covid-19, frontline, primary care center

A COVID-19 frontliner provides a glimpse into the lives of Filipino healthcare workers in barangay health centers, community clinics, and other primary care facilities—a reflection of the overall capacity and condition of the Philippine healthcare system in the face of this pandemic.

In the middle of the storm that is the COVID-19 pandemic, I sometimes imagine our health facilities as islands sticking out above a deluge.

People flock to these “islands” to literally breathe, to get respite from the virus, and to find safety and relief. We, the healthcare workers, are in charge of making sure that everyone coming to our respective islands is cared for, treated, and safe. We watch the tide that continually threatens to rise over our heads and take us all, patients and healthcare providers alike.

A lot of COVID-19 coverage focuses on our tertiary health facilities, but something also has to be said for primary care facilities such as barangay health centers and community clinics. These places are closest to the water line, so to speak, face to face with “catchments”: areas with populations in the tens of thousands.

Here, doctors, nurses, midwives, medical technicians, nutritionists, barangay health workers, and other personnel keep up with the programs that absolutely cannot fall by the wayside, even during the pandemic. These include providing prenatal care and immunizations, as well as check-ups for those with hypertension, diabetes, and other noncommunicable ills. They come in contact with people suffering from many commonplace ailments such as cough, colds, stomach upsets, every conceivable sort of body ache, and the occasional accident. And on our doors, you will not find signs that read “For non-COVID cases only” or “For COVID referrals only.” We cannot pick what the tide sweeps in.

I am currently stationed in one of these health centers. Each day, the consults pile up, with patients of all ages seeking some relief from the currents that bring them to the door.

Sometimes, it is a complaint they already know: a grandmother’s backaches, a child’s allergic dermatitis, a young lady’s dysmenorrhea, or a high cholesterol level that has continually plagued a padre de familia.

Other times, I pray that I am not tussling with a more nefarious ailment lurking behind a commonplace scenario. I bite my lip as I look at a child’s rashes, and hope that the fever preceding it was not a hallmark of dengue fever or measles. I move swiftly towards a person suffering from chest pain, and hope that it is not a sign of a heart attack. The slightest cough or sniffle from a patient has me handing over a triage form, has my stomach in knots as I anxiously listen to his or her story, and then decide if this is a simple case of the cold or if it’s time to notify the city epidemiology and surveillance unit that we have another person for monitoring and swabbing.

This has been the daily struggle for me and my colleagues in our local government unit’s facilities. Each day’s end, we doff our PPEs, wipe away sweat that has gathered on our wrists from the hot gowns and “bunny suits,” and wince at the marks that our N95 masks and face shields have left on our skins. For my part, I would go home each day, leave all my personal effects at the makeshift UV box my family has left by the door, and then shower and disinfect before getting to sit down, join the evening meal, or even greet my aged parents. I consider myself lucky that now, I do not have young children to care for.

Lately, however, we have noticed an ominous change in the wind. With the general community quarantine, we have seen not only more patients being swept in by the tide, but some of our own falling ill.

It began insidiously with a story or two floating our way, of a doctor, nurse, or barangay health worker suddenly being asked to undergo home quarantine and get swabbed. We would shake our heads and pray that this colleague or friend would get well soon.

Then one Monday rolled around, and we heard that the neighboring health center was closed, pending the swab results of the personnel there, who would now be under home quarantine. Every patient from that large barangay would be diverted our way. Suddenly, we found ourselves in a deluge, with only a door and two rickety triage booths between us and the storm surge. I could not send patients to the next “island”; many centers were also closed, and their neighbors were also struggling to deal with the increased influx of patients. Other centers were struggling with temporary medical teams at the helm, trying to familiarize themselves with patients who were new to them. It would be this way until the original teams would return with negative results.

Healthy people seeking clearances to return to work or commence travel mingled with those trying desperately to hide their coughs and colds or dragging themselves over with aching bodies or simply with fear in their eyes. Some patients were too sick for me to manage at the primary care level; the fear in their eyes when I told them that they would have to seek consult at a tertiary facility is something that still haunts me. It has taken all the nerve and poise that I can muster, or sometimes even fail to muster, in all my thirty-one years to try to assuage their panic or deal with the never-ending waves that battered the door. Each day had me holding my breath, waiting till the clock could strike four in the afternoon and we could close the facilities for disinfection. It was this way for more than a week, till at last we heard that our colleagues were well and returning to their posts.

Yet a few days ago, one of my teammates began feeling sick. Another found out that a colleague she had worked with for some days suddenly tested positive. Both are waiting for swab results, which will decide if the rest of us must also undergo testing as well.

This island has just been breached.—MF

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Author: Katrina G. Gomez