Out of beds, Tondo hospital sets up tents at parking lot for COVID-19 patients
MANILA - The Gat Andres Bonifacio Memorial Medical Center (GABMMC) sits at the heart of Tondo, Manila, surrounded by many of Metro Manila’s poorest and most overpopulated communities like Happyland, Smokey Mountain, and the Baseco Compound.
Delpan - the street fronting the hospital - is bustling with kuliglig, an improvised vehicle that seems to be a cross between a pedicab, a tricycle, and a rice thresher. Residents use the kuliglig to transport everything from produce they need to sell, garbage they need to collect, or family members they need to take somewhere.
By the side of the Emergency Room, a group of young children played on the parking lot, their happy smiles visible in the absence of face masks.
On the same parking lot, just a few steps away from them, stand seven white tents that are hard to look at under the blinding noonday sun. Since COVID-19 ravaged Metro Manila, these tents have now become an extension of the ER, and an extension of places that Nurse Audrey Cruz now needs to check.
These are the tents that house confirmed coronavirus-positive patients who no longer have room inside the hospital’s fully-occupied COVID-19 wards, and patients awaiting their test results.
“Paki-suot lang po ang mask. Pakiusap po, mag-mask po kayo,” Cruz said, each and every time she peers into one of the tents. Every time, patients inside guiltily reach for the masks they had tossed aside.
[Please, wear your masks.]
“Napaka-init po, ma’am,” reasoned one shirtless patient apologetically, as he fanned himself with a piece of carton.
[It’s too hot here, ma’am.]
Cruz didn’t need to tell them she knew exactly how they felt. Not only are the tents powerless to deflect the heat – she and her colleagues have to stay there for 8 hours a day, covered from head to toe in thick Level 4 personal protective equipment (PPE).
“'Yung Critical and Resuscitation namin ay 'yung Tent 1. Kapag nag-positive po sila, sa Tent 3,” Cruz explained, pointing to each and every tent and the kind of patient it houses. Tent 2 is for new arrivals. Tent 4 is for respiratory cases awaiting the results of their swab tests. Tent 5 is for the children.
[The Critical and Resuscitation patients go to Tent 1. Once anyone tests positive for COVID-19, they go to Tent 3.]
She peered into Tent 3, where three confirmed COVID-19 patients were resting at the time, each connected to oxygen tanks. They, too, had their masks off.
“Pakisuot lang po ang masks. Tatay, mag-mask po tayo,” she repeated. Only when they had their masks on did she enter to check on them.
[Please wear your masks. Sir, wear your mask.]
“’Pag puno na po sa taas, dito at least mayroon silang pinaglalagyan,” Cruz said.
[At least until the wards upstars are full, they have somewhere to stay.]
Asked if it gets any easier months into the pandemic, Cruz mumbled under her suit: “Nakakapagod po. Pero kailangang gawin namin 'yung responsibility namin sa nakararami."
[It’s exhausting. But we need to keep at it, it’s our responsibility to the people.]
Inside the building, hospital director Dr. Ted Martin met with his senior staff, relaying new guidelines as Metro Manila again reverted to the modified enhanced community quarantine, a stricter lockdown level.
This, as COVID-19 cases in the country surged past 100,000, and medical workers warned the health care system was on the verge of a collapse.
He is acutely aware that housing patients inside tents on the parking lot is far from ideal. But Martin said it was a choice between putting up tents and sending them away. GABMMC chose to let them in.
“Kailangan mo talagang mai-admit,” Dr. Martin said. “Kawawa ang tao eh. Kawawa ang pasyente. Wala na silang mapuntahan – nagri-rigodon na lang sa mga ospital ng Metro Manila.”
[We need to admit them. We feel sorry for the patients. They have nowhere to go anymore – they have been knocking on the doors of one hospital after another.]
Martin said they used to be able to transfer patients to the bigger COVID-19 hospitals but have no longer been able to since the number of cases spiked across the metro.
“Hindi pa rin maipanik (sa COVID-19 ward) kasi walang bakante dun sa taas. Hindi naman namin ma-transfer sa ibang ospital like PGH (Philippine General Hospital) kasi overcapacity na rin sila. Lung Center ganun din. So lahat ng ospital na dati naming nalilipatan ay hindi naman namin ma-facilitate ang transfer.”
[We can’t take them up the COVID-19 ward because there’s no vacancy. We can’t transfer them to PGH or the Lung Center because they’re overcapacity. We can’t transfer them to any other hospitals.]
Martin is one of the doctors who joined the public call for a return to the enhanced community quarantine (ECQ) over the weekend, seeing the exponential rise of cases and hospitals slowly getting overwhelmed.
The President responded with declaring a return to MECQ for Metro Manila and surrounding provinces from August 4 to 18.
“Since tumuntong ang July 1, talagang nag-soar siya. Rocket-high 'yung pagtaas nung census,” he said. “We started April na 200 a day lang. Nung 300, 500, natatakot na tayo. But come July, nung nag-relax sa NCR, after 2 weeks tumataas na siya unti-unti. July 1 nasa 800, 1,000 na siya. Then come August, latest yesterday was 5,000?” he said in an interview on Monday.
A new single-day high was recorded on Tuesday, with over 6,000 additional cases reported.
