The lines that we often straddle as health care workers are thinner than a laundry wire. This is especially true for a country whose infectious disease record is akin to that of a failing immune system. Tuberculosis is such a common occurrence that a running joke in medical school lessons goes like this: Everything could be TB, and often it’s the health care workers who are exposed to this bug, while not having adequate personal protective equipment (PPE) to fully protect themselves.
Enter COVID-19.
N95 has now entered our daily lexicon. So have words such as “PPE,” “surgical masks,” and “face shields.” It used to be that these space-suit-like turnouts are seen only in tertiary hospitals, but go to any of our clinics and you’ll see doctors and nurses donning and doffing PPE as a precautionary measure.
This is a heralding sign that the virus causing thousands of undue deaths worldwide is also changing the landscape of medicine. We could no longer look at cough, colds, and fever the same way, for the breadth of the virus’ effect in the human body crosses the abstract lines that once distinguished one disease from another.
It has been said a lot of times, COVID-19 exposes a country’s health care weaknesses. For us health care workers who knew this since our first foray into community medicine, we assert that it should not have taken something like this for us to really see what is happening.
Medical anthropologist and physician Gideon Lasco had written about the continued endemicity of TB in our country. Indeed, it is a glaring but taken-for-granted symptom of our sick public health measures. Now COVID-19 shines a light on that thin laundry wire that all health care workers in the country are trying to straddle in managing patients, not just with TB, but with all sorts of preventable diseases. COVID-19 is the weight that fell on the cracked ice of our health care system.
Just like TB, COVID-19 is prone to stigmatization. Take an example: A patient in a distant province was admitted to a hospital due to difficulty breathing. The hospital staff was worried; was it the virus finally paying a visit?—they secretly asked in their heads. The patient, however, was being treated for an abscess in the abdomen before this happened. The breathing alluded to a sinister complication such as disseminated bacterial infection.
An urgent referral was needed since the hospital had no capacity for intubation, but fear paralyzed the staff. Who would do the referral that the patient needed? Finger-pointing ensued, for everyone was afraid and nobody wanted to admit to their fear. The logic behind PPE use in order to safely administer care despite the possibility of COVID-19 was thrown down the drain because of irrational fear, and this is the seed that germinates to stigmatization, then to discrimination.
Imagine the irony: Some of these health care workers might have handled PTB (pulmonary tuberculosis) cases without wearing an N95, and it bore them no fuss—just a natural everyday thing in a society used to such health care incapacities whose problems are woefully systemic.
COVID-19 is jolting us out of our collective stupefaction over things that we should not have taken for granted. Our reaction, understandably, is fear, and the natural sally of any human being is to bolt to safety—a survival trait exploited by clueless authoritarians still peddling inane promises of safety from criminals and drug addicts.
The patient died as a result.
This underlines the importance of the use of PPE. It is not merely a dictum to safety why we as health care workers have begun to treat every minor cough or low-grade fever as possible COVID-19. The safety that PPE grants allows us to do our job; and our job is to provide the care that the patient needs without compromising our own health.
Health care workers need to master that fear to do what we signed up for, even if that fear is further inflamed by that precarious anxiety bubbling right beneath the surface of what once was a benumbed consciousness, like a shaken can of soda thrown to the wall with “COVID-19” written all over it. For who wants the stress of shaking up a system that has been “working” far too long without someone making a fuss? Why demand PPE and isolation units for PTB patients when things are “going smoothly” anyway? When COVID-19 hit us, it exposed the tabooed absurdity of our working conditions in the Philippines.
I’m afraid not everyone will be able to channel this fear into focusing on what we need to do once we’re past the pandemic. But for those who will choose not to succumb to an id-level response, I hope that these events shift the conversation inside our heads: from the unimaginative concession of constantly making do with the excuse of meager resources, i.e., the ugly tune of being “resilient,” to an uncompromising attitude of constantly demanding to be able to do our job and do it safely. For in our task of ensuring good health to the people we serve, who in turn will ensure that we are healthy?
So, by all means, let’s honor our dead colleagues and bury them in the Libingan ng mga Bayani. But these heroic labels ring hollow if we just revert to our old ways once things are settled. Many of us would rather not be called a hero if it means seeing patients get the care that they need, and us able to do the jobs we signed up for safely.
So the clarion call begins with this: Please get us PPE.
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JM Deblois, 29, is a first year family and community medicine resident physician in FamilyDOC.