First EXECOM meeting post #OdettePH

first F2F EXECOM meeting post #OdettePH makes me want to cry.  i guess i'm just tired of being cheerful and working like business as usual, when outside people are lining up for cash at atm, food and groceries, fuel at gasoline stations, water at deep wells and refilling stations, and construction supplies at hardware stores.  my soul is weary.

i'm glad everyone is safe, PEOPLE's LIVES and SAFETY are most important, after all.  everything else takes a back seat.

thank you for all the friends outside Cebu who poured out your support thru text messages and cash donations.  what we need most is power, drinking water, food supplies and fuel.

CEBUANOS, please behave and keep your prices down.  everybody sustained damages during the storm.  everybody is patiently lining up - please don't hoard and please don't cut the line (baka mapaaway kayo).

#OdettePH

#OdettePH

nothing for it but to wait out the storm and to rebuild after.  just please keep everyone safe.

with #OdettePH visit:

impassable roads with fallen trees.

strong winds howling, playing with the roof.

sounds like a rollercoaster above the ceiling.

GI sheets and debris flying around.

power outage and communication issues.

flooding in the ER CCU and other patient areas.

shattered debris in construction areas (thank God the crane still stands).

THANK YOU to the health workers who stayed when their relievers could not arrive for the next shift. 

thank you Marx Valencia and the nurses who take charge.

thank you Leoncio Eramis and your team of brave housekeeping staff who help make us safe amidst the destruction.

thank you Arnuld Cuanan and your roving security officers.

Lord, keep my mother and my family safe.

Lord, give us faith and a resilient spirit to get thru this storm.

HIV Disclosure for Prevention of Mother to Child Transmission of HIV

For almost two years now, the world was pre-occupied with responding to the COVID-19 pandemic.  We take a look at another pandemic, just as important, as it affects us here in the Philippines – the HIV/AIDS epidemic.  As of August 2021, the HIV/AIDS & ART Registry of the Philippines reported 90,031 confirmed HIV-positive cases since January 1984.

 

An HIV diagnosis will change your life.  Living with HIV can increase the risk of stress, anxiety, and depression.  The most frequent stressors experienced by PLHIV at diagnosis were confidentiality (93.2%), risk of infecting others (86.9%), distressing emotions (86.3%), physical functions (83.9%), and disclosure concerns (83.7%) (Huang, 2020).

What is HIV Disclosure?

 

HIV DISCLOSURE is the personal experience of communicating to another individual or group of individuals that you are a person living with HIV.  HIV disclosure is central to debates on HIV because of its potential for HIV prevention on the one hand, and privacy and confidentiality as human rights issues on the other (Obermeyer CM, 2011).  Disclosure of HIV status is an essential part of behavior modification and access and adherence to treatment in people infected with HIV (Norman MA, 2007)

 

Unfortunately, existing HIV disclosure laws in the US seem to contradict rather than complement public health efforts to prevent the spread of HIV (CL Galletly, 2006).  By singling out persons who have HIV in a criminal statute and by criminalizing sexual behavior that would be legal for HIV-negative or untested persons, these laws link HIV-positive status with criminality, potentially reinforcing the stigmatizing attitudes that public health leaders identify as significant barriers to prevention efforts. 

 

The public health response to HIV/AIDS is founded on the following key recommendations.  

1. practice safer sex correctly, consistently and universally
2. seek testing and take steps to eliminate or modify behaviors that put them at risk
3. HIV-positive persons are encouraged to seek treatment, to apprise past sexual partners that they may have been exposed to the virus, and to avoid behaviors that would put future partners at risk.

We are fortunate in the Philippines to have the Republic Act 11166 or the HIV AIDS Policy Act of 2018, which provides the following:

• Extended scope of HIV education and information, which shall form part of the constitutional right to health
• Evidence-based, gender-responsive, age-appropriate and human rights-oriented prevention programs and measures.  Goals are to reduce risky behavior, lower vulnerabilities, and promote human rights of PLHIVs
• Testing and counseling made accessible to the young population – voluntary, confidential, available all the time with informed consent, extended to persons aged 15 or over, child below 15 who are at higher risk of HIV exposure any young person aged below 15 who is pregnant or engages in high risk behavior

In fact, there are stricter penalties for violation of confidentiality, a comprehensive treatment, care and support program for PLHIVs and higher penalties for discrimination based on HIV status

This translates to better access, better education, better care and better partnerships.

