Two doctors sound the alarm: PPEs and the lives of front-liners

• By Mariam Mokhtar

By Dr Zulkifli Ismail and Dr Musa Mohd Nordin.

(Editor’s note: Let’s be clear about one thing; we are united in the fight against the invisible enemy. No-one is point scoring or making a political statement. All of us want our medical workers to be protected. If there are failings, then these should be addressed. A pandemic and national emergency does not mean we stop asking questions. Try and put yourself in the shoes of the frontline medic.
This piece is published with the permission of Dr Zulkifli and Dr Musa. On 22 March, they sounded the alarm about the lack of Personal Protective Equipment (PPE) amongst frontline health workers. )

Despite an unusually heavy and tiring Sunday schedule, it was simply impossible to hit the sack. We were inundated with multiple and repeated messages from doctor friends serving in Ministry of Health (MOH) hospitals across the country appealing for personal protective equipments (PPE). These are MOH doctors working in the frontline of the COVID outbreak.

While bigger hospitals like Sg Buloh Hospital may have sufficient supply of PPEs, the same cannot be said of the many other hospitals, including private hospitals. Even the earlier suggestion that Sg Buloh Hospital was immune from this PPE deficiency  syndrome, was not entirely true, because in the midst of writing this piece, we received an SOS message for mask N95, face shield, PAPR power air purifying respirator, hood cover, boot cover, etc from a trustworthy colleague serving a COVID dedicated hospital

Videos of MOH staff making their own PPEs using plastic bags, dustbin liners and other paraphernalia does not augur well for the reputation of the ministry. There have also been offers from individuals who have volunteered to make face shields for our MOH healthcare providers (HCP). 

A team of doctors who were doing needs assessment of our HCPs managing the COVID patients in MOH hospitals concluded that the lack of PPEs was paramount. 99% of GPs are having difficulty getting PPEs, even the surgical masks. The prices for face masks have soared from 80 sen to RM3.50 per piece.  

And in their efforts to redress this deficiency, they discovered that there are at least three plants manufacturing PPEs in Selangor state alone. According to them, there were long queues of trucks of agents and distributors to buy PPE supplies from the three plants.

Why have we not heard from these companies? Are they expecting to increase their price at a time of national crisis or are they ‘stockpiling’ to force the demand and reap from a supply shortage? Presumably, the middlemen, the agents and distributors, are similarly cashing in on the COVID pandemic.

At the height of the SARS-CoV2 infection in China, apart from the disciplined mobilisation of their healthcare workers, the PPE factories ramped up production and provided these to the front-liners and the infectious disease specialists. Where are our PPE manufacturers when our MOH front-liners most needed them? 

The gravest sin to be committed during this outbreak is for unscrupulous individuals, politicians and companies to profit from the sufferings of our HCP who are risking their own lives to care and nurse the critically sick COVID patients in the Intensive Care Units (ICU).

And if they are infected as have happened among our HCP, or worst still if they lose their lives to the infection because Majlis Keselamatan Negara (MKN), MOH and the companies cannot provide adequate PPEs, blood of our HCPs will be on their hands. The failure to produce and ramp up production by manufacturers and to provide by MKN and MOH, basic PPEs to HCP who care for a patient with a potentially fatal disease is undoubtedly irresponsible, negligent and criminal.

The government has appealed to the people for their cooperation, to the private hospitals to sacrifice for the nation and to the front-liners to nurse and care for the sickest amongst us ravaged by SARS-CoV2.

The MKN must take the initiative to immediately mitigate the PPE shortages.

They must secure urgently the supply chain, eliminate the middlemen and undertake bulk purchasing, which would ensure fair pricing.

And they must distribute equitably to all COVID designated hospitals and not just in the Klang Valley. 

They must also keep reserve supplies to secure surge capacity.

It is high time for the government to demand the PPE manufacturers to step up without fanfare and ramp up production, accept reduced profit margins and supply the critically needed PPEs to our healthcare workers.

It is utterly shameful that our HCP have to appeal to the public to provide them with PPEs which should be the primary responsibility of the MOH and by extension the MKN which is orchestrating the war against COVID.

These are our young men and women who have young families and who need the protection. They do not need to make PPEs from old plastic bags and garbage bags, the videos of which are a shame to show to the world. 

Our frontline HCPs must wear their PPEs before they care for the sick, nay any COVID patient. The manufacturers should be able to supply them. The government of the day must ensure and if need be enforce this as much as they are enforcing the movement control order (MCO). Have a heart for our young doctors, nurses and allied health professionals!

Step up and be counted.

Dr Zulkifli Ismail and Dr Musa Mohd Nordin are paediatricians at private hospitals.

The article dated 22 March is reproduced here, with permission. - rebuilding malaysia