A two-hour e-learning forum entitled, “Behind Masks: COVID-19 Care in the Hospital and at Home” was held last June 22, 2021. The event aimed to provide civil society perspective on the Philippine health care system response to the pandemic led by Dr. Faith Joan Mesa-Gaerlan of the Medical Action Group, as well as perspectives of actual COVID-19 patients on the health care system’s capacity to absorb various patients amidst the pandemic.
COVID-19 care in the hospital
Mr. Jun Virola, a development worker and a business adviser said, “it was a bit scary” and “felt uncertain” when he found out that he and his family tested positive. On the first week, he and his family stayed at home to manage the symptoms thinking that these would go away after 14 days. Unfortunately, his symptoms worsened quickly from mild to moderate.
On the second week, after consulting with a doctor, Mr. Virola was given advise to go to the hospital immediately. This is primarily because of three factors: he has hypertension that may exacerbate his condition, the symptoms could not be managed at home as these require respiratory support, and regular monitoring by medical professionals would be needed. According to his doctor, he needed to receive proper medication as early as possible and aggressive treatment was critical to recover from the virus.
Mr. Virola also talked about the difficulty of recuperating alone in the hospital. “You know that everyone is trying their best – doctors, nurses... but, it is difficult when you’re in isolation. Family members are not allowed to visit you.
He recovered completely after three months. And according to him, it really helped that there was a doctor who monitored his case regularly.
Recovering from the virus at home
Ms. Aniles “Leles” Duma is an educator and a civic volunteer. She underwent isolation immediately when she tested positive for COVID-19. Unlike Mr. Virola, she experienced mild symptoms that involved chronic coughing. She shared, “No matter how brave you are, when you test positive, you will be terrified. I panicked.”
Ms. Leles decided to go in isolation for a month in a rented apartment about half kilometer away from her residence. According to her, they had to endure the stressful experience of waiting for her family’s test results to come out. It took five days before these were released. “During that time, I was stressed even though I was isolated in the apartment. I was stressed not for me but for my family. Thankfully, the results were negative.”
Why did she choose to go in isolation? “Because the feedback on the community facility was not commendable.” She added, “The facility was a classroom that was converted into an isolation room. There were four patients who were admitted in one room.”
Health Care System Response: what works and what are the gaps
It has been a year since the World Health Organization (WHO) first declared that COVID-19 is a global pandemic. Dr. Faith Joan Mesa-Gaerlan, Emergency Doctor at the Philippine General Hospital (PGH) identified what works and what are the gaps in the health care systems response of the country.
The establishment of One Hospital Command Center (OHCC) is considered as the most effective intervention of the government that is supported by the WHO. The OHCC is a “healthcare referral network linked with service providers such as hospitals, quarantine facilities, and medical transportation.” Its three cornerstones are aggressive community testing, contact tracing and hospital treatment which is commonly known as T3.
Early detection also helps, but Dr. Gaerlan points out that public cooperation is important to facilitate this successfully. “If a person does not take the test, we will not know what his condition is. We will not be able to admit him in the health care facility nor will he receive the medication he needs. Most of all, he can infect others.”
The contact tracing program of the Department of Health is also helpful. With the assistance of local government units, barangay leaders and community health workers can monitor COVID-19 positive individuals who are experiencing mild symptoms during isolation and quarantine in their homes. On the other hand, individuals who are experiencing moderate to critical symptoms must receive treatment (such as steroids, anti-coagulation, fluid management and the use of oxygen) in hospitals.
What are the gaps?
Dr. Gaerlan asks the basic question, “What was the status of the health care system prior to the pandemic?” She explained that, “The biggest lesson here is that our health care system is weak at the beginning of the pandemic. Our services are centered at the hospital. We are short of health workers. Most of our financing were out of pocket. And there is a lack of emergency medical services. These are the weaknesses of our health care system, that is why we were not able to address the needs of the people immediately.”
According to her, emergency medical services are very much involved in the response and resilience plan of the government. “It’s a seamless care from the pre-hospital setting in the community to the facility. This can be the framework for the universal healthcare system wherein primary care can be strengthened.” Dr. Gaerlan further explains the primary health care system is not that stable at present. There is also a need to integrate Emergency Medical Services (EMS) in the establishment of a referral system for facilities. “We don't have an EMS system and that is why people tend to access services directly to tertiary facilities when, in fact, they can avail [of these services] if our health care facility is good at the local level, in the primary care setting. Not everyone needs to be admitted in the hospital.”
What can be improved?
Dr. Gaerlan recommends the following should be at least maintained or improved in the present health care system:
Strengthening the knowledge and capacity of community health care workers.
Identifying COVID-19 positive individuals through their symptoms.
Ensuring the continuity of primary health care programs such as vaccination, feeding programs, and lifestyle changes.
Integration of diagnostic centers and EMS referral centers.
Support research and studies so protocols are evidence-based.
Establishment of contact tracing and testing.
About the writer: Kathleen Reodique is the Knowledge Management and Communications Specialist of MedNet. She has over 10 years of experience in the field of media and public relations, content production, and communications. She is currently completing her Master's degree in Political Economy with a sub specialization in Public Policy and Governance from the University of Asia and the Pacific.
Mediators Network for Sustainable Peace, Inc. Social Links
Like and Follow us at Facebook, Instagram and Twitter
Like and Subscribe our YouTube Channel (MedNet TV)