 

DISCLOSURE AMONG HETEROSEXUAL ADULT PLHIV

 

In 2008, Arnold et al researched on disclosure among heterosexual adult persons living with HIV in different relational contexts: with partners, family members, friends, healthcare professionals and in work settings (Arnold M, 2008).

 

Disclosure is higher among women than men, among Latinos and whites compared to African-American families, and among younger compared to older HIV-positive adults.

Disclosure decisions are often made to tell everyone, someone or no one. (Arnold M, 2008)

• EVERYONE - Makes HIV status a central attribute of one’s identity
• SOMEONE – Requires strategic decisions based on context
• NO ONE – requires strategies for securing social support while remaining anonymous

Disclosure decisions are central to personal identity.  Disclosure is intimately related to how communities stigmatize or accept PLHIV and how individuals perceive themselves, their identities and their roles in the communities

 

DISCLOSURE AND TYPES OF SOCIAL RELATIONSHIPS

 

Here are some tough questions on Disclosure of HIV+ Serostatus

 

•      If an individual is HIV+, is it their responsibility to disclose to their sex partner?

•      In your opinion, how or when should a person living with the virus disclose their HIV+ serostatus to potential sex partners?

•      How likely are people to disclose their HIV+ serostatus to casual sex partners?

•      If someone is having unsafe sex, how likely are they to disclose their HIV+ serostatus?

•      Of those who do not disclose to all partners, how do you think they make the decision regarding who to tell and who not to tell?

•      How truthful are people (or do you think they lie) in telling their HIV+ serostatus when they have intimate contact (sex, needle sharing) with others and why?

•      In your opinion, what is the best method to encourage disclosing a person’s HIV+ serostatus with current and potential sex partners?

•      What are your thoughts and feelings regarding disclosing to persons other than sex partners?

  

Model on HIV Disclosure and Types of Social Relationships

Social relationships were categorized as sexual and nonsexual, with varying degrees of HIV disclosure, depending on the social relationship with the person to whom one did or did not disclose.

·   HIV is still a fearful and stigmatizing disease, and disclosure of HIV status is a complex phenomenon embedded in various types of social relationships. (Bairan, 2007)

·  Disclosure of one’s HIV+ serostatus depends on (1) social relationships (2) fear, and (3) stigma, with social relationships being the predominant theme

·  Social relationships - Concerning sexual relationships, some participants defined nondisclosure of HIV+ status to casual sex partners as ‘‘anonymous sex.’’  Being a gay man, I have relations with people that I don’t e.ven know. I don’t want to know your name. So I don’t tell them [disclose] right off the bat. And if I don’t say that [I’m HIV+], well now, the sentence is 10 years in jail.’ if you don’t expect to see them again, you wouldn’t disclose. The main reason given for not disclosing was that the HIV+ person wanted sex.  A subject shared that he would not tell a casual sex partner but would tell his partner if he was in a long-term relationship.  Most people, when they find out that they are HIV+, go through a period that they DON‘T disclose.  It’s different with every person.

 

DISCLOSURE AND HAART

  

Is disclosure associated with HAART adherence?

 

Four groups of factors have been associated with adherence to highly active anti-retroviral therapy: (1) patient factors; (2) medication characteristics; (3) interpersonal characteristics (e.g. social supports); and (4) the general health care system.  The relationships between decisions about disclosing and about starting and adhering to highly active antiretroviral treatment (HAART).  Does disclosure always facilitate adherence? Does adherence facilitate disclosure? Many advocates have hoped that improved treatment would lessen the stigma associated with HIV and ease the lives of PLWH.

