Although there are no signs of the COVID-19 pandemic abating, the world remains hopeful. As we continue to cope with this new way of life, healthcare workers in Singapore and across the globe carry on to battle SARS-CoV-2, putting their lives at risk to take care of the people who are infected by the disease. Let’s take a moment to thank the frontline workers such as doctors, medical specialists, and other healthcare support providers for their relentless efforts.
Dr Adrian Ng, a consultant anaesthesiologist tells us how his daily work routine is affected because of the pandemic and what he and his colleagues are doing to make sure that Singapore stays safe.
Can you tell us a little about what you do?
I am an anaesthesiologist in private practice. I take care of patients in the peri-operative period who require anaesthesia or sedation for their procedures or surgeries.
How is a typical day now different from before the virus outbreak?
I had always believed that there are no typical days in medicine; that is perhaps part of the reasons why I enjoy the practice of anaesthesiology and look forward to it every day.
The situation on the ground during this pandemic also changes from day to day within the healthcare institutions and for the general public at large so there is really no typical day during this period.
Having said that, the COVID-19 situation has necessitated certain changes in our routines, on the professional and personal fronts. In the hospitals, clinics and ambulatory surgical centres, there is greater emphasis on temperature screenings, adherence to appropriate precautionary measures and maintaining personal hygiene.
Medical emergencies and urgencies such as heart attacks, strokes, cancers, trauma are some examples of conditions which require immediate and responsive care, and the management of these patients have to continue despite the presence of COVID-19. So far the Singapore-style “all of nation” approach to manage the COVID-19 crisis has prevented the nation’s medical capabilities from getting overwhelmed and we are able to continue providing optimal medical care to every patient requiring management of these emergencies during this period. We are still called in to provide anaesthetic and/or critical care support to these patients where needed.
What are some of the precautionary measures now at the hospitals and clinics?
The hospital in consultation with the Ministry of Health (MOH) provides the front-of-door precautionary measures such as temperature, health and travel screenings.
Specific to anaesthesia, we risk stratify our patients and don the appropriate level of personal protective equipment (PPE), also taking into consideration the clinical interventions that are required. The nature of our work tends towards procedures that generate aerosols in the immediate vicinity, such as intubation of a patient after induction of general anaesthesia. Hence the overt concern regarding the potential spread of the SARS-CoV-2 (COVID-19 virus) during such procedures. As such, we have institutional guidelines that mandate certain levels of protection equipment for the different clinical settings.
I feel that these guidelines and the availability of such protective equipment are adequate to safeguard the health of the patients and that of the healthcare workers in this ongoing crisis. As a healthcare professional, I feel safe at work.
What are some challenges that you’re facing now?
This COVID-19 situation is unprecedented on many fronts. We have encountered SARS, its cousin, about a decade plus ago in Singapore so the medical situation is not unfamiliar to those of us who had gone through that period (I was a junior trainee at that time). Months of daily N95 mask use and witnessing fellow healthcare colleagues catching SARS and in some instances, succumbing to it, had left an indelible imprint in my memory. But this pandemic presents its unique set of medical challenges. From the point of view of an anaesthesiologist and a clinician, I want and need to know more about the nature of the disease — the virology, the pathophysiology, the diagnosis, the management and prognosis, and its epidemiology. I critically appraise and rely on trusted and reliable sources of scientific data and papers for this information. It can be extremely challenging to sort out the noise, especially with the infodemia that is pervading the digital space, and also due to the fact that the crisis and science are unfolding as we speak.
Some challenges apply more to the specialty of anaesthesiology, as we are involved in procedures that put us at higher risk of exposure, but we have guidelines and training on the PPE to be used as mentioned. On the PPE front, donning an N95 mask might be physically tiring and uncomfortable, but I am grateful that I have access to the protective equipment that I need to get the work done. This applies across the country’s healthcare institutions, and the people who made this happen should be highly commended.
On the personal front, I believe many are facing disruptions in their usual routines. For one, we have not seen our older folks since Chinese New Year as we made an early deliberate decision to social distance ourselves from the more vulnerable group. We do look forward to spending time with them when this eventually blows over. While we do leverage on technology to overcome this safe distancing, nothing warms the heart more than a simple sit-down meal together at the table.
How is your family supporting your work now?
I am glad that my wife [Dr Loh May-Han] is also an anaesthesiologist. She practices at the National University Health System. Within the context of our professional work, we have always discussed and shared (within the constraints of patient confidentiality) our clinical experiences, best practices, the latest guidelines and evidence in anaesthesia practice. This COVID-19 situation is no exception. We are able to rapidly understand and appreciate the challenges that the other is going through. The emotional support bolsters the confidence to continue persevering in this crisis, knowing that we have each other’s back all the way.
The older folks in the family are extremely supportive of the work that we do. They are aware of the nature of our work, and of course, remind us constantly to stay safe in this crisis. I believe that they are adequately reassured from our personal accounts of the safety measures taken in the hospitals.
Any advice to Prestige readers on how to stay positive at this dire time?
I believe that Prestige readers are part of an extremely positive community. We know that we will get over this crisis together. Do continue to contribute in our own positive ways to society during this crisis, continue to appreciate and be grateful for the sacrifices and efforts that others have made during this pandemic.
What has been one good thing that you’ve noticed during this outbreak?
I think Singapore’s reputation for excellence has been reaffirmed during this crisis, from our governance to our crisis management, from the people’s resilience to the depth of our country’s reserves. Our leaders and people have shown composure and rationality in the face of this unheralded and unprecedented crisis. I am happy and proud to call myself a Singaporean.
Any other bright moments?
I see hope for humanity. It would appear that Mother Earth is healing herself — cleaner air, bluer skies and clearer waters. I am hoping that these positive environmental consequences will last longer, even though pragmatism tells me that these tangible effects might be short-lived. But I see beyond the transient climate clarity. Sustainability and environment-friendly practices are possible and necessary for a cleaner and greener future. The global community has been given a glimpse into this crystal ball and I remain hopeful that nations, businesses and individuals are able to work together towards more environmentally friendly practices.
I sense goodness in humanity. We bear witness to the enormous outpouring of positive human spirit and action in this period of pessimism and negativity, and hear many stories of people who go beyond to help the disadvantaged and vulnerable.
What else keeps you going in a tough time like now?
I believe in this country and our leaders. We are rational, composed, and deliberate in our thinking, decisions, and actions. This imparts great confidence to me as I know that we will ride this storm as one nation, and emerge from this in the best possible shape to tackle the future.
I believe in science and its processes. We will be able to come to grips with this crisis though the laboratories, the clinical trials, and the scientific community. One way or another, we will science our way out of this crisis.