The Revised Declaration Of Geneva In Display Among Frontliners

By Dr Schee Jie Ping | 30 October 2020

A brief report on personal observations on the ground by doctors in Tawau Hospital, Sabah.

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Sabah is the state with the highest number of cumulative Covid-19 cases in Malaysia since March 2020.

Through the multiple waves of the pandemic, frontliners and health care workers in Sabah, especially the east coast region consisting of Tawau, Semporna, Kunak, and Lahad Datu, have been withstanding the rampaging hits 24/7 with all our hearts, our souls, our mind, and our strengths.

Serving on amidst this seemingly dark, distressing age, the frontliners shine on like beacons through unforgiving nights, instilling hope, calmness, and probably sense of direction among the local community, fittingly and in accordance with the Revised Declaration of Geneva.

“I SOLEMNLY PLEDGE to dedicate my life to the service of humanity; THE HEALTH AND WELL-BEING OF MY PATIENTS will be my first consideration”.

The Revised Declaration of Geneva: A Modern-Day Physician’s Pledge

The health and well-being of our patients have always been prioritised within our best capabilities. We may not be the most resourced, yet we may be among the most resourceful. Resource management has been exceptionally challenging, yet painstakingly optimized since Day 1 of outbreak.

Hospital Tawau, being the only public hospital with specialists in the entire Tawau, extends our coverage across other moderately distant districts (Semporna and Kunak). As the daily numbers of new cases and cumulative active cases spike while the bed numbers and human resources remain finite, our health care burden and workload multiply as well.

Unlike multiple regions in Peninsula, the similar measure of converting Hospital Tawau into a dedicated Covid centre while shunting non-Covid patients to other hospitals remains a logistically unfeasible luxury.

The hospital administration, working hand in hand with frontliners, has been swift in actions. Wards have been rearranged, extra health care equipment and manpower have been sourced from other regions/states, and additional treatment centres (even a freshly constructed field hospital) have been established.

No patient has ever been turned away. Delay in assessment or admission has been minimal to none. Whenever we run out of beds or wards, we create additional beds and wards.

Many health care workers may need to, even voluntarily, work extra hours from time to time to care for the rising numbers of patients while maintaining the standard and quality of care. Some show up to work daily despite battling physical and mental exhaustion, even physical pain and injuries.

Furthermore, medical officers in Hospital Semporna once worked continuously without any rest day for weeks. Such practices should not be impetuously glorified, yet they are being carried out out of transient necessity and volunteerism while prioritising patients’ health and well-being.

Fortunately, the worst stretch may have been over as our workforce is constantly being boosted by the support and reinforcement from our counterparts in Peninsula.

“I WILL MAINTAIN the utmost respect for human life; I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patients”.

The Revised Declaration of Geneva: A Modern-Day Physician’s Pledge

SARS-CoV-2 is the greatest equaliser which does not differentiate nor discriminate. Therefore, every patient, every life is treated equally with utmost respect within our best capabilities, regardless of patients’ age, gender, ethnicity, nationality, and even financial status.

Prisoners, criminals, wrongdoers, illegal immigrants, the needy, the underprivileged, innocent civilians, and fellow colleagues / health care workers are all being cared for promptly, comprehensively, and respectfully across the board.

Stepping into prisons, detention centres, quarantine and low-risk treatment centres, one will witness the sacrifice of frontliners who serve day and night while drenched under their personal protective equipment (PPE), all for the health of every patient, every life.

Meanwhile, frontliners stationed in the hospitals are caring for ill patients intensively round the clock, serving on with empty stomach and full bladder (even soaked diapers in some), constantly exhibiting tip-top form under stress while standing between our patients and graves.

Underprivileged communities in the interiors are not forgotten nor forsaken as well. Frontliners who stride through floods to reach the patients demonstrate their dedication through palpable actions. Frontliners who step through hoary, damaged wooden bridges between stilt houses, who put patients’ health over own safety in offering timely helping hands, often radiate reassurance to the local community that we serve not by mere convenience but by conviction and commitment.

“I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard”.