 

Medications may ‘out’ people living with HIV.  Disclosure of HIV and/or HAART may also result in antagonism from others who hold negative attitudes and beliefs about HAART, potentially impeding adherence.  Conversely, medications may improve appearance, delaying or impeding disclosure.  HIV disclosure can lead to support that facilitates initiation of, and adherence to, treatment. HIV disclosure and adherence can shape one another in critical ways (Klitzman, 2004)

 

 

PARENTS DISCLOSURE OF HIV TO THEIR CHILDREN

Parents were more likely to disclose to older than younger children.  Mothers were more likely to disclose earlier than fathers and they disclosed more often to their daughter than to their sons (Lee, 2002).

Disclosures impact adolescents negatively.  Healthcare workers need to discover how to reduce this impact.  Clinical literature suggests that family secrets are destructive.  The negative impacts of disclosure on both parents and their adolescent children persist for a considerable period of time. Parents who disclose report significantly more stressful life events, family stressors, and perceive that their children experience HIV-related stigma.

As the quality and duration of life for PLH has increased, there appears to be less urgency to disclose one’s serostatus to children.  The medical setting offers a venue for providing support regarding decisions about whether, when and how to disclose their serostatus to their children.

If parents are discouraged from disclosing, an implicit message is communicated that HIV is stigmatizing and must be hidden. We are not advocating hiding one’s status.  Yet, we need to understand that disclosure takes courage, planning and a lot of time in a long process to reduce negative impact of disclosure on both the parent and adolescent.

Healthcare workers must take care to avoid involuntary or unplanned disclosures.  More efficient process flows must be developed during testing, linking to care, contact tracing, immigration, in dealing with legal cases and managing accidents and gossips.

It is important to know the stages of adapting to life with HIV, which goes thru each step of the process, including: shock, denial, anger, bargaining and depression.  This allows healthcare workers to adjust, provide support and assist the PLHIV in disclosing their HIV status to prevent transmission and access care.

The disclosure process would vary from person to person and their tolerance for coming out.  Considering the possible negative impact of HIV disclosure, the process involves recover and support, education, preparation, planning, disclosure and the follow up after the disclosure.

More attention should be paid to PLWH with younger age, not living alone, less income, presence of HIV symptoms, and lack of social support (Huang, 2020).  Disclosure is believed to affect health, mental health, disease transmission and the quality of relationships; the importance of disclosure behavior will only increase as treatments and life expectancies improve.

  

I remember one young man who mustered enough courage to disclose his HIV status to his strict parents.  In the process, he had to reveal the fact that he was gay as well.  When his parents failed to accept him as their child, the young man fell into deep depression and committed suicide.  

The bottomline is that role of disclosure for HIV prevention should be balanced against the person’s privacy and confidentiality as human rights issues.

 

 

References

Arnold M, E. R.-B. (2008). HIV Disclosure among adults living with HIV. AIDS Care, 80-92.

Bairan, A. (2007). A model of HIV disclosure: Disclosure and types of social relationships. Journal of the American Academy of Nurse Practitioners, 19, 242-250. doi:https://doi.org/10.1111/j.1745-7599.2007.00221.x

CL Galletly, S. P. (2006). Conflicting Messages: How Criminal HIV Disclosure Laws Undermine Public Health Efforts to Control the Spread of HIV. AIDS Behav, 10, 451–461. doi:DOI 10.1007/s10461-006-9117-3

Huang, Y. (2020). HIV-Related Stress Experienced by Newly Diagnosed People Living with HIV in China: A 1-Year Longitudinal Study. Int. J. Environ. Res. Public Health, 17, 2681. doi:doi:10.3390/ijerph17082681

Klitzman, R. (2004, July). Intricacies and inter-relationships between HIV disclosure and HAART: a qualitative study. AIDS CARE, 16(5), 628/640. doi:https://doi.org/10.1080/09540120410001716423

Lee, M. (2002, November 8). Parents’ disclosure of HIV to their children. AIDS, 16(16), 2201-2207. Retrieved from https://journals.lww.com/aidsonline/Fulltext/2002/11080/Parents__disclosure_of_HIV_to_their_children.13.aspx

Norman MA, C. M. (2007). Factors related to HIV Disclosure in Two South African Communities. American Journal of Public Health, 1775-1781. Retrieved from https://ajph.aphapublications.org/doi/epub/10.2105/AJPH.2005.082511

Obermeyer CM, B. P. (2011). Facilitating HIV Disclosure Across Diverse Settings: A Review. American Journal of Public Health, 1011-1023. doi:doi: 10.2105/AJPH.2010.300102

 

 

 

 

HOW TO MAKE HOSPITAL REFORMS HAPPEN?

