'Not in our nature to feel hopeless' - A doctor's account of Covid-19 frontline

 

The following is a personal account by a contract doctor at a public hospital. The doctor, in his 30s, spoke to Malaysiakini on condition of anonymity.

Government doctors are not allowed to speak to the media without authorisation as they may face disciplinary action.

This doctor recently tendered his resignation. He was attached to the Emergency Department.

On the desperate situation

I resigned with a 24-hour notice because I couldn't stand to work another day. I'm too exhausted. My mental health is out.

Despite the minister saying that everything is under control, it's chaotically out of control in the Emergency Department.

We have tried to make spaces by closing down the Outpatient Department and dengue wards, but patients still keep coming in non-stop. Currently, there are more than 300 patients in the Emergency Department alone.

The problem with opening more spaces (for Covid-19 patients) is that the number of staff remains more or less the same.

There are those deployed from other departments and states but it's still not enough. A lot of us are also under home quarantine or are positive ourselves. Almost 20 of the senior nurses are positive.

Patients on ventilators should be on one-to-one care in the intensive care unit i.e. one staff nurse for one patient.

But on my last shift, we had up to 11 ventilated patients but only one doctor and two medical assistants.

Patients in the Emergency Department have to wait up to five days to be admitted. Sometimes, they have to sit on metal benches all the while. We have canvasses set up everywhere but it's still not sufficient.

Imagine your parents have to sit on benches for five days, sometimes gasping for air because oxygenation is not adequate.

Sometimes we have to split one oxygen tank for six to eight patients. It's not just that one night. It has been going on for several weeks.

As a doctor, I find it very difficult for me to be hopeless. I mean hopeless in the sense that I cannot do anything to help my patients. They need oxygen, I can't give them that.

These (picture above) are three-way valves and they are currently being modified for oxygen use. It is inadequate, but better than nothing.

On what needs to be done

I think the Selangor Health Department and Health Ministry need to step up their game. Time is of the essence. People are dying by the dozens as we speak.

Heavy mobilisation is needed, especially from states that are doing well.

The thing is now it's getting worse for states like Malacca and Negeri Sembilan.

If all the states become like Selangor - which I hope to God that it will not reach that point - then we won't be able to do anything about it. It's Italy, UK and India all over again.

Our half-cooked movement control order (MCO) is not working.

As long as new cases still pile up daily, we can't do much. There is only so much manpower and equipment that we have.

The majority of my patients are from factories. Even some I've clerked have been positive for several days but are forced to work and work with others. It's madness.

We are not controlling the source of the infection at all.

I'm not an expert in disaster or crisis (management). There are people in charge of that. They have to step up their game before it becomes completely like India.

On 'everything is under control'

We are not okay. None of us are. We really need manpower and a little break. We are already at our limits.

Everybody says the Health Ministry has an oversupply of staff but this is clearly not true, even during the pre-Covid-19 era.

There have been several medical officers deployed from other departments to help us and some couldn't stand it and resigned. We in the Emergency Department have been facing this for so long.

The staff really need psychiatric support. The staff are on the edge. Their physical, emotional and mental well-being is being pushed to the limits.

My colleagues are crying every single day. My medical assistants and staff nurses are working double shifts (more than 14-15 hours on average) on a daily basis.

My specialists are tirelessly working with us on the field, trying to sort all the chaos into order but it's uncontrollable.

Patients keep coming and we as doctors are extremely devastated that, for most patients, we can't do much.

It's not in our nature to just see patients suffer without being able to do anything about it.

We can't magically make oxygen appear out of nowhere. We can't make more beds out of thin air. We can't attend to them in time.

We can't monitor their saturation on a regular basis. We can't give medicine to them as soon as possible.

If we can't provide the optimum standard of care to the patients, then how can we say everything is under control? It is not.

On the resignation

As for me, I've been suffering mentally and emotionally. Maybe I'm not as strong as my colleagues. They too are holding on to their dear life.

Before every shift, everyone is crying (out for help) in our Emergency Department and medical officer groups.

And a majority of us are contract doctors whose contracts are expiring in a few months.

Contract for us is only three plus two years, non-renewable. After the contract is due, you are out - kicked out. After being used, we are just thrown away.

I just got a job at a friend's general practice. There's no more opportunity to enter private hospitals, it's very difficult.

My passion has always been emergency medicine. I loved the place. My specialists are all really nice.

The real heroes are the specialists working the floor, the emergency physicians tirelessly working among us.

But for us contract doctors nearing the end of our contracts, it's no longer about passion or ambition - it's about survival.

If there are any job offers or opportunities, we are forced to grab them. We have to put food on the table for our families, too.

One of the reasons we left is not just because we are burnt out. It's because we have nothing to look forward to, there's no future. - Mkini