MANILA – Thrust into the frontlines as the Philippines confronts the coronavirus disease 2019 (COVID-19), three Filipino doctors stay committed to their profession despite the risks and challenges that come along.

“This pandemic is not only physically challenging, but mentally and emotionally draining as well,” said Dr. Eli John Berame, 41, an Internal Medicine specialist currently on fellowship training for Pulmonary Medicine at the Lung Center of the Philippines (LCP) in Quezon City in the country’s capital.

Berame started dealing with the disease in January, with people classified then as “persons under investigation” -- people who traveled to China and later developed symptoms after arriving in the country.

“Frankly, I was scared. A lot of things ran in my mind,” he told ABS-CBN News when asked in an online interview Thursday about his initial reaction upon being told to attend to COVID-19 patients.

“What scared me the most is the idea that I might not see my wife and (one-year-old) son again, that I cannot kiss them again, and what will happen to them if I got the virus and die,” shared Berame, whose family are in Iloilo City where he is originally from.

• 252 health workers infected with COVID-19 — DOH

“When I called my wife, I told her to take care of our son if I might not make it. I told her how I have prepared for their future and how to go about it. It is like saying my last will.”

Dr. Riel Baclayon, 30, who is finishing his residency training in Internal Medicine at the Southern Philippines Medical Center in Davao City, was “excited” when he learned last month that he would be part of his facility’s COVID team. But later, he realized he could end up as "part of the statistics.”

“I was really excited hearing that I will be part of the COVID team. Since this is new, I was really curious regarding this disease. I wanted to know more (about it),” Baclayon said in a separate online interview.

“But on the night prior to my deployment, when I talked to my parents and after hearing some news that doctors are dying in the frontlines, I just thought that shit is real… I was beginning to feel anxious and nervous that I couldn’t sleep.”

But like Berame, Baclayon wanted to help despite the dangers he would face.

“My will to help in this crisis weighed more than my fear,” said Baclayon.

He started attending to COVID-19 cases on March 23, manning the isolation facility of SPMC where he talks to and screens patients with symptoms.

“We made an oath. This is our vocation. I think it is the right thing to do,” Berame of the LCP said.

“If it is not us, who will do it? I want to be part of the solution.”

IN THE BATTLEFIELD

Baclayon said the risks medical frontliners face stem from the fact that “we cannot see the enemy,” that some “patients tend to lie (about their real condition) because of the stigma they get when they are labeled as PUI or PUM (persons under investigation),” and the initial scarcity of proper equipment for their protection.

He shares that even wearing and doffing personal protective equipment, which is vital for them, must “be done with a clear mind” because, “according to studies done outside, most doctors and nurses were infected because of improper doffing procedure.”

Handling several patients in a day was very challenging, he said.

"I remember seeing 58 consults, and I admitted 27 of them in my 24-hour shift. These are PUIs and some are already positive,” Baclayon said.

“It’s very tiring and draining, and fear creeps in, that you may already have contracted the disease because of too much exposure,” he said.

Another challenging moment was “intubating a COVID-19 suspect.”

“Gladly, I turned out to be negative after my 7-day duty,” Baclayon said.

Berame said the LCP and its healthcare team were overwhelmed with the growing number of patients. He, himself had to take care of 8 patients in ventilators who were “fighting for their lives,” during his tour of duty.

“Lack of masks and PPEs, lack of medicine and ventilators, demands and frustration of patients and family, red tape, and politicking” add up to “the problems the frontliners have to face every day,” said the doctor who admitted to using “trash bags over the PPE so that we can reuse it.”

Berame shared that he goes on duty for 24 hours every after 3 days.”And if he gets assigned at the isolation unit, he attends to patients severely ill with COVID-19 who “are usually unstable" and need "more close monitoring than the patients in the wards.” This entails being on his feet for 24 hours.

Some of the unstable patients require ventilators, and sometimes, dialysis and ECMO (Extracorporeal membrane oxygenation), he said.

“Unfortunately, the patients I handled were usually so sick, intubated, or unconscious that you cannot talk to them. It is sad to learn that most of them are in the prime of their lives and contributing so much in our society,” Berame said.

“They are doctors, heads of offices, businessmen, etc.,” he added.

For their safety, Berame and his colleagues practice correct and stringent infection precautions before entering the room of the patient. This means full PPEs, correct donning and doffing, disinfection, and avoiding aerosolization of the virus.

Berame lamented that seeing “first-hand how this virus kills, how the patient struggles, how limited the information on treatment and management of the disease, and how helpless we are” made the situation scarier for him.

“It feels like a death sentence,” he said.

“The hardest thing as a doctor in this time of pandemic is when you call the family to deliver a message that their loved one did not survive, (and) telling them that they cannot see the patient since it is important that the body bag should not be opened and the body should be immediately cremated or buried,” said Berame.

Dr. John Paul Ner, 40, an emergency medicine physician assigned at the emergency department of East Avenue Medical Center, also in Quezon City, said the loneliness and fear of dying alone is felt also by some of those undergoing quarantine.

“Yun ang kinakatakot nila, na ‘pag may mangyari sa kanila or lumala sila, they will die alone. Yun din ang malungkot dito sa sakit na ‘to eh. Kung mamatay ka, walang burol na mangyayari. Derecho ka, either within 12 hours, malibing or ma-cremate,” Ner told radio DZMM last March 28.