I have just come home from attending the 2021 International Hospital Federation World Congress (#IHF2021 #IHFBarcelona) in Barcelona, Spain. The sessions discussed about how every hospital on earth were affected by COVID-19 and had to cope and adapt with changes to respond to the deluge of patients who need critical care. The concept that nobody is safe until everyone is safe pushes forward intensive vaccination efforts and COVID-19 protocols to prevent transmission.

Other sessions tackled on hospital innovations like digital transformation for more efficient health systems especially with logistics, and knowledge transfers for public information dissemination to combat the infodemic; cultural sensitivity while implementing changes in the hospital with special mention of sufficient salaries for healthcare professionals; improved patient access thru teleconsultation; the concept of green hospitals for sustainable hospital environment, patient navigation systems and health financing.

As we arrived back in the Philippines, we checked in to the hotels accredited by the Department of Health and the Bureau of Quarantine for our mandatory quarantine. We were fortunate to attend the Philippine Hospital Association Annual Convention (#PHA2021) remotely. Dr Iris Thiele Isip-Tan discussed about the infodemic and invited interested hospital staff to join the WHO program for infodemic managers. Speakers shared about services offered such as hospitals in the home, programs for healthcare worker retention, collaborations with media partners to organize webicons, ease of doing business and health financing.

This was topic for #HealthXPH tweetchat November 20, 2021 (Saturday) about the current condition of our hospitals and health care systems and much needed hospital reforms.  Let us peek into some of those tweets:

T1. The COVID-19 pandemic exposed a lot of weakness in our current hospital systems. Which one do you think needs to be addressed most urgently?

T2. Learning to live in the new normal after COVID-19 pandemic, what hospital reform do you think will improve access to healthcare?

T3. How do we make these hospital reforms happen?

In closing, hospitals were war zones for COVID-19 and this is the time to reform and rehabilitate our hospitals to make them environmentally sustainable, efficient, collaborative, coordinative and integrated with external health systems with digital transformation of all processes, including communication with patient clients.

Looking up the SYMPLUR analytics for this tweetchat:

The Journey to Barcelona: Breaking COVID-19

 Everything seemed too real to be true, but it was.

There were so many obstacles that we needed to get through before we finally boarded our flight.  Scrounging for resources, applying for our leaves, we made this trip happen - to give justice to representing our institution and our country.  This mission may as well have been a mission impossible.  But now, it is a reality.

Our RTPCR SARSCoV2 results turned in negative, we were on our way.  

We had to pack our gala uniform and our Filipiniana costume.  Pierre helped me shop for my official grey suit gala uniform at a nearby shopping mall.  My mom handmade my beautiful black Filipiniana with glitter lace fabric.  I can't wait to wear it during this 44th International Hospital Federation World Congress with pride.  So many people gave me "pabaon" and I am

For many, this trip felt like breaking free from the oppression of COVID-19 and learning to live in the new normal.  For the past year, we basically stayed where we were:  at home, at work, with limited mobility.  With strict border controls, people flocked to nearby beaches and open air amusement areas, outdoor cafes for face to face interaction.  We could hardly go to another part of the country without testing and facing the great inquisition, for fear of mandatory quarantine, much less travel to another country.  Indeed, when we posted photos on facebook about our trip to Barcelona, Spain, a number of my friends called me to ask about my experience.  I will post all that on facebook for public information dissemination, but this blog is for my insights.

The last time I went on an international flight, it was in 2016 for the Arthur Ashe endowment fellowship to New York Presbyterian Hospital with Weill-Cornell to observe how HIV/AIDS care is done in the US.  Many wonderful ideas on how we could improve our patient retention and level of satisfaction.  One of the things I didn't like was the cold.  When I arrived back in the Philippines, I clapped my hands for the deliciously warm weather!