[Since July 1, the numbers skyrocketed. We started in April with 200 cases a day. When we had 300, 500 cases, we were spooked. But come July, when the National Capital Region relaxed, after 2 weeks it started rising. In July 1 we had 800, or 1,000. Then come August, the latest yesterday was 5,000?”]
GABMMC, he said, was not alone in now having to resort to makeshift tents. “Ito rin 'yung ginagamit ng lahat ng mga hospital sa Metro Manila. Nagiging tent city na ang labas ng mga ospital.”
[Other hospitals in Metro Manila are doing the same thing. Our hospitals are becoming tent cities.]
“IT’S LIKE IT NEVER ENDS”
At the 6th floor, GABMMC’s official COVID-19 ward, the hallway was dimly lit, and all the doors were shut. One could have easily mistaken it for a deserted floor, except there was a song wafting from one of the nurses’ speakers. It was “Imagine,” by John Lennon.
Nurses behind their station were doing paperwork, all covered in full PPEs. The entire nurses station itself was covered in a sticky sheet of plastic, beaded with moisture from the humidity.
Placed on the counter was a bottle that looked a lot like ethyl alcohol, but was actually Holy Water. They looked too busy to ask if they actually use it.
A COVID-19 ward nurse walked into one of the rooms, where five COVID-19 patients were staying together.
“Okay pa naman kami dito,” said one male patient. “Nagpapalakas kami ng loob, kasi kapag malungkot ka daw mas matagal gumaling.”
[We ‘re still okay. We’re keeping our spirits up because we heard that you recover more slowly when you’re sad.]
Inside another room, three other COVID-19 patients were hooked into dialysis machines, the room silent except for the occasional beeps.
Dr. Fresco Yapendon, the Infectious Disease Specialist Chair and head of the hospital’s COVID-19 Task Force, conceded that their frontliners were spent.
“Yung mga nurses… 'yang pagsusuot ng PPE na 'yan ng walong oras, it will drain you,” he said.
“And of course, 'yung fear factor. 'Yung takot, nakaka-drain 'yon. Kasi parang wala nang katapusan eh. Parang every day, 'pag uuwi ka, nag-aalala ka, baka nahawa ka, baka makahawa ka. Tapos nage-expect ka na matatapos, tapos di natatapos. 'Yun 'yung talagang tingin kong nakakapagod.”
[These nurses… wearing those PPEs for eight hours will drain you. And of course, the fear factor. The fear, that’s draining, too. Because it never ends, Every day you go home, you worry – have I been infected? Will I infect my family? And you keep expecting it to end, but it never does. That is what I think is wearing the health workers down.]
'NO ONE ASKED FOR A ‘REVOLUTION’ AGAINST THE GOVERNMENT'
Yapendon understands the need for the economy to keep running, and how hard it is for the government to balance the need to keep the citizenry safe and the economy afloat.
But Dr. Martin believes it is time for another significant quarantine to curb the spread of the virus, and keep even the communities surrounding their hospital locked down in order for them to survive.
The director refuted statements made by President Rodrigo Duterte, accusing the health workers of calling for a revolution when they publicly called for a “timeout” in the form of an ECQ.
“Hindi naman nagtatawag 'yung mga doctor ng rebolusyon eh,” said Martin. “Gusto lang nilang ma-hear, maiparating kay President 'yung talagang sitwasyon. Baka gusto niyang tingnan ng second look, bakit ganito, 5,000 a day ang kaso natin?”
[The doctors never called for a revolution. We just wanted to be heard, to let the President know what the real situation is. Maybe he wants to take a second look and ask why the situation is like this, we have 5,000 cases a day now.]
Martin said many hospital workers were also angered by the latest statement of Sen. Cynthia Villar saying instead of calling for an ECQ, health workers should just do their jobs better.
“'Yung context kasi medyo nasundan eh. May sinabi na siyang dati [tungkol] sa nurse lang,” Martin said, referring to an earlier Villar statement saying nurses don’t necessarily have to be good to be able to do their jobs.
“Baka hindi naman niya intended din, pero siyempre ang tao, iba't iba ang interpretation. Lalo na siya, senador siya, isa siya sa pinakamayamang senador at saka tao sa Pilipinas.”
[The context is she has already said something before against the nurses. Maybe she didn’t intend it, but people interpret things their own way. Especially coming from her – a senator, one of the richest senators and people in the Philippines.]
Martin said it was an unfortunate thing for a sector already wrought by anxiety and fatigue to hear.
“Para magsalita ng ganun, na ayusin daw 'yung trabaho, para bang pakiramdam ng mga doctor at mga nurses, frontliners, di nila ginagawa 'yung trabaho. Nasaktan [ang frontliners] dun sa sinabi niya. Puwede mo kasing sabihin nang maayos di ba? Kaya di nila matanggap.”
[For her to talk like that, tell us to do our jobs better, is like telling the doctors, nurses, frontliners that they’re not doing their jobs. They were hurt by what she said. Can’t you say that in a better way? They couldn’t accept it.]
As of this writing, 27 GABMMC staff were infected with COVID-19. Since the pandemic began, a total of 118 hospital workers have been infected, with one fatality. As is the case with other hospitals, the infection has spread even to the departments that have no direct dealings with patients.