As the threat of COVID-19 sees no immediate end, we trudge towards the ravaged front lines and listen to the stories of humanity and hope from the bold and brave souls who are fighting to keep us alive.
“It feels surreal to come to work everyday in such strange circumstances. Any doctor, nurse, aid, janitor, or guard will tell you that it’s almost unbelievable what is happening around us while we still put in the hours, as if nothing and everything as changed at the same time,” begins Dr. Denise, an Internal Medicine resident for a private hospital in Quezon City, describing what the days have been like since the alarming and critical outbreak of the highly infectious novel coronavirus in the country sometime in March. Like the violently aggressive and insuppressible tempest that it has proven to be, the persistent threat of COVID-19 has dug its sharpened claws deep into the fiber of society, rendering it to an unflinching standstill. With the abrupt ushering of a new normal, life has quite frankly never been the same—and by all accounts, it won’t rescind to what it once was. And at least for the foreseeable future, this is what life is going to be: unsure and uncertain.
There has been no greater collateral to the crisis than those who were immediately thrust to the front lines of this battle with the pervading pandemic. They say it’s like modern warfare, but unlike the dramatic stories of sustained struggle and chapters of conflict that have colored the pages of our history books or formed the backbone of many nail-biting, hold-you-breath, and edge-of-your-seat type of war-flick, there is no face to the enemy, no tangible realization to zero in on and blast to smithereens. Instead, we are threatened by a silent and deadly killer, baring its lethal fangs when we least expect it. However, unlike the confrontations that literature has informed us, the bold men and women braving the front lines of this do-or-die battle on a cragged uphill are not soldiers clad in an assortment of curious camouflage, an impenetrable helmet, and heavy artillery strapped on strategic points, but rather the selfless healthcare professionals formerly decked out in immaculate white with the familiar glint of silver snaking around their necks.
In place of the textbook image of doctors, nurses, aids, technicians, and all the other links that form the chain of ecosystem in the medical field are indeterminate figures in meticulous layers of medical-grade scrubs, hair caps, goggles, gloves, masks, and hazmat suits scurrying about doing everything they can to not only flatten the spiking and swelling curve, but to ultimately, save lives—as they were sworn to do.
“I will prevent disease whenever I can, for prevention is preferable to cure,” and so goes the Hippocratic oath as they are bound to the field of medicine. “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.” As antiquated as the promise to the profession may be, it certainly holds the most true as they troop the front lines of the apparent wartime caused by the persistent threat of the COVID-19 pandemic.
IN THE TRENCHES
“I have always known that a pandemic will happen and the question is not when, but are we prepared? So, my thought process is that I will ride out this tide, sick or not, but I will be ready for whatever happens to me. Sounds melodramatic, pero the fact that I am in this profession seals the fate. Not to mention internist pa ako. So, yes, I signed up for this, and yes, ‘ginusto ko naman ‘to,’ explains Dr. Jaff Gonzales, Rheumatology fellow-in-training at Philippine General Hospital. “No one can really prepare, really. Unprecedented ito, and it is what it is, wala ka na magagawa kundi sumabak…Pero no one is invincible and even if you are in perfect shape, you will get infected and you will transmit the infection, albeit a mild [one.]”
The awareness of the viral potency was always there it seems, however the early warnings fell on deaf ears to the country, as well as with the rest of the world. While it was earnestly downplayed as just another graduated form of the flu, science and the medical field have been getting to work, laying the groundwork of a solution, slowly and surely preparing for the potential outbreak, and yet it still wasn’t enough. “In my opinion, I think we were all caught off guard by the COVID-19 virus. During the early stages of the outbreak we believed that the infection control protocols we have were sufficient to fight the virus. But we were wrong, this is a new form of the influenza virus and we just followed our mantra about standard precaution ‘treat everything (patients and specimen) as infectious,’ knowing that this is enough to eradicate the virus. Little did we know that this situation needs special attention until it all blew to proportions and became a world wide pandemic,” says Emil Cayco, Medical Technologist from Philippine Children’s Medical Center Pathology Division.
“No one was ever really fully prepared for this, (or maybe we were initially procrastinating until it blew up), but what’s important is we move forward, accept the facts, be updated, be efficient, utilize what we currently have, learn from our mistakes and improve the next day, continue that burning passion to serve, take your vitamins, rest and pray. We are thankful for people with good hearts that find ways to help us, in any way, shape or form in this time of crisis,” concurs Dr. Lawrence Cyril Vitug, MD, MPM-HSD Internal Medicine at the Quirino Memorial Medical Center. In fact, as he shares further, quick adjustments had to be made in order to accommodate and admit more of the COVID-19 patients. “In all honesty, we are not prepared for this, but we are compelled to do this because we are a government institution. We started to accept PUI, we converted some rooms in the pay ward into isolation rooms. It entailed a concerted effort from many individuals to transport a suspected case to these isolation rooms, making sure to limit the chance of communicability. At this point, I was now stationed at the Hemodialysis Unit and another problem we had was what to do when a PUI is needing dialysis – how to transport patients to HD (Hemodialysis Unit) without exposing other patients to the now called SARS-CoV2. We did not have an isolation unit in the Hemodialysis Unit, so then we had to build one—the first HD isolation unit in the hospital, (although temporary) located in the now called COVID ward,” he says.
