While they understand the urgency to address the COVID-19 pandemic, their hearts go to thousands of Filipinos relying on services only the likes of a government tertiary hospital can provide.
By JANESS ANN J. ELLAO
This was the first thing that popped into Anthony’s mind upon learning that the Philippine General Hospital (PGH) will downsize its operations to pave way for patients of both suspected and confirmed cases of the deadly coronavirus disease 2019 (COVID-19) pandemic.
Anthony, not his real name, has been battling chronic myeloid leukemia, a type of cancer that starts in the bone marrow, for nearly a year now. The 28-year-old was diagnosed two years after his father’s death, who died of kidney problems. The family’s pocket, so to speak, has long been emptied.
As such, the PGH’s Cancer Institute, where they can avail of almost free treatment and medicines, gave him hope.
“Where will we go now? Where will all the cancer patients and critically-ill go?” he asked repeatedly.
Last week, the PGH was designated as among the three government hospitals in Metro Manila that will serve as the COVID-19 referral center. The PGH is considered as one of the country’s biggest modern tertiary hospitals that provides services to more than 600,000 Filipinos annually.
This has initially left the PGH community divided, a source tells Bulatlat. While they understand the urgency to address the COVID-19 pandemic, their hearts go to thousands of Filipinos relying on services only the likes of a government tertiary hospital can provide.
Is PGH prepared to face head on the challenges of dealing with COVID-19?
Health advocate Dr. Josh San Pedro has no doubts that the PGH, with its years of experience and highly-qualified doctors and health workers, can rise to the challenge of confronting the deadly COVID-19.
As an end-referral center, San Pedro said the PGH is competent in treating the most difficult medical cases of thousands of patients from all over the country, despite the overall budget cuts in the health sector over the decades.
“But why PGH? Any other hospital provided due resources and equipment can serve as referral center of the COVID-19. Whereas PGH is the only tertiary hospital that many poor Filipinos can turn to,” community medicine practitioner and University of the Philippines College of Medicine professor Gene Nisperos told Bulatlat.
Primarily established to attend to medical and surgical services to “non-infective” conditions among indigent Filipinos, Nisperos said PGH has, over the years, been receiving barely enough funds to operate.
PGH, he added, can continue its current job more efficiently if provided at least P5 billion annually, instead of the P3 to P4 billion public funding it has been getting over the years. To maximize its full potential it will need P10 billion, the amount health workers have been calling for even before the COVID-19 pandemic.
The low public funding of PGH, said Nisperos, resulted in inadequate medical equipment, facilities, and supply. This increases out-of-pocket expenses of patients. At times, health workers dig their own pockets to help patients in need, Nisperos said.
This, too, has also taken toll on PGH’s human resource – with one nurse covering work that should be carried out by three, and their dependence on students and interns to serve in the frontlines. In an earlier statement, Nisperos said nurses are working way beyond their eight-hour shifts daily.
Meanwhile, a 2018 WHO publication said at least 82 percent of patients wait for nearly six hours to get a bed in PGH.
Despite this, the health department has designated the PGH as a COVID-19 referral center. A 130-capacity ward was retrofitted to become negative pressure room, which the Centers for Disease Control and Prevention said is necessary to minimize transmission of infectious agents that are usually transmitted from person to person through respiratory droplets.
The PGH’s Cancer Institute is among the services that will be affected. While the PGH has already clarified it will remain open, along with other essential services such as the Emergency Room, Cancer Institute will still scale down its operation.
Dr. Marvin Mendoza, chief fellow of the Medical Oncology of the PGH’s Cancer Institute, told Bulatlat they are now down to a skeletal workforce, with only a third of doctors and health workers running their services as entire workforce were divided into three teams – taking turns working for one straight week before going on self-quarantine for the next 14 days.
As of this writing, the Cancer Institute is still working on the best protocol to best continue their operations. But with a skeletal workforce, they are, in the meantime, constrained to limit their services and not accept new patients. The Medical Oncology, one of the clinic bays in the Cancer Institute, used to be the busiest – attending to at least 150 to 200 patients daily. The number of patients seeking medical services never dropped despite years of massive budget cuts in the health sector, said Mendoza.
