Klang Valley’s Regional Covid-19 Response – Doctor On The Ground

Many hospital departments were reluctant to forgo their beds early on and reasons were given to avoid being involved directly in Covid-19 management.

When the health care fraternity first heard about Covid-19, many assumed it would be another new virus that we would be able to manage, just as we did with the Middle East respiratory syndrome coronavirus (MERS-CoV) which began in 2014.

This was before the news started to come in that Covid-19 was highly infectious and had taken so many lives in China. By then, there was growing concern in Malaysia that we may suffer the same fate.

These concerns were shared with the then-ruling government for them to take early measures to prevent Covid-19 from reaching our shores, but to no avail. 

It soon became evident that the spread of the virus would eventually result in a pandemic. True enough, Covid-19 brought the world to a standstill. An unseeable microscopic organism held everyone hostage; none were spared, and people were dying in the millions. 

As the days went by, with news and status updates coming in from other countries, many of us on the ground knew that Covid-19 would eventually arrive in Malaysia and we had to brace for our own surge sooner or later.

The only way to prepare ourselves for a potential surge was to learn from the experience of others — what worked and what didn’t. 

All hospitals, particularly in Klang Valley, were preparing for the foreseeable surge — hospital directors were alerted to start preparing their hospitals for a possible Covid occurrence.

This was indeed a challenge early on as many departments were reluctant to forgo their beds, citing the need for their services to continue even though Covid-19 cases were emerging. 

Day-by-day, as Covid-19 cases climbed further upwards, the departments dealing directly with the coronavirus began to feel extreme pressure. Lack of manpower, equipment, medication, oxygen, and space were a major challenge. 

Many failed to grasp or simply refused to understand the need to prepare for a sudden surge in Covid-19 cases as this was a health crisis they had never experienced before. A thousand and one reasons were given to avoid being involved directly in Covid-19 management. 

At the same time, the medical community had difficulty moving as one unit. Subspecialties were an obstacle. The primary health care and emergency community were quietly manning the front lines.

These unsung heroes were constantly and vigilantly trying to identify and manage probable and confirmed Covid-19 cases as best as possible with what little was available to them. 

The health ministry, through the health director, had reached out to all health care providers, especially specialist groups, reminding them that they were once medical officers, staff nurses, medical assistants, and generalists before branching out into specialities and subspecialities.

They were told that we should band together as one, instead of being divided during this time of need. 

This is one of the shortfalls we should not overlook at all health care facilities, including public, private, university, and military hospitals alike, in preparing for a possible surge in the future. 

This will be a challenge as many are adamant that this is not their field of interest, hence, it was not their problem. 

One way to overcome this underlying problem is to perhaps get all registered health care providers to do a compulsory service to help manage pandemics, in this case, Covid-19.

This would be a great help and may even be a solution to the manpower issue that keeps reoccurring, especially when there is a requirement to manage a surge in cases.

The fact is, our health care system is at par with other developing countries — some say even better. While many deemed the pandemic as a disaster, some see it as a health crisis that overwhelmed our existing system. 

We have ourselves to blame as many resources that we needed to enhance our service, although requests were made repeatedly, always ended up entangled in a bureaucratic knot. It just took too long to get the required resources needed.

This is another issue that needs to be addressed. Those in the ivory tower need to realise that for the system to work, they need to facilitate the needs of those on the ground at lightning speed, rather than hindering efforts with unnecessary questions. They should accommodate and always look for immediate solutions rather than simply declining urgent requests. 

Interestingly, these are the very people that claim to represent the health care system. Yet, not many have actually led from the front. Leading from the front line would have increased morale and reduced many negative comments that were received from our own frontliners. We fear getting infected, yet we still do nothing to prevent it. Ironic but true. 

Hospitals of all designations should be ready to make room to accommodate Covid-19 patients. Relying on government hospitals alone will not be enough to cater for Covid-19 patients. 

The issues we face today will be the same as we adjust to a life of living with Covid-19. Pushing away Covid-19 patients and trying to offload them to government facilities should not be a practice in these trying times. Some even see it as unethical and unprofessional. 

Therefore, all hospitals need to be clever in utilising whatever existing resources that are available to them. Health care personnel need to be ready to go the extra mile to ensure care is available at all times.

Quarantine centres should be set up in all districts to accommodate Covid-19 patients. These centres can be put under the purview of the district office with multi-agency involvement. 

Combining multi-agency resources would help overcome transport, logistics and manpower issues. This would also help reduce the movement of patients across borders and allow for family support to be near when needed. 

These centres would also help accommodate patients who are not fit for home quarantine but yet have a low-risk infection. Health monitoring could be done by local health clinics or general practitioners (GPs) under the guidance of the district health department. This would allow health facilities and personnel to continue with daily health services without unnecessary delays. 

The public too needs to understand that in the efforts to find a cure, prevention is still the best medicine when dealing with a virus threat. We must all take the steps recommended and abide by the advice given. All efforts taken by the government are in the best interest of the public. 

A healthy population ensures all economic activities can run without hiccups. We tend to forget that we are sometimes the cause of our suffering. Blaming others is just a waste of time as one irresponsible act can lead to many casualties leading to disruption to daily activities.  

Overall, we persisted, we have stayed resilient. We took it in our stride, we managed all patients as best as we could, with what we knew and had. Kudos to those on the ground for giving their all. May God bless all of them and make them stronger in the days to come. 

The Covid-19 threat still looms, and we should be able to respond better on all fronts compared to before since we now have a better understanding of what is to come and how to act. 

Our current challenge now is to manage Covid-19 in a hybrid state, thus ensuring non-Covid cases are not alienated like before. The coronavirus will remain a constant threat and the fear of an outbreak will always play in everyone’s mind. 

We accepted this calling to become health care providers, a choice made that has its perks spiritually and financially. But we need to remember that the core of our service is to serve the public as best as possible, foregoing fame and fortune. 

This is what sometimes we forget and it is hoped when there is a need, we will all come together to answer the call as we are meant to, which is to provide care to patients in need. Let us not forget this. 

This essay was written by a doctor at a public hospital in the Klang Valley. CodeBlue is publishing this anonymously because civil servants are not permitted to speak publicly without authorisation from their superiors.

This article is part of an exclusive series of guest essays by experts in the health care sector for CodeBlue on their reviews of Malaysia’s 2021 Covid-19 response and their outlook for 2022.

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