This time around, I am more prepared with the winter clothes to keep me warm:  bubble coat, trench coat, bonnet, scarves and mittens/gloves.  Somehow, I also prepared myself for the mental and social cold of another culture, not like the uber friendly Filipino environment.  There is also the language barrier - many people probably would say "no habla Ingles" same way that I would respond "no comprendar Espanyol"

When the immigration staff interviewed me, she congratulated our team for being finalist for the award by the IHF World Congress.  This is super good vibes for the frontliners of Vicente Sotto Memorial Medical Center, as we were the recipient of the IHF Award for Beyond the Call of Duty for COVID-19 Response.  This year, the award is for hospital management, and VSMMC is a finalist of the highest award, the Dr Kwang Tai Kim Grand Hospital Award.  It calls for a celebration and this special trip to Barcelona, Spain!

Dungan

 

It has been more than a year since the COVID19 pandemic started, and long enough since I took on the role of chief implementer of the COVID19 Health Facility.  While we were shooting our video for PSMID, Naynay mentioned that we would use DUNGAN as the sound track for our short film.  This brought a lot of memories, as this was my theme song since the first surge. 

Dungan means TOGETHER.

We rise up together, we fall and we die together.

Much like the official hashtags of the DOH COVID19 pandemic response #BeatCOVID19 as #weHEALasONE.

The first surge felt like the Avengers Endgame when suddenly many of our colleagues were dying from this unknown disease, from this unseen enemy.  We were all tears, caught off-guard.  We didn't know how to protect ourselves.

To Spain we go!

October 13, 2021.   After more than a year of staying put in Cebu, I have the opportunity to fly to Manila to apply for our Schengen visa going to Spain for the International Hospital Federation.

It was such a joyous feeling to test negative for RT-PCR after a swab for rapid antigen test. With good company, we trooped to Greenbelt V to look for our dinner.  We ended up at the Bulgogi Brothers as my blowout for my recent promotion to Medical Specialist IV. 

Cramming for documents to be submitted to the Embassy of Spain the next day, we stayed up late but made an effort to wake up early to be on time for our 7:00 a.m. appointment on October 14, 2021.  

We were overthinking the interview because we even practiced what we would answer if asked what we would be doing in Spain, where do we intend to go and what was our source of funding.  There was an issue of our COVID-19 vaccine Sinovac not being accepted in France.  No worries, there was always Switzerland and Austria to visit as well.

We had a long brunch at the Venice Grand Canal Mall in Taguig talking and planning and discussing all topics under the sun.

As it was time for the party to go back to the airport, I headed for home.

Three whole days of not doing work, spending time with the girls singing karaoke, playing in the garden, cooking, biking and running.  This was pure auntie bliss!

OUR CALLING IS HIGHER

I was hurt when we received a text message from a panicked family member "ang hospital known raba nga maniwasay ug tawo..." meaning patients die in our hospital. My first instinct was to want to ask why they brought their patient to our hospital in the first place if they did not trust our healthcare workers to take care of their patient? My second inclination was to press legal charges for slander or libel. Their statement was unfounded. Our resident was taking care of the patient as best as she could.

When I consulted a lawyer for legal advice, this was his reply:

"A public official, more especially an elected one, should not be onion skinned. Strict personal discipline is expected of an occupant of a public office because a public official is a property of the public. He is looked upon to set the example how public officials should correctly conduct themselves even in the face of extreme provocation. Always he is expected to act and serve with the highest degree of responsibility, integrity, loyalty and efficiency and shall remain accountable for his conduct to the people." - Yabut et.al. vs. OMB, G.R. No. 111304, June 17, 1994.

As government employees, we are considered public officials. We are professionals. We need to take the higher ground when patients insult us and provoke us. They may be uneducated, so they don't know any better. It's not really their fault either. They are overcome by their panic and helplessness over the condition of their patient, whom they have entrusted to our care.

We have always encouraged our patients and stakeholders to provide their comments and feedback to improve our services, but sometimes complaints hurt especially if unfounded. However, there must be some truth in the comments. We do not disregard, but we investigate and evaluate.

