At Sungai Buloh, Two Doctors Manage 30 Sick Covid Patients

Doctors in Sungai Buloh Hospital’s Covid-19 wards have to review patients, clerk new admissions, discharge patients, take blood, do referrals to relevant subspecialties, and attend to emergencies in between, with the help of only two to three nurses.

KUALA LUMPUR, Jan 20 — Sungai Buloh Hospital (HSB) is so understaffed that only up to two doctors and three nurses per ward care for more than 30 ill Covid-19 patients who may worsen rapidly, a staff said.

The HSB staff, who spoke to CodeBlue anonymously as government staff are not allowed to speak to the media without prior permission, said that most of the health care workers currently working in HSB — Malaysia’s main Covid-19 hospital located in Selangor — are the same ones from March 2020.

And with the increasing number of Covid-19 patients, mostly category three to four, their workload has significantly increased. Category three refers to Covid-19 patients with pneumonia who can breathe on their own, while category four refers to Covid-19 patients with pneumonia who need supplemental oxygen. Category four is considered clinically severe disease.

In a statement by Selangor state health director Dr Sha’ari Ngadiman last Sunday, he stated that the Selangor state health department (JKNS) had redeployed health care workers from the same state and other states to work in HSB. Besides that, the statement also highlighted that the Ministry of Health (MOH) has hired health care personnel on a contract basis to work in HSB.

“JKNS talk about redeployment of doctors or staff. They are not doing enough and not enough are being redeployed,” the anonymous HSB staff told CodeBlue in response.

“In March or April, 2020, one to two medical officers per ward was taking care of up to 28 patients who are mostly asymptomatic. Now, one to two medical officers per ward is taking care of an average of 30 over category three to four patients.”

In one Covid-19 ward, there will also be only two to three staff nurses at most to care for the patients.

The anonymous staff said there is no guideline to say that a certain number of doctors will be required to take care of a certain number of patients.

To put things into perspective, based on the staff’s observation, in a normal non-Covid ward at a government hospital, 30 patients are managed by two to three house officers (trainee doctors), two to three medical officers, one to two specialists, and consultants. However, in a Covid-19 ward in HSB, one to two medical officers are additionally carrying the roles of housemen and certain roles of specialists.

The staff asked if JKNS could reveal the number of health care workers being deployed to HSB, as compared to the high number of staff being redeployed to Sabah during its major Covid-19 outbreak following the Sabah state elections last September.

“Mind you, cases in Sabah back then were not as high as in Selangor at the moment.”

The average daily Covid-19 cases in Selangor over the past two weeks was 920 infections between January 5 and January 18, which is 3.6 times higher than the average daily cases in Sabah during the first two weeks of October at 258 infections.

On a typical day, the anonymous HSB staff said doctors will get a pass-over from the previous shift doctor on ill patients, new admissions that have yet to be seen, patients who need blood-taking, scans, referrals to subspecialties like nephrology, cardiology, endocrine etc.

Then, doctors will prioritise which patients to review first because they cannot jump from one cubicle to another, as some parts of their personal protective equipment (PPE) has to be changed in between. If there’s a person-under-investigation (PUI) patient, that patient has to be seen first.

“We need to work with a partner. One person dons (PPE), one person outside the contaminated area because once you are inside the patient’s cubicle, you cannot simply go out again just to take a pen or a stethoscope or a needle etc,” the HSB staff told CodeBlue.

“So, in wards where there’s only one doctor, the nurse will have to be the partner.”

In between all of this, the anonymous staff said, specialists will carry out their rounds in the ward but mostly, board rounds, where medical officers will discuss individual patients’ progress on a white board.

“Specialists will identify which patients he or she needs to don [PPE] to see because specialists are in charge of multiple wards at once.”

Once the review is done, doctors in charge of the ward will have to document everything in the computer and start doing discharges.

“Discharges comprises of doing a discharge summary, a discharge note for patients to bring home, writing referrals for patients that need follow-ups, arranging quarantine centres for patients that do not have means for quarantining at home, ordering medications, and contacting family members,” the anonymous staff said, pointing out that there could be up to 10 to 15 discharges per day.

“In the midst of all this, [if] suddenly a patient in the ward deteriorates and needs to be resuscitated, everything goes to a halt until that patient is stabilised or transfered.”

According to JKNS director Dr Sha’ari, in his statement, staff in HSB work in a shift system that helps to reduce their workload.

However, the anonymous HSB staff told CodeBlue that the shift is either from 9am to 9pm (AM shift) or from 9pm to 9am (PM shift). Most HSB health care workers have been working on an endless loop of AM and PM since the beginning of the pandemic last year.

“Even when there was no Movement Control Order (MCO), most of us cannot leave town because there is only one full off day in between, and if there are people on sick leave or quarantined, those who are off can just be called back to work,” the staff said.

The staff added that although their annual leave is not frozen, it is difficult for them to take leave in between because there won’t be anyone to substitute their slots because of the lack of manpower.

“Take Turns To Sleep, Sleep Is A Luxury Anyway”

The staff said that the initiative of providing a green zone in HSB for health care workers to rest, eat, pray, and shower, as mentioned in the JKNS statement, was true and a good initiative.

However, the staff said that it is difficult to maintain social distance and prevent spread of the coronavirus in these areas among health care workers.

“Standard ward has one oncall room with one single bed. Since Covid-19, some rooms have been equipped with double decker beds and some doctor offices and seminar rooms have been converted into resting rooms. Even corridors are being converted into pantries and rest areas.”

As some rest areas are shared, staff were warned by the higher-ups of the hospital that if one of them contracts the virus, none of their colleagues should be a PUI.

“Hence, the higher-ups have reminded us to take turns to sleep because ‘sleep is a luxury anyway’,” the staff quoted HSB management as saying.

“Actually, I don’t know how to solve this resting area issue other than making our shifts less exhausting.”

The HSB staff said that shortening shifts won’t help, but adding more workers to the shifts will make it less exhausting.

Eating Complicated By Red Tape

JKNS had also mentioned that oncall doctors are eligible to receive food from the hospital, but unlike the beginning of the Malaysian epidemic, HSB no longer receives food donations from volunteer groups, industries, and agencies. Hence, staff can either buy food from the cafeteria or food outlets in the hospital, or order food through delivery services like GrabFood.

“JKNS’ response about food is all true, just not the whole truth,” the HSB staff stressed. “We had a kopitiam and a canteen at the hospital, but now the kopitiam has closed down.”

The anonymous staff also added that even though the canteen is open, it is troublesome for health care workers in the ward to find a suitable time to remove their PPE, go to the canteen, and purchase food on time.

Besides that, in order for doctors to get meals from the hospital, they will have to fill up manual forms for each day, which should be done in advance and submitted to the food department along with their rosters to prove that they are really working on that day.

The staff said sometimes in the midst of a busy schedule, doctors don’t manage to order meals from the food department in the hospital, hence they are left hungry.

In fact, the staff said although the JKNS director said health care workers can order meals through GrabFood, but due to the MCO, the last order through GrabFood is now limited to 7.20pm.

Fortunately, the HSB staff told CodeBlue they were informed by their bosses that from January 19 onwards, there will be someone sponsoring food for them.

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