Frontline workers such as doctors, medical specialists, and other healthcare support providers are feeling the heat and pressure as the number of COVID-19 victims continue to rise in Singapore. As the Singapore government puts into place measures such as the circuit breaker to stop the vicious spread of Coronavirus, there are other healthcare workers who continue to be on standby, in case of emergencies.
Dr Loh May-Han — whose roles include being a consultant and obstetric anaesthesia lead at the Department of Anaesthesia National University Hospital, Undergraduate Medical Education Director as well as assistant professor & clinician educator, among many others — says it best: “A pandemic does not stop medical emergencies from happening. Patients still require emergency surgeries to fix their broken bones and perforated appendices. Urgent cancer surgeries have to carry on.”
So how has her duties changed since the pandemic and what keeps her grounded and sane in a time like now?
Can you tell us what are some of the measures that are in place for your department now?
Our multidisciplinary team (of obstetricians, anaesthetist, neonatologists, adult and paediatric infectious diseases physicians, midwives and nurses) developed a workflow for the peripartum management of women with COVID-19. A systematic approach with multiple measures are in place to provide evidence-based care to the parturient and her fetus/newborn, as well as to protect the personnel in the care teams (in isolation ward, delivery suite, operating theatre, neonatal ward and paediatric ICU) caring for the patient.
I will get activated when a suspect or confirmed patient is admitted, to provide the anaesthetic input for management of the patient.
How is a typical day now different from before the virus outbreak?
With the evolving situation, no day is typical. A pandemic does not stop medical emergencies from happening. Patients still require emergency surgeries to fix their broken bones and perforated appendices. Urgent cancer surgeries have to carry on. Pregnant women still go into labour and have their babies. Patients still collapse and require resuscitation. In addition to office hours clinical duties, I still go on my usual 24 hours stay-in hospital shifts about once a week. With the pandemic, any of these patients can subsequently be diagnosed to be COVID-19 positive after they have received anaesthetic care. So we risk stratify and don the appropriate level of Personal Protective Equipment (PPE) for each case.
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Thank YOU, for standing guard as a frontliner in our global battle against COVID-19. Healthcare workers are now the last line of defense, caring for patients who fall ill from community spread. Let us all do our best to protect the vulnerable, flatten the curve and exercise social responsibility – by staying home, practicing safe distancing, washing hands and sanitizing. Be safe, and stay healthy. Together, we will overcome this. #covid_19 #pandemic2020 #sgunited #circuitbreaker #frontliner #flattenthecurve #stayathome #saferathome #socialdistancing #savelives #washhands #staysafe #healthcareworkers #anesthesia #anesthesiology #togetherwecan #wewillovercome @nuhig @alexandrahospitalsg @nus_singapore 📸 @vanessachuaa
All usual work flow has now got to take the pandemic into consideration. It is important to keep vigilant by constantly keeping up with the latest, verified news from Ministry of Health public health and government advisories, institutional guidelines, global pandemic situation, and medical updates from journal publications.
Clinical services that COVID-19 patients may require such as Intensive Care Unit (ICU) are prioritised and ramped up. My department run simulations to practice on and prepare to handle resuscitation of COVID-19 patients while caring for them in ICU.
Medical students teaching in clinical areas was stopped when we went into DORSCON orange, with more time spent on classroom teaching and development of e-learning programmes to minimise clinical tutors in contact with students and gathering of students in big groups. Now under MOH’s directive, we are planning to gradually resume clinical postings, while keeping students safe and not overburdening clinical tutors.
Clinical governance activities that were slowed down are picking up with video-conferencing which allows segregation of healthcare professionals.
Besides being part of the team that developed the workflow for peripartum management of women with COVID-19, I was also involved in preparing a clinical opinion manuscript that was submitted to a scientific journal for publication, to share our workflows and practices with healthcare teams worldwide.
What are some challenges that you’re facing in a time like now?
Just as everyone’s lives are being affected globally, mine has changed too. With the pandemic in mind for every waking moment, some of the changes at work are mentioned as above. Planning, keeping updated, administrative and teaching work do not end when office hours end.
Besides work, I have mostly been staying at home since the Chinese New Year holidays. I do miss meeting my parents, catching up with friends and being able to take breathers by travelling overseas. But I keep up by messaging and calling. Physical distancing does not mean cutting off social ties. Travel destinations will still be there when the pandemic is under control.
How is your family supporting your work now?
Being in the same profession and specialty, Adrian [Ng] and I have unspoken understanding of each other’s work responsibilities, and are fully supportive of each other.
My parents have always been very encouraging and supportive of my work. Never once have they ever mentioned about my hiatuses in maintaining contact with them because of work. They keep independent and reassure me that they are coping well with staying home. We will have a belated celebratory birthday dinner for my dad when it is safe to do so.
Any advice to Prestige readers on how to stay positive at this dire time?
Count our blessings! There are many seemingly small things that we are incognisant of, or take for granted — our health, essential services being available, food supplies, a supportive society who cares.
There had been reports and pictures circulating, of healthcare workers with facial marks or sores caused by the prolonged use of tight-fitting N95 masks. I do not find the use of N95 masks any bit comfortable, but I am grateful that I am equipped with protection to do my job while so many of my colleagues around the world do not have such essential resources.
What has been one good thing that you’ve noticed during this outbreak?
Our strong human spirit to survive, to adapt, to share, to care for, and work with one another, in our common goal to overcome the SARS-CoV-2.
Any other bright moments you’ve noticed?
Friends and colleagues who are pledging our (yet to be received) healthcare workers COVID-19 bonus to The Courage Fund or similar funds, to be channelled to people who are severely affected and in need.
Continuous clapping that lasted more than 10 minutes, from people everywhere in Singapore, for everyone who has been working tirelessly to keep Singapore safe and stocked.
The hospital administrative staff deployed to do temperature and travel screening, greeting everyone who walks past with a cheery “good morning”, even though he is undoubtedly stressed by being thrusted into the frontline.
A social media personality, who gave out supermarket vouchers out of her own pocket with no strings attached, to people in difficulty whom commenters shared about. And the anonymous people who privately messaged the personality to contribute more vouchers to be given out.