As doctors, when we are at the end of your patience, good advice would be "DO NOT ENGAGE". The difficult patient case should be referred to the senior resident or to the consultant. A referral may also be made to social workers as a third party to try to mediate with the relatives to address their concerns. We should not allow ourselves to engage in anger, especially since we are in the business of providing service and care. If your path is more difficult, it is because your calling is higher.

The True Mandirigma

 

Lessons from the COVID-19 Pandemic Response

Thru the Eyes of the VSMMC Chief Implementer

Helen V. Madamba, MD, MPH-TM, DHPEd, FPOGS, FPIDSOG

 

In times of crisis, leadership is important to keep the team together.  The novel coronavirus originated at Wuhan City of China early December 2019.  It changed the world, and we will never be the same again.  As we faced the uncertainties with fear, we had to make sure we were not paralyzed by that fear.  On March 20, 2020 the Vicente Sotto Memorial Medical Center Incident Command System was activated on emergency mode, for a unified chain of command in the management of COVID-19 infections. 

One of the functions of planning section chief was to write policies and guidelines into hospital orders to document and disseminate the direction of management.  To ensure proper implementation, we must be sure to give clear understandable instructions that employees can follow.  It is also important to follow the rules that we set.  During times when following minimum health protocols of wearing face shields, physical distancing and hand hygiene can spell the difference between life and death, it is life-saving to follow rules.

Surge capacity planning involved looking into zoning beds (space) to segregate COVID-19 (red zones) and non-COVID-19 (yellow and green zones), putting on hold private and elective admissions to allocate more beds for incoming symptomatic patients.  It meant looking into logistics (stuff) necessary to protect healthcare workers for infection prevention and control measures, and arranging manpower (staff) in alternative work arrangements to ensure 24/7 operations while maintaining social distancing, allowing quarantine post-duty and minimizing employee exposure risk to the hospital.  The world stood still, and we had to prioritize triage, algorithms and our COVID-19 pandemic response down to essential services.   The medical center chief conference room was converted to our war room operation command center where everyday data was submitted, analyzed and disseminated.  Hard decisions were made every day, when we headed for work before the sun rose and called it a day wee into the night.

 

An effective COVID-19 pandemic response takes a whole community doing its part to contribute.  The elderly and the children stayed safely at home, many occupied their time praying, writing encouraging notes, creating inspirational drawings to boost the morale of both patients and healthcare workers separated from their families.  Families started sewing cloth face masks and preparing food packs to donate to the hospitals.  Medical students and allied health professionals volunteered to help out at the hospital to man non-COVID-19 wards so that employees can focus on working in the red zones. 

The economic law of supply and demand jacked up prices of personal protective equipment and supplies.  Government hospitals were constrained by the procurement process.  Coveralls, gloves and N95 respirators became the new gold.  Volunteers collected hospital supplies at drop-off points and distributed equitably among the government hospitals.  When we least expected it, there was an outpouring of donations from the community.  In the true spirit of Bayanihan, everyone pitched in to help as the shared identity of Vicente Sotto Memorial Medical Center (VSMMC) was born.  Maximizing responsible social media use, hashtags like #BeatCOVID19, #weHEALasONE, #sharedidentity and #sottobrandofcare were utilized.

Quality health data analytics and effective risk communication and is at the heart of efficient command operations. To combat infodemic during COVID-19 pandemic, VSMMC developed daily Facebook Live programs, dubbed as SOTTO LIVE Productions, utilizing social media to connect with the stakeholders (our ka-QUARANTeams) to provide the general public a reliable source of information.   To stop fake news and bashing of healthcare workers, we went on facebook live every afternoon to provide briefer updates on what was happening on the ground at the hospital to help people understand.  As the Hospital Epidemiology and Surveillance Unit (HESU) collected and submitted data to the Department of Health and the Inter-Agency Task Force (IATF), this live dashboard was updated on our facebook page and presented daily on our social media platforms for transparency and accountability.  By having experts discuss in the local dialect what little we know about COVID-19, we improve the level of knowledge of the viewers.  These programs also serve to maintain transparency and accountability.  

