Alleged data manipulation by Sarawak’s State Disaster Management Committee (SDMC)/ Sarawak State Health Department (JKNS)
Sibu Hospital has opened up more wards for Covid positive patients as compared to the previous wave. The bed occupancy rate (BOR) in Covid wards in Sibu Hospital for Covid patients has exceeded 100 per cent.
A single ward, which was meant to admit 20 to 30 patients, is currently being forced to accept up to 40 to 50 patients. The reason why bed utilisation has not reached 100 per cent on paper is because top management is allegedly manipulating the denominator of bed capacities.
Data manipulation of intensive care unit (ICU) utilisation in the state is also allegedly happening. In reality, we do not have many available ICU beds (by ICU beds, we mean a physical bed, staff nurses, monitoring, and ventilator).
Last week itself, many Covid positive patients are stranded for several hours in the emergency department – about five to 15 patients daily – awaiting bed availability. They can wait up to 12 hours. The number of stranded patients has been increasing over the week.
The newly built modular or field ICU in Sibu Hospital did increase ICU bed capacity, but this is not the same as manpower.
Sibu Hospital is also facing a shortage of oxygen ports for Covid-19 patients who require oxygen therapy. As of now, we have started using oxygen concentrators donated by the public. We have six Covid wards (one without oxygen ports; one is our daycare with limited oxygen ports).
We do have oxygen concentrators, a few of which are being used in ward based on our observations. One cubicle roughly has two to four oxygen ports. We are placing up to seven Covid-19 patients per cubicle, which means Patients No 5 to 7 will need other form of oxygen support.
If the port is being used, we try to support them using an oxygen flowmeter that can cater for two patients using one oxygen port if their oxygen requirement is not high. However, if they are intubated or on high-flow oxygen setting, this requires one port per patient; they can’t share.
On another matter, the data published by SDMC regarding newly diagnosed Category One to Five Covid-19 patients is not representative of the actual situation.
About 10 per cent to 15 per cent of patients diagnosed in Categories One to Two deteriorate to Category Four and Five after several days, like what we can see at Sibu Hospital, which is worrying.
Almost 90 per cent of Covid-19 patients admitted to ICU at Sibu Hospital in this new wave had received two doses of vaccine, mainly Sinovac. Most are aged above 60, though some are as young as in their 30s. Most of them have no serious underlying health conditions – mainly diabetes, hypertension, and dyslipidaemia.
Manpower and assets
Most of the staff nurses/ pembantu perawatan kesihatan (PPK) were called back to work for overtime during their entitled off-days due to the lack of nurses taking care of the wards.
Doctors in the Covid team were given only one full “day off” per week as compared to the regular two off days/week. This situation is causing severe and continuous burnout among medical staff who need their leave days.
Hospital staff leave (cuti rehat) were frozen again, according to an internal circular from the hospital administrator, starting from 24th September 2021.
We are in need of more manpower, including doctors, nurses, and PPKs. Many staff are being infected with Covid-19 and being placed under quarantine orders. Roughly about 10 doctors were infected in the past fortnight, excluding other staff like nurses. All of us were fully vaccinated with Pfizer. Almost every day, we get news that there are either staff infected or quarantined due to close contact, including nurses, medical assistants, doctors, PPK.
This too has caused a reduction of manpower across all departments (Covid and non-Covid).
Hospital assets are always an issue when it comes to a crisis. We rely on donations from the public in terms of monitoring, ventilators, and oxygen concentrators, including drinking water etc.
Compromised patient care for non-Covid cases
As Sibu Hospital is a hybrid hospital that also needs to treat non-Covid patients, patient care is compromised for non-Covid patients.
Approximately six to eight elective surgeries were postponed per week, mainly due to Covid-positive status / PUI (patient-under-investigation). There were cohorts in the same cubicle during their admission.
We only have one Covid operating theatre to cater for emergency surgeries or life-or-limb-saving surgeries for Covid positive/ PUI cases. The anaesthesiology team had to close down one to three elective surgery slots per week as they had issues with manpower (each slot is able to cater two to four cases, depending on the type of surgery).
Semi-emergency surgeries will still be done under the emergencies slot, thus this will not affect any life-threatening illness.
Only a handful of cases were outsourced to private doctors to carry out the surgeries. However, this stopped in the past few months due to budgeting issues. This group of patients ended up in our emergency department with acute life-threatening conditions, subsequently passing away due to their illness.
This has caused certain injustice to patients who are supposed to receive standard of care by the hospital.
Most of them had complications of end-stage renal disease who are long due for their AVF construction. They mainly died due to sepsis from their temporary dialysis catheter. The cancer patients died due to disease progression and complications from not receiving treatment like surgery. The anaesthesiology team has been kind to the hospital in catching up on these sorts of semi-emergency cases in hopes that care to the patient is not compromised.
This letter was written by a doctor in Sibu Hospital. CodeBlue is publishing this letter anonymously because civil servants are not permitted to speak publicly without authorisation from their superiors.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