In another government hospital in the city, the situation is just as bleak, but functioning to their best abilities. According to Dr. Raya*, a Medical Officer III on the front lines manning the triage area to separate possible COVID-19 patients to regular or non-infectious patients, “Like most of the hospitals in Metro Manila, our hospital is faced with a challenge that is not easy to deal with. Aside from delegating newly opened stations, allocating proper and complete PPEs prove to be difficult. The Philippine healthcare system is not prepared for this type of outbreak,” she details. “Even before this happened, medicine, medical supplies, and even manpower are not enough to meet the demands of the population. We are, however, grateful to the generous contributions of the medical societies, NGOs, local businesses that donate food, supplies and improvised PPEs. Despite this, we are sure that if the cases rapidly increase, our hospital will not be able to cope.”
But it is a general consensus that this is par for the course of the calling they had dedicated their lives to—that if and when it happened, they will be answer to the call of duty on the front lines. “A thought that always comes to mind since before this outbreak is that risk will always be part of the job description, and it therefore just becomes a matter of precaution. But the magnitude of this pandemic is of a different scale, and the physical and mental preparation has no doubt been disproportionately more,” shares Dr. Jerson Ngo Taguibao, a general practitioner engaged in health research, medical consultancy, and clinical practice for various public and private institutions, as well as a volunteer physician for the Lung Center Covid Ask Force—a free and accessible online platform where Filipinos can have their questions answered and pressing health concerns addressed through consults with doctors. “The mounting pressure is palpable, but we never perceive a call to arms as an imposition. It is part of the oath we solemnly and willingly pledged as healthcare professionals, and that is to consecrate our lives to the service of humanity. It is inspiring, to say the least, to see the different professions coming together and (cheesy as it may sound) healing as one. We already do this on a regular basis, but never has it meant more than it does now. How strange is it that a virus could give us all such a renewed sense of purpose and camaraderie?”
Roused by a duty that is greater than all of them, it has been quite the inspiration to witness healthcare workers eagerly and efficiently mobilizing themselves in this unprecedented war, doing what they can with whatever much they have, and even subjecting themselves to the perils of their job that has now been dialed way higher than anticipated. It seems that now more than ever, they are functioning beyond the assumed privilege, going above and beyond for all those in need.
“This pandemic has been excessively exhausting manpower and resources. I would say that we’re trying our best to make do with what we have. These are really difficult times. It is also a big struggle to attend to the growing number of PUI’s and COVID-19 positive patients without compromising the care rendered to those with other illnesses,” shares Dr. Aletha Go*. “The capability to save lives is not something that everyone is blessed with, to hell with people who say we think so highly of ourselves. But how I push myself to go on despite the risks and uncertainties are these: 1.) This profession is all-or-none. You cannot just savor the good parts of it and walk away when things go ugly. 2.) The person you’d be saving means the world to a person or a family. And when the time comes that one of my loved ones would be needing help, I would want the medical team to have that thought in mind.”
View this post on Instagram
Kim, a registered nurse echoes this train of thought, zeroing in on the equal opportunity to serve, especially at a time like this. “Everyday I wake up to the Department of Health’s update on the daily count of people confirmed positive with COVID-19, along with this, confirmed deaths are also reported. These are my fueling factors to go on each day. Who am I to turn back to my profession when people are separated from their families, hungry, jobless, and dying? But most of all, I am deeply motivated when the number of recoveries are reported. It gives us people a chance. A chance for recovery, a chance for a second life. I am a healthcare provider and my job is to ensure that everyone gets that chance,” she says. “Everyday we are all inspired by the thought that being a healthcare worker, we are expected to stand between the gap of life and death of every affected person brought by this outbreak, “ says Emil Cayco. “And being considered as modern day heroes on the front lines, this is the time where we have to engrave in each other’s heart the very true definition of a true servant leader of the nation. In addition, helping out for the community is good, but helping out for the community using your knowledge, skill and expertise is fulfilling.”