One of the concepts we espoused on SOTTO LIVE was that no one hospital could handle the pandemic by itself.  All hospitals needed to work together to provide essential services to make sure that patients had easy access to healthcare.  Hospitals in Cebu had to learn how to function as one healthcare system.  Cebu was lucky to have the Central Visayas electronic referral system and the functioning healthcare provider network with VSMMC as its apex hospital.  The electronic referral system was strengthened to ensure the right patient was at the right facility at the right time.  The private sector organized temporary treatment and monitoring facilities with the support of businessmen in Cebu and the members and alumni of medical societies and private schools.  The BAYANIHAN Center at the Sacred Heart School and at the International Eucharistic Center (IEC) were developed safe for both patients and healthcare workers.  The beds were spaced two meters apart with an industrial grade ventilation system with HEPA filter.  The local schools were converted to barangay isolation centers for asymptomatic COVID-19 positive individuals.  Contact tracing of the emergency operation centers were intensified with the goal to test (to diagnose COVID-19 positive cases), transport (to isolation centers to stop transmission), and treat (if symptoms progress and there is a need for hospital admission).

The community workers at the grassroots level are the true frontliners, hospital workers are in reality, endliners.  Public health information dissemination is pivotal in prevention of transmission.  The idea of “chismis for disease control” took advantage of the stigma and discrimination of people who test positive for COVID-19.  Neighbors would alert authorities if patients in home isolation would break quarantine or isolation.  The pressure ensured that infected people avoid exposing other people around them.  The paradox of expressing love and care was to stay away from people.  When patients get sick and need hospital admission, healthcare workers become the endliners, struggling to provide intensive care resources to help patients survive.  At the beginning, mortality rates were high because patients would consult late and there was limited armamentarium against COVID-19.  Later on, we discovered which reformatted drugs worked against the cytokine storm.

The main message was simple: stay at home (pagpuyo sa balay), wear face mask (pagsul-ob ug mask), physical distancing at least one meter (distansya ug usa ka metro) and hand hygiene (paghugas ug kamot).  By sharing these information, we help authorities make good decisions to prevent transmission.  The goal was to limit the movement of people.  Malls were closed.  We communicated with the bishop of the archdiocese of Cebu that we needed to temporarily close the churches to protect the elderly from exposure risks.  Difficult decisions and sacrifices had to be made, but with open communication lines, people understood the reasons why.  Open dialogue worked much better than enforced orders that don’t make sense to the public and brought out more resistance, negativity and feelings of oppression.

On March 27, 2020, the VSMMC Sub-National Laboratory (VSMMC SNL) was given certification by the Research Institute for Tropical Medicine to perform independent COVID-19 RT-PCR Testing. This was just in time for March 28, 2020 when mayor Edgardo Labella ordered an enhanced community quarantine (ECQ) in Cebu City for one month.  Hours after, the Cebu province was placed under enhanced community quarantine by Governor Gwendolyn Garcia in a bid to contain the spread of the COVID-19, effective March 30, 2020.  Knowledge is power when dealing with an unknown.  The ability to process nasopharyngeal and oral swab specimens for RT-PCR SARSCoV2 locally cuts short the turnaround time for availability of results.  This was a big boost for hospitals with admitted patients waiting for results.  The VSMMC SNL also provided training for molecular laboratory staff of other hospitals to assist in their accreditation to run RT-PCR SARSCoV2 as well. 

Having the ability to test admitted patients afforded us the chance to test the patient watchers as well, only to discover that a high percentage of watchers were testing positive, resulting in potential nosocomial infection.  This is the reason why on June 9, 2020, the “No Watcher Policy” was implemented.  This perhaps was one of the most unpopular decisions we had made, however patient safety took precedence over patient convenience.  We were also running out of space, so we prioritized patients over their watchers, and healthcare workers committed to improve nursing care to do away with the added helping hands of the watchers.  With the second surge with more patient case load, it also became too risky for volunteer to continue exposing themselves to COVID-19 positive patients, so we sent our volunteers home.  To assist the community for testing with the second surge, VSMMC SNL initiated the country’s first drive-thru/walk-thru swabbing for RT PCR testing for SARSCoV2 in compliance with DOH Memorandum No 2020-0258-A on July 24, 2020.  This innovation provided ease of access to RT-PCR results free of charge for the general public, with a commitment to send results to the patient’s registered email within 24-48 hours.  

