Serving Patients on the COVID-19 Frontline

INTRODUCTION

Every day amidst the pandemic, health workers all over the world put their lives on the line to serve patients. This is the story of one of these masked heroes.

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Dr. Dulcinea Balce-Santos first noticed something unusual in February 2020. “Some of my patients who were admitted to hospital due to abdominal pain or gastrointestinal bleeding showed normal baseline chest x-rays. After 48 hours, they developed fever and dry cough. Repeat chest x-rays revealed moderate pneumonia in both lobes of the lungs; less than 24 hours later, they developed severe pneumonia and died shortly. It was puzzling,” recalls the internist-gastroenterologist.

In the early days of the pandemic, medical knowledge about COVID-19— its symptoms, mode of transmission, diagnosis, and treatment— was not as extensive as it is today. A global shortage of COVID-19 diagnostic test kits and personal protective equipment (PPE) made the situation even more difficult.

“With the limited testing capacity at that time, we had no way of confirming if patients had COVID-19. We had to assume that all patients were positive. Our PPE consisted only of surgical masks and isolation gowns, and we were not yet trained in PPE techniques for COVID-19. I felt scared and helpless,” Dr. Balce-Santos admits.

Battle Scars
The test kit and PPE shortages were eventually addressed. Many frontline health workers in the country underwent PPE training. According to Dr. Balce-Santos, they were taught how to choose the right PPE for specific situations, when to wear PPE, how to properly put on and take off PPE (donning and doffing), how to engage with patients while wearing PPE, and what type of PPE patients should wear.

PPE typically consists of multiple layers of protective barriers such as an N95 mask, latex gloves, medical goggles, face shield, isolation gown, coverall, head cover, and shoe covers. Frontline health workers have been donning and doffing PPE every day since the pandemic was declared in March 2020. It is a tedious but necessary process meant to protect patients, medical staff, and the community.

“After only several minutes in full PPE, I would be drenched in sweat from head to foot. The constrictive N95 mask makes breathing difficult,” says Dr. Balce-Santos.

After a long day at the hospital, she arrives home with deep marks on her face left by tight-fitting N95 masks and goggles that dig into the skin—battle scars from the war against the novel coronavirus. Every day she tries her best to comply with infection control protocols, especially for doffing which must be performed in a precise sequence to prevent contact with contaminated PPE. But even this may not be enough. Health workers are human after all, and they can make mistakes, so much so in a long-drawn-out pandemic. Feeling feverish after treating suspected COVID-19 patients, Dr. Balce-Santos had to self-quarantine several times. Fortunately, subsequent thermometer readings showed that she was not febrile and a swab test came back negative. Still, it was a distressing time for the physician and her family.

One evening at home, her husband noticed Dr. Balce-Santos was unusually quiet. “What’s wrong?” he asked. She looked at him with a blank stare and then burst into tears. He hugged her tightly. The frontline physician reached her breaking point at the height of the Enhanced Community Quarantine (ECQ) in Metro Manila, when there was an acute PPE shortage and hospitals were on the verge of being overwhelmed by the surge of COVID-19 patients. This was also the time when a number of doctors succumbed to the disease. Some of the doctors who died in the line of duty were her mentors and friends. “I was devastated. The worst part was I couldn’t even go to their funeral.”

Invaluable Support 
Dr. Balce-Santos acknowledges the invaluable support of friends and colleagues who help her cope with the daily stresses and difficulties brought about by the pandemic. “I often talk with my medical colleagues to share our frustrations, fears and small victories. A friend who is a psychiatrist counsels us through our Viber group, always reminding us that it’s okay not to be okay. My friends and colleagues help boost my morale and keep me focused on what’s important.”

Many frontline health workers choose to look at the daily grind of hospital work through the lens of humor. They do so to ease the tremendous physical, emotional and psychological strain that they must bear to do their job effectively while keeping their sanity. At the hospital hallway, with their faces barely visible through coveralls, masks and goggles, Dr. Balce-Santos, her doctor colleagues and the nursing staff strike fashion-model poses in photos that they share among their group. They poke fun at themselves and have a good laugh, wounded warriors drawing strength from each other as they close ranks against a deadly adversary.

She thanks her family for their understanding and support. “I’m so proud of my family, especially my kids who, despite their young age, understand the risks and demands of my profession. I’ve never once heard them complain. They have all been very supportive.”

She is grateful to the community for supporting frontline health workers. “I’m so touched whenever my patients say they include me in their prayers.” With a smile, she recalls the day in Pasig City when members of the community joined local police personnel and firefighters in serenading their hospital staff. In other hospitals she’s affiliated with in Antipolo City and Parañaque City, local residents gave hospital staff gifts, balloons, and food. A flower shop which had to close down because of the lockdown gave away all their flowers to the hospital staff. Private citizens and companies donated surgical masks, face shields and other PPE to hospitals.

Extra Careful And Vigilant 
Dr. Balce-Santos urges everyone to be extra careful and vigilant amid the latest spike in COVID-19 cases in Metro Manila and surrounding provinces. A year after the pandemic was declared, this latest surge is once again pushing the healthcare system to the brink. “We must continue to follow all health protocols, stay home as much as possible, wear masks and face shields when going out, and practice social distancing,” she stresses. “Hopefully, COVID-19 vaccination of priority populations will be ramped up until a substantial portion of the population is vaccinated. This will be a big step toward reducing cases and deaths, easing the burden on healthcare system, and restarting the economy.”

For Dr. Balce-Santos, staying healthy and providing continuous care to patients during the pandemic are her biggest achievements. She does hospital rounds for admitted patients and performs digestive endoscopy procedures wearing the highest level of PPE protection. Through video calls on Viber, she conducts teleconsultations and refills her patients’ e-prescriptions. With physical examination not an option in teleconsultations, she explains that doctors have to use surrogate cues in performing a virtual examination and making a diagnosis to address the patient’s chief complaint. For bed-ridden elderly patients who are unable to do teleconsultation, she makes house calls in full PPE.

Faith In The Time Of Pandemic
A source of solace and strength for Dr. Balce-Santos during these difficult times has been her spiritual faith. “In my car on my way to the hospital in the morning, I pray to God for wisdom and strength to overcome the challenges that lie ahead. At the end of the day on the drive home, I tell God that today I did all I could for my patients, and pray that they make it through the night.”

On the sun visor of her car, held in place by a red paper clip, is a small piece of paper. On it written in all caps and black marker are the words HONESTY, COMPASSION, COURAGE, DUTY, FAITH, and I’M A HERO!

I believe these are my best attributes,” she says. “I read these words aloud before I get out of the car and enter the hospital. Hearing myself say the words motivates me and keeps me focused on my mission to serve patients.”

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