For families of cancer patients like Beth, not her real name, they understand the need for the PGH to look into COVID-19 patients but the news that the Cancer Institute will limit its operations still shook her. Her father has non-Hodgkin lymphoma and has been seeking cancer treatment at the PGH.
“Our PGH doctor went out of his way to help us. He found us another doctor who was willing to treat my father for free. But still, we had to cough up P9, 600 for his medicine,” she said.
Like Beth, patients might find it difficult to find other hospitals for treatment. Mendoza said other government hospitals, unfortunately, do not have some of the much-needed equipment, such as those used for radiation therapy. PGH, being government-funded, still has the lowest-priced medicines for treatment – at times free if patients are part of certain programs that are either state-funded or through charitable institutions.
Mendoza said only patients needing the most critical treatments are advised to go to PGH as of this writing. Those that can be dealt with virtually, such as health surveillance, are contacted only via text messages or phone calls.
“We hope that the Cancer Institute will be able to return to its normal operations soon. We look forward to returning to our ‘second home,’ where we are kindly nurtured by its doctors, nurses, social workers, and staff,” Beth said, adding she knows the institute is finding ways to prevent their immunocompromised patients from being infected by the virus.
Apart from the Cancer Institute, both the PGH and the Research Institute of Tropical Medicine are considered as the “busiest” among the 50 hubs nationwide where antiretroviral medicines for HIV patients are available, per the 2018 WHO review of the Philippine health system.
Impacts of devolution
If at all, the deluge of patients in PGH reveals how secondary and tertiary public hospitals in both Metro Manila and neighboring regions are lagging behind in terms of capacity and resources. Such uneven development has long been blamed on the devolution of the public health system since 1991, where government hospitals from the provincial to the barangay levels operate at the whims and mercy of their respective local government units.
Nisperos said many of their patients, for one, come from the provinces of Cavite and Laguna for a practical reason that PGH is more accessible compared to the regional health unit based in Batangas.
Apart from the health infrastructure itself, health workers are also poorly distributed in the country.
As of 2017, even regions near Metro Manila, where many PGH patients come from, have very low density of health workers. Central Luzon has 3.6 doctors per 10,000 population while Calabarzon has 2.8 and Mimaropa, 1.9 compared to Metro Manila’s 10.6 doctors per 10,000 population.
Nisperos, in a recent Zoom conference, recommended the nationalization of deployment of health workers to combat COVID-19.
Protection for health workers
Protection, too, for health workers is compulsory. Now a COVID-19 referral center, PGH has identified low to high risk areas and the corresponding protection gears their health workers should wear. As of this writing, Nisperos said they have at least a month’s worth of buffer supply.
“Nowadays, you cannot mindlessly wander around PGH. You have to be aware of the appropriate protection gear to use,” Nisperos quipped.
Doctors and health workers in the frontlines are advised to be tested periodically to minimize exposure and incidence of infection among them. Personal Protective Equipment (PPEs) should be provided in the “fastest and most efficient way to protect our frontliners in the health sector and prevent further loss of precious lives,” a group of community doctors said.
Mendoza of the Cancer Institute said even those not directly attending COVID-19 patients are required to wear PPEs as part of their protection from the deadly virus. He called for public support as PPEs may run out in the coming weeks if replenishments are not provided on time.
Despite efforts to equip PGH and other hospitals and health workers in combating the COVID-19 pandemic, a group of community medicine doctors reminded the government that the actual battle is taking place in communities.
Massive clinical surveillance, according to the Community Medicine Practitioners and Advocates Association (COMPASS), will help the government identify communities with high COVID-19 cases and redirect their limited health resources accordingly. For densely populated communities, the doctors recommended the testing of at least half their population.
“A lockdown, without measures to identify and isolate afflicted individuals, is merely buying time,” the doctors said in their appeal.
COMPASS added that barangay health workers must be accredited, hired, and mobilized to conduct house-to-house visits to monitor the vulnerable populations and Persons Under Monitoring (PUMs) and for the much-needed mass health education.
Meanwhile, cancer patient Anthony awaits further instructions from PGH’s Cancer Institute. His online business, which helps to cover his medical expenses, is on hold due to the lockdown. For now, he still has a month’s worth of medicines.
“Please don’t abandon us,” he said, addressing the government, “This is not our choice. If you no longer have empathy in your hearts, then it could lead to our deaths. Our blood is in your hands.”