By 3^rd week of June 2020, the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF) and the Department of Health (DOH) Secretary Duque descended upon us in Cebu City to intervene on the control of transmission of infections, down to the community level.  Hospital data was presented, which showed mortalities <48 hours from admission indicating delayed consultation.  The “happy hypoxics” phenomenon was coined for the occurrence of hypoxemia with no symptoms among infected individuals.  The IATF/DOH accepted that VSMMC continues to provide basic essential health services to non-COVID19 as well as responding to COVID-19 positive patients.

This is why on June 26, 2020, the VSMMC COVID-19 Health Facility was created as a facility within VSMMC.  Infrastructure for the COVID-19 health facility was identified as the RED ZONE areas where COVID-19 positive patients are admitted.  The hospital bed utilization follows the accordion-type contingency plan, meaning as soon as bed utilization reaches 70%, we expand the COVID-19 health facility to other ward areas.  As the COVID-19 positive cases decrease down to less than 50%, we contract the red zone by closing, cleaning and converting back for COVID-19 negative patients.

The VSMMC North District (VND) Extension building is the nearest building still under construction, but already utilized for patients considering this is preferable to heated tent accommodation.  The specialized rooms for emerging-reemerging infectious diseases (EREID) with linear air flow were renovated to accommodate more patients.  Other rooms in the hospital were improved with CCTV, patient monitoring systems, fiberglass barriers and floor plans to also be ready in case there is a need to expand the COVID-19 positive areas.

As the Department of Health rolled out its national vaccination operations, intensive planning and coordination meetings were done with stakeholders from different government agencies.  By March 4, 2021, healthcare workers of VSMMC were among the first in the country to receive COVID-19 vaccines.  Vaccine hesitancy was another barrier to breach.  Massive orientation and town hall meetings were conducted.  Infomercials and electronic posters saturated our social media platforms, and expert speakers formed a panel for the SOTTO LIVE discussion on COVID-19 vaccination.  In this regard, we were considered influencers: influence through one’s actions, not just one’s words.  Media publicity for the ceremonial vaccination placed the spotlight on the healthcare workers of our hospital getting their jabs.  Veering away from setting up tents for our vaccination post, we utilized a newly constructed but still unfinished building for the Center for Behavioral Sciences for our #SOTTOVax COVID-19 vaccination program. The top management, members of the VSMMC Executive Committee led the first vaccines of the VSMMC COVID-19 Vaccination campaign dubbed as #SOTTOVax.  Eventually we were able to vaccinate more than 90% of our employees and the members of their household, another victory to be celebrated in a coffee table book to commemorate the event.

By the 3^rd surge with the threat of the more virulent delta variant, there was a need to integrate all the efforts for COVID-19 pandemic response to a patient navigation system to ensure patients have ease of access to healthcare to reduce delays and improve survival.  The Cebu COVID-19 Telegabai  was created from volunteer medical specialists and post-graduate interns, patterned after the PGH Telegabay and the Office of the Vice President (OPV) e-konsulta programs.  In coordination with the DOH 711 emergency healthline to access the Central Visayas electronic referral system and the LGU emergency operations cen
ter to mobilize forces on the ground, the facebook-based Cebu COVID-19 Telegabai provided medical advice to patients who needed to be connected to the healthcare system.  Statistics showed that this system, although utilizing cellphone calls and texts to patients, but with heartfelt service by the doctors and post-graduate interns, is effective in providing timely intervention for patients.

The COVID-19 pandemic has affected us all.  COVID-19 changed us.  We will never be the same again.  This disaster exposed the weaknesses of our healthcare system.  We’ve lost a lot of patients as well as fellow healthcare workers.  This time has allowed us the opportunity to step up to improve and establish more efficient health systems policies based on data.  The new programs, policies and guidelines are aligned to the goals and performance indicators of the VSMMC quality triangle that VSMMC.  Quality service is our pride!