The Revised Declaration of Geneva: A Modern-Day Physician’s Pledge

Every week, there will be news of health care workers being diagnosed with Covid while some other are put under quarantine. The emotional stress among health care workers is not to be dismissed. As quoted by a colleague in Hospital Semporna, “It’s like a survival game, every few days one of us may be infected and hence eliminated from daily duty.” There is indeed no telling whether tomorrow or Covid diagnosis will happen first.

However, we are being increasingly responsible and accountable for our own health, both at the individual level and collectively as a group. We adapt to the new norms and adhere strictly to the SOP in order to minimise transmission among health care workers:

  1. teaching for junior doctors is conducted virtually,
  2. non-essential meetings and gatherings are cancelled,
  3. all staff are to wear both masks and face shields (or eye covers) in the hospital compound, and
  4. all staff are monitored daily at work with daily temperature and presence/absence of symptoms clearly documented in record books.

Each of us is responsible for our own health and the health of our colleagues at the workplaces. There is strictly no over-the-line heroics at work. Every staff who develops fever or other symptoms will seek treatment proactively, swiftly report to the respective superiors / supervisors accordingly while being assessed, tested, and even quarantined in the timeliest manners.

Apart from physical health, the mental health of health care workers is being exclusively cared for as well. Our supportive and approachable colleagues in the Department of Psychology and Mental Health have been offering their expertise diligently without the slightest prejudice or judgement. Such practical, tangible help represents the best option for most health care workers who are separated from respective families by the South China Sea.

Non-Covid Patients

Medan Hospital Tawau, Sabah, treats non-Covid-19 patients. Picture credit anonymous.

An infinite number of non-Covid patients are still seeking treatment for various critical conditions, such as stroke, heart attack, severe dengue, malaria, tuberculosis, sepsis with life-threatening infections, obstetric complications and emergencies, surgical and orthopaedic emergencies, and so on.

Human and health care resources may have been stretched thin at times, certain aspects of health care (for example routine outpatient care for stable conditions) may not have been “business” as usual, yet indicated inpatient care has never been significantly jeopardised nor compromised throughout this pandemic.

Urgent treatments and interventions are still being prioritised without additional delay. Despite a multitude of multifaceted challenges in logistics, health care facilities, and human resources, it is still possible, provided with concerted efforts to work within the confines of these limitations, to deliver the most efficient treatments and services to the entire spectrum of patients within our best capabilities and creativity.

Incessant Support from Sabah State Health Department, Ministry of Health, Non-Governmental Organisations, Good Samaritans, and Local Community

Volunteers from Semporna Heroes deliver food packs to needy villagers in Sabah. Picture from Twitter @maszlee.

Efforts in channeling human and health care resources from the Peninsula by the authorities, well elaborated on mass and social media, must be applauded. We would also like to express our gratitude towards NGOs (Tzu-Chi Foundation, Lions Club, Tawau Tiong Hwa Chamber of Commerce, Hup Seng, and so on) for their selfless contributions in the forms of PPEs, ventilators, industrial disinfectants, and even diagnostic test modalities. In addition, plenty of individuals and members of local community have come forward and offered similar contributions as well.

Most notably, even health care workers, a junior doctor who is currently undergoing housemanship training in Hospital Tawau, has astonishingly contributed hundreds of thousands of ringgit worth of PPEs since the first wave of this pandemic. All in all, such morale-boosting supports from every direction have been cheering all the frontliners on, reminding us that we are never alone in this fight.

Last but not least, voyaging on a sea of eternal controversies on human and health care resources, a fresh angle, a different perspective may form a positive wave, offering encouragement and positive vibes across the health care community, and if God-willing, the general public as well. We are all at war against the virus, yet it is not all doom and gloom.

Undeniably there are issues which should not be swept under the carpet. At the same time, there are plenty more positives worth highlighting too. The frontliners are still fighting on, as strong and sound as ever. Join us in this battle and, prayerfully, the victory parade in the foreseeable future.

Dr Schee Jie Ping, on behalf of all the staff in the Department of Medicine, Hospital Tawau. This group of health care workers cares for both Covid and medical (non-Covid) patients in Tawau.

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