Stories of Challenges Faced by Primary Care Physicians Against COVID19

Dr. Lionel Peters - Palawan

Agutaya Rural Health Unit

Brgy Bangcal, Agutaya, Palawan

The current way of thinking in the public space regarding COVID-19 is primarily that the disease is managed at the level of the hospital, and that “frontliners” consist mainly of clinical workers such as nurses and doctors in hospitals.

This view, however, captures only a small portion of the actual general health response going on all over the country. There is a vast proportion of our population that lives away from the hospital-dense urban areas that are almost exclusively featured on the news. It is in the rural, underserved areas where we will see some of the most vulnerable of our countrymen, and yet there is little highlight on how these communities are being protected from the scourge of COVID. One shudders to think of the devastation COVID can wreak on the poor and ill-equipped health systems that operate in these areas, but health teams in the communities are still doing their best to contain the disease. If these communities fail, so will the hospitals, no matter how well-prepared they imagine themselves to be.

For this not to happen, emphasis should be placed on what is being done at the community level. The real front line is manned by community health volunteers and health care workers, who should be empowered to hold the fort and protect the hospitals from being inundated by patients. It is the health personnel at the barangays, municipalities, and cities, who are mandated to provide the most wide-based care and shepherd their communities to health. Often, though, they are the ones who are given little regard and sent to the proverbial battlefield with little to no armor.

Key to beating COVID is the recognition that our local health systems need to be mobilized and prioritized. There should be a concerted effort to prevent overburdening and overwhelming of our hospitals, and this will come from a shared response by not only our heroes in the corridors of our major COVID centers, but also those in the shores, hills and valleys of the provinces. Support is needed for these community-based health workers, who may be back-of-mind in the public consciousness when it comes to COVID response, but who will ultimately determine whether our measures to contain and prevail over the disease will succeed.

Dr. Lorenzo Maria de Guzman - Turtle's Island, Tawi-Tawi

0 confirmed cases po. As of today po, 32 PUM po in our municipality. The whole province is under Enhanced Community Quarantine already, but individual municipalities are issuing lockdown orders. Sabah is handling the situation quite differently. News black out po, delaying official reports by days even. This is causing quite some panic. Filipinos are trying to repatriate desperately, kaya po umaakyat ang PUMs and PUIs namin everyday.

One of the greatest challenges po is to confirm the cases. For a single PCR test, the sample has to be flown to Zamboanga then to RITM, Manila.

If patients in Luzon are having a hard time getting results, I'm afraid we won't even get to test all our severe PUIs on time at all

The existing challenges in our health system, geographically, resource-wise and access wise, are all much much more aggravated by this.

For our municipality, our Frontline here is the backdoor entry/exits of the country, literally the boundaries of the sea.

I don't think med school trained us enough for this, but I am Mu, and we will hold the fort here.

I'm currently in the islands po kasi and will ask someone to pick it up po for sending via sea.

Dr. Kaka Bolong - Sallapadan, Abra

Good morning, I am assigned in Sallapadan po, a 5th class municipality in the uplands of Abra. Currently, we have one confirmed case of covid in our municipality and 6 other PUIs po. We are currently in the process of contact tracing to identify our PUMs po for the positive patient. Currently, we are having difficulties in procuring PPEs and other medical supplies as LBC branches in NCR are no longer accepting shipments and the provincial government is enforcing an inbound travel ban making it hard for local suppliers to get their goods into the province as well po

Dr. Johna Mandac - Dinalupihan, Bataan

I want to share with you some of our best practices in implementing disease surveillance in our municipality. We have a designated Hotline for reports of newly arrived people from NCR and abroad, barangays have set up checkpoints to disallow/prevent non residents from entering their areas, we issue home quarantine notice and fill out daily monitoring sheets for symptoms, BHERTS have daily monitoring of PUMs and PUIs and RHUs are operational 7 days a week, so as to help unload hospitals in Bataan. However, we still need PPEs for the health workers since the DOH still has not provided any here in the ground po.

Thank you very much po, Doc. We appreciate your well thought out initiative. Most of these were patterned after the various DOH and DILG circulars issued to us. We coordinate with PHO and Provincial DOH for our next steps... Our upcoming challenges include setting up LGU quarantine centers to accommodate the PUIs that cannot be accommodated in the hospitals. Due to lack of hotel in the area we are looking into getting approval of DepEd to use their schools. I foresee that we would really need PPEs for this doc to protect the health workers and other frontliners that will go on duty.

If you will check a map doc, Dinalupihan is in a very vulnerable location in terms of COVID-19. That's why we keep on telling the brgy captains to be very judicious in issuing travel passes because it adds to the risk of having a COVID-19 positive patient here.

This is fairly comprehensive nman po Doc. We can also share our best practices to other aspiring DTTBs and MHOs po showcase our LGU initiatives. We can also create articles or creative outputs to make it more engaging po to others.

My map of influence po haha. 12 municipalities - the RHUs, PHO, BGH, District hospitals namely Dinalupihan District Hospital, Orani District Hospital, Mariveles District, Mariveles Mental Wellness and General Hospital, Bagac Medicare Center, Orani District Hospital. We can probably prioritize the RHUs in the municipalities po since hospitals are receiving lots of donations from other private institutions po both in and outside Bataan.

Dr. Patrisha Quema - Polanco, Zamboanga del Norte

I am Cheeka Quema, Mu batch 2019. I'm a DTTB assigned in Zamboanga.

I'm assigned in Polanco, Zamboanga del Norte.

Currently, we have 1 confirmed positive case in Zamboanga City, around 6 hrs away from my area. But in my particular municipality, we have 0 confirmed cases as of date. But I am monitoring over 300 PUMs and 18 PUIs who cannot be tested due to lack of testing kits.

Dr. Anne Dominique Asis - Pintuyan, Southern Leyte

Good morning. I am assigned at Pintuyan, Southern Leyte. Currently we have 130 Persons Under Monitoring and 5 Patients Under Investigation (mild symptoms). Our province and municipality is currently on heightened community quarantine (travel bans, home quarantine pass), with 24/7 Emergency Operations Center. We lack personal protective equipment such that most of our personnel (especially our barangay health workers) make do with cloth masks.

Thank you for this initiative. I agree that it is expected that most cases will be in the provinces especially with the lockdowns in the major Metropolitan areas. The tendency is for the people to go home. We had our first peak of increase when Metro Manila underwent community quarantine. We expect another one soon when Cebu also strictly closes their borders.

ROJ@20apr8