(They are afraid that if something happens to them or their condition gets worse, they will die alone. And this is the sad thing about this disease. If you die, there will be no wake. Within 12 hours, you either get buried or cremated right away.)

Ner said some resident doctors and nurses in the hospital’s emergency room underwent “swabbing” and quarantine” after showing some symptoms.

“Some tested negative and just came back to work. Yung others, pending pa for the result. If may mag-positive sa kanila, the most probably, kami na rest of the ED staff will undergo swabbing as well,” Ner said.

(Some tested negative and just came back to work. The result of the others are still pending. If anyone of them turn out to be positive, then, most probably, the rest of us, ED staff, will undergo swabbing as well.)

Ner said he knew of some doctors and nurses who have been confined after testing positive for the disease.

“Nakakalungkot kasi nahawaan sila, and realization din na talagang kahit sino, pwede magkaroon ng sakit,” he said.

(It’s sad that they got infected. It’s also a realization that anybody really can get the disease.)

To keep their spirits up, Ner said he and his fellow health workers talk about other things when they gather for meals. On his own, he turns to God.

“Ako, sinusurrender ko lahat kay Lord. At the end of the day, talagang nag-uusap kami ni Lord. Sa Kanya ko binubuhos lahat ng nararamdaman ko sa araw na ‘to. Every day. Kahit sa paggising ko, ganun ang ginagawa ko,” he said, noting how important doctors should be emotionally strong during this crisis.

(I surrender everything to the Lord. At the end of the day, I talk to the Lord. I pour out everything that I feel within the day. That’s every day. That’s what I do even upon waking up.)

Baclayon, the doctor at SPMC, said dealing with COVID-19 patients impressed on him how precious life is.

“No amount of money or position in society could protect you from this disease,” he said.

SACRIFICES

The three doctors said that dealing first-hand with the disease means sacrificing time that should have been spent with their families.

Ner shared how he had to explain to his family his absence at home since the health crisis began.

“Paraan ko na rin ‘yun para proteksyunan kayo, dahil ako mismo, pwedeng vulnerable ako dun sa sakit. So, ayoko nang dalhin siya diyan sa bahay,” he would tell his family, including his 71-year-old father, he said.

(It’s my way of protecting you, because I myself may already be vulnerable to the disease. So, I don’t want to bring it home.)

On Monday (April 13), when he turns 41, Ner said he will not celebrate his birthday with his family “kasi naka-isolation ako sa kanila” (because I’m on isolation from them).

“Separating ourselves from our family is a must. It may be sad and lonely, but it’s for the best,” said Baclayon, whose family hails from Kidapawan City in Cotabato province. “I can’t wait for this crisis to end and be with them again.”

Before the crisis broke out, Berame went home once a month to spend time with his family in Iloilo City, even for just two days. When the call of duty for COVID-19 came, his wife cried and told him how she felt he was going to war and was not sure he was coming back alive.

“I am on quarantine now. It is sad and depressing to hear that our situation is still bad. I am planning to go home to Iloilo, if there is a chance. They might need someone who has first-hand experience in fighting the virus in ‘ground zero’,” Berame said.

“I pray I can see my wife and son soonest,” he added.

The three physicians appreciated the response given by the government, the private sector, and the public in general to the concerns of medical frontliners--from ensuring enough supplies of PPEs, to boosting their morale.

“The overwhelming response of the public to our appeal for PPE and other support lifted our morale and gave us the strength to go on with our job, even though it is draining and scary. That feeling that you are not alone in the war is just encouraging,” Berame said.

APPEALS, HOPES

Berame underscores the importance of education about the novel coronavirus and training in infection control and precaution, especially for those tapped to be frontliners for the pandemic.

“Not all doctors or nurses are trained to handle infectious cases. We might be seeing more infected healthcare workers if they are not properly educated and trained,” he said.

Ensuring the “availability of infrastructure, resources (especially PPE), and medicines” cannot be overemphasized either, he said.

“I hope authorities realize how much we lack, and how vulnerable our healthcare system is, and that they need to invest more,” Berame said.

Baclayon hopes the government stands ready to support families of health workers if something bad happens to them while performing their duty during the pandemic.

For the general public, Berame and Baclayon reiterate the need to stay at home, observe physical distancing, frequent handwashing, and observing proper hygiene.

“Actually, the public’s cooperation is the game-changer in this fight against the virus, and in effect, will shorten the lockdown (period),” Berame said.

“I want to tell everybody that COVID-19 is a notorious virus. It can kill you in days. Once full-blown, you have a very slim chance of surviving,” he warned.

Baclayon appeals also for an end to discrimination against his fellow frontliners, some of whom, according to him, are being forced to leave their boarding houses based on baseless fears they may be carriers of the virus.

“We don’t demand a hero’s welcome or treatment, but only respect and gratefulness,” he said.

As with everyone else, the doctors pray for the crisis to end soon and for everyone to have learned from it.

As of Sunday, the Philippines has logged 4,648 cases of COVID-19, of whom, 297 patients have died and 197 others have recovered.

• Philippines reports 220 new COVID-19 cases; total now at 4,648