulu Langat has reported 358 confirmed Covid-19 infections as of yesterday, Malaysia’s second-worst affected district after Lembah Pantai in Kuala Lumpur.
“We are lacking of PPE for our clinics since our staff sending Covid patients. Would appreciate if you could help me?” the doctor told CodeBlue yesterday, adding that the clinic sends Covid-19 patients to Kajang Hospital, University Malaya Medical Centre (UMMC), Serdang Hospital, and Sungai Buloh Hospital.
“We are only using the loose gown for now. We need the full PPE at least for our MAs (medical assistants) who is sending positive cases to hospitals. For the clinic, we still can use the loose gowns.”
A full PPE set comprises coveralls, a face mask or N95 mask, shoe covers or boots that extend until the knee, and a cap or head cover.
A doctor from another Klinik Kesihatan in Hulu Langat said yesterday the clinic does not have any hoods, boot covers, hazmat suits, or white Tyvek coveralls. The government clinic has run out of Tyvek coveralls since April 5, said the doctor, while the 15 blue suits left can last for perhaps another two or three days.
The blue suits, according to the doctor, are reserved for medical assistants and ambulance drivers who transport confirmed or suspected coronavirus patients to hospital, as well as for health workers taking Covid-19 samples.
“New stock was due Monday still not available,” the public health clinic doctor told CodeBlue.
Doctors screening patients at the clinic’s fever centre are not in blue suits because there simply aren’t enough. “They are just using 3-ply mask, white plastic apron, shield, and gloves,” the doctor said.
That government clinic in Hulu Langat functions as a fever centre and a coronavirus sampling centre, besides transferring confirmed or suspected Covid-19 patients to Sungai Buloh Hospital.
A doctor from a Klinik Kesihatan in Kuala Lumpur alleged that doctors at the clinic seeing people with acute respiratory infections currently only have seven full PPE sets each, but they need at least five a day.
“My doctors in ARI (acute respiratory infections) are using basic PPE only which compromise their safety, but we are doing this as to save on our PPE use,” the doctor told CodeBlue yesterday. “We are also running low on our 3-ply masks.”
Doctors at that clinic are allegedly only wearing basic protective gear to see patients with acute respiratory infections that leave the hands and feet exposed.
“As you can see, we are low on our full PPE and the ARI centres has compromised protection. I really hope you could help us with this. Thank you,” said the doctor.
That public health clinic in Kuala Lumpur screens patients with acute respiratory infections and transfers Covid-19 patients-under-investigation to Sungai Buloh Hospital.
Health director-general Dr Noor Hisham Abdullah previously urged all health care workers to treat patients with pneumonia-like symptoms as Covid-19 cases until tested otherwise. He said yesterday that 36 MOH staff got infected with coronavirus in clinics, as they were not in PPE gear when they saw patients who did not inform doctors that they were close contacts of Covid-19 cases. But he stressed that no health care professional in Covid-19 or intensive care unit (ICU) wards have been infected because they wore PPE on duty.
A doctor at UMMC in Kuala Lumpur, a coronavirus-admitting university hospital, complained yesterday that UMMC staff lack hoods and boot covers.
The doctor also alleged that UMMC has asked doctors to replace the plastic sheet on face shields in a ward of Covid-19 patients and to reuse N95 masks.
Reusing N95 masks, said the doctor, was potentially hazardous and should not be practiced unless in dire emergencies. Changing the plastic sheet on face shields while keeping the holder is not easy and still puts doctors at risk, the doctor said.
“There should be no compromise of safety when it comes to wearing PPE,” the doctor told CodeBlue.
“A quick glance through social media will see many requests for raw materials such as non-woven fabric for gown/hood/boot cover making, plastic sheets and other material to make face shields, etc. It is heartwarming to see many Malaysians rally together to help each other, but let us not forget that DIY PPE is already compromising the safety of health care workers.”
The doctor also claimed that infection control guidelines in Malaysia varied, especially between university hospitals and MOH hospitals. Even within many hospitals, the doctor said unit heads and departments enforced different practices, including in public university hospitals in the Klang Valley.
“Even the types and number of layers of gloves to be worn differs from departments within a single centre, and differs between centres.
“The confusion and lack of standardisation has caused social media requests for PPE by doctors in these centres as they do not receive adequate PPE (due to unclear infection control guidelines) despite the hospital having enough stock. We urge those in power to set one single standard and guideline for all to follow.”
Dr Noor Hisham told a press conference yesterday that MOH had sufficient stock of PPE, but acknowledged some distribution problems in various states last week that he said have been resolved. He also praised DIY efforts in making PPE so that Malaysia doesn’t have to depend on imports.
Update at 9am:
The names of three public health clinics in Kajang, Hulu Langat, and Kuala Lumpur have been removed upon request by interviewees, who feared disciplinary action. The photographs they sent of DIY and basic PPE used in their clinics have also been removed upon their request.