No matter how deep one digs his or her boots in the quagmire of circumstance they have to navigate, what really speaks volumes is their commitment to treat, heal, and hopefully eradicate the coronavirus, even if it means coming to terms with their own human fears. “Despite these risks, we go to work because honestly, if we don’t then who will? We remain loyal to our oath and commitment, because this for our family and country. It is a scary and sad fact that we are not only exposing ourselves to this virus, but also the people that we come home to – our families. It is a tug on our conscience that with every time we come home, we could possibly be carrying the disease, but it is a moral obligation to help those who need us, those who are sick, ultimately hoping that by doing this, we could save ourselves and our loved ones as well,” says Dr. Lawrence Vitug. “Everyday I get scared not only for myself, but more for my family because of how easily I could pass this to my loved ones when I come home. Just a small nip on the gloves, or unconsciously touching my sweaty forehead or scratching a masked induced itchy nose could be an opportunity for this virus. It’s scary, yes but what bothers me more is if this gets out of hand, whether because people are stubborn or because there are not enough health workers/facilities to care for those inflicted to a point where we won’t be able to do anything. But even with all these scary thoughts, at the end of the day, we must tell ourselves that we’re bigger than our fears and that we are capable as long as we help ourselves and each other out.”
Just as they have assumed the functions of soldiers in a war that is a complete opposite from the typical military suit, these front liners have inextricably formed a bond that holds its own against that of kin and friendship. Here, they are bound by duty, leaning on each for much-needed support on ground zero. “What scares me is the possibility that more doctors would be casualties of this war. How can you win a battle when you have no soldiers left? But at this point, fear can be acknowledged, but not entertained,” ponders Dr. Aletha Go*, which Kevin Tan Espiritu, a surgical nurse from a private hospital in Makati is quick to corroborate. “As part of the front lines, it is given that we will face this virus, nakakalungkot na pwede anytime kami ang mahawaan at matalo sa laban na ito. Pero pilit namin nilalakasan ang loob , iiwas ang sarili sa takot na dulot ng krisis na ito. At higit sa lahat alam namin sa mga sarili namin isa kami sa makakatulong upang malabanan ito na may sinumpaan kaming duty na kailanman hindi naman ito tatalikuran para matulungan ang mga nangangailangan.”
As understandable as fear is to the human condition, compounded by many other factors that snowball the already unique situation into something unfathomable to the comfortable and privileged people waiting out for the curve to flatten, it eventually evens itself out in the field, when responsibility is called to the line of duty. “Aside from we are all wary, anxious, physically tired, sometimes discriminated and not to mention the unfavorable circumstances that we are facing in our daily living inside the hospitals, we still remain unfazed and we keep our spirits high for this is the perfect time where we can serve our nation and to put into our hearts the oath we all took,” affirms Emil Cayco. Meanwhile for others, the desire to help and serve in times of need outweighs their own concerns, sometimes to a fault. “There’s no time to entertain the fear, frankly. You hold on to hope, to colleagues and patients, and to the prospect of recovery after giving them the best care one knows to give. When you are the few whom so many are counting on, there’s very little room for anxiety and very little space for despair,” mulls Dr. Jerson Ngo Taguibao. “If there is one more thing I worry about, it is the thought of losing the Filipino people’s trust in our healthcare system, by both health workers and patients alike.” Pandemic or none, this why they do what they do.
While it is true that the willingness of these medical practitioners, healthcare workers, and front liners vary based their past experiences in the profession, it becomes increasingly clear that despite the obvious hurdles, such as the decaying and rotten state of healthcare in the country, these good souls and Samaritans are the pillars that hold up the institution to serve the country. “It Is frustrating that the government is relying on the spirit of voluntarism and expecting doctors and nurses to, of course, fulfill their oath without convincing support,” says Dr. Jaff Gonzales, which included the once contested and maligned stipend of only 500 pesos. Thankfully, that has been verbally addressed and rectified. Despite these setbacks, nothing is compelling them to hang their scrubs and suits and give up the cause, because as they continue to stress: This is more than themselves. “I am positive. My outlook has always been it will get better, pero we’ll suffer,” he asserts. “Healthcare in our country is rotting and mostly based on band aid solutions. But we have bright minds out there and my hope is someday, when another pandemic like this happens, we will be more organized and logical, and selfless.”
“Para sa amin tamang maganda na matulungan kami ng government—public man o private na bigyan kami ng sapat na pagtrato, bigyan ng sapat na supplies para magawa namin ang aming trabaho sa pang araw-araw kasi hindi naman bastang sakit ito, apektado ang lahat bata man o matanda,” adds Kevin Tan Espiritu, to which Dr. Lawrence Vitug concurs. “The government needs to listen to us more and provide us with necessary tools and protection to face this battle,” he says. “We will follow all the guidelines and protocols they set up, but they need to listen because things can only be properly addressed and improved based on what is truly happening at the front lines.”
As heroic and inspirational as the country and the world paints our tireless and tenacious soldiers on the front lines, these PPE-cloaked crusaders are but human, too. Aside from what scares them, these healing heroes are not only risking their lives on the front lines to see the end to this crisis, but they are also inevitably sacrificing so much to stand at the front lines of this battle.
We see snippets every now and then, slices of life from the harrowed front lines that not only tug at the hollowed chasms of many a jaded heart, but also remind us that they are just like us, afraid of what isn’t certain. And yet they forge on, putting people at risk so that more get to breathe again. They are probationary practitioners who have no regular benefits and must subsist with no safety net on a no-work-no-pay scheme; a community pharmacist who has to contend with hostile customers and fetch co-workers just to get to work everyday; a son and brother who is neck-deep in the front line efforts that he barely has time for a phone call home; a sister, wife and mother who is steadfast and hopeful, but also selflessly prepared for the inevitable in her line of work. Faceless and nameless as they may be to most, clumped together as a general whole, each and everyone of them is that someone special you have the good fortune of seeing everyday, while they have to contend with love from an aching distance.
Even if they could be selfish, they become the bigger person in this already supposed biggest picture situation and rationalize their wants for the needs greater good. Dr. Raya* opens up, sharing, “My husband, Dr. Gustav*, and I have been trying to conceive for the last few years. Since we are both in the front lines, we realize that this pandemic is probably one of the reasons why God has put that on hold,” she contemplates. “We see our colleagues worry for their family, especially their kids, and we are somehow grateful that we only worry about exposing each other to the virus. We have distanced ourselves from our respective families, and chose to stay near our work. We are fearful that other countries with better health care systems are overwhelmed. We are scared to go to work but we continue because our conscience will not let us stop. We found ourselves praying longer and harder that usual because most of the time, that’s where we draw our strength from. For now, our hospital staff is hopeful that we can survive this.”
At this point, in whatever pedestal of privilege we find ourselves perched at, we are all rendered equal with one primordial function: We are all trying to survive. It isn’t even a matter of a considerable future, but rather a day to day thing. Coping, making do with what we have and what we know. Can you imagine being at the front lines, cavorting with the enemy that continues to evade even our consolidated best efforts? The risk is not only real, but it is alarmingly exponential, and still they are subjected to so much inanities. Struggle as it seems, doesn’t end when their back-breaking extended shifts. In fact, unbeknownst to many, it is only the beginning, because they still have to get home and deal with a whole other social layer with so much more nuance than in the battlefield.
“We come back to an empty home, stay as far away as possible from our family, and loved ones just to keep them safe from us. Nurses, nursing aids, and doctors stay at the hospital dorms, clinics or patient rooms repurposed to be quarters, because they cannot afford to put their homes at risk. It is very depressing, if you think about it too much. We stay away from very people we do this for, but only precisely because we have seen what this virus can do. We have witnessed how a patient can be sitting comfortably one second and suddenly need to rely on mechanical ventilation for the very air that they breathe. It’s terrifying! And yet I see Facebook and Instagram stories and pictures of colleagues and nurses making the most out of staying together at the quarters as if it were a sleepover, of having to wash their laundry in the sink of the hospital, of being grateful for the food being shared by our patients, generous businesses, and our very own consultant doctors. It is inspiring,” Dr. Denise illustrates. “It is very possible to quit in such hard times, to simply protect oneself from the danger in the comfort of our homes. And no one would blame you for it, it will be very understandable. However, I am proud to say that not one of our department’s residents gave up. Not one of us. I saw how our chiefs found every way possible to help us, ensuring that we had basic provisions such as safe transport, comfortable beds, and meals, as well as personal protective equipment so we that didn’t have to worry about ourselves too much. When you see good leadership and solidarity among your colleagues, that is motivation enough.”
It does make you wonder, as you sit here, hopefully still taking in these stories as much as I have, that there is still so much to be grateful for as we draw our first breath when we wake up, and as we continue to do so in steady rhythms throughout the day. And conversely, there is an endless amount of thanks that goes out to the men and women on the medical front lines that suit and shield up and go to the throes of war so we don’t have to. The applause, cheers, and songs are perhaps the bare minimum we can give, and of course, as they continue to tell us: wash those hands, keep your distance, and stay alive.
“The human race has been in so many pandemics and outbreaks before, and somehow we overcame all of this and survived. We can do this again, especially now we are more equipped and knowledgeable. We all have our share of sacrifices. We must all have a sense of social responsibility. We can only succeed against this virus in solidarity,” concludes Dr. Lawrence Vitug.
With the outbreak, the paradigm has shifted, obviously. Once upon a time, we were tasked to choose between the mission and the man, but this time it is clear: you are the mission.