The Big Read: Frontline healthcare workers pushed to limits by non-stop, never-ending COVID-19 fight
A common refrain among healthcare workers interviewed is that a big part of the psychological toll comes from not knowing what to expect when dealing with an unpredictable disease.
SINGAPORE: It has been about eight months since Dr Wong Choo Wai ended his volunteer stint taking care of COVID-19 patients at Singapore Expo, but the 50-year-old sometimes wakes up in panic, thinking that he has overslept and is late for work.
The senior family physician is still reeling from his experience of working almost 24/7 from April to September last year - pulling 12-hour volunteering shifts at the community care facility, while also still running his two clinics and seeing his regular patients.
Getting only three hours of sleep each day, Dr Wong said that there were days where he almost dozed off at work due to the mental and physical exhaustion.
He recalled one particular night in early May last year when he and other volunteers saw patients coming into the facility up until around 4am the next morning. Usually, new cases would stop coming in by midnight.
“The next day, we were all so zonked out because each one of us saw at least a few hundred patients for that 12-hour shift,” he said.
“I will say that I haven’t had a good break for a long time, and as much as I’m trying to go on every day without thinking too much about the past, I think I’m a bit burned out. And I think most of us (frontliners) are, but what to do?”
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Like Dr Wong, many healthcare workers on the front line have been in overdrive for over a year fighting a pandemic which has infected over 160 million people and claimed more than 3 million lives globally.
Not only are they working longer hours to contain the far-from-tamed outbreak, they also shoulder the mental stressors of being away from loved ones, getting infected or passing on the infection to those around them.
These fears became very real for a Tan Tock Seng Hospital (TTSH) nurse, who was among the healthcare workers there served with quarantine orders after a 46-year-old nurse tested positive for the infection last month.
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The young nurse, who did not want to be identified as she was not authorised to speak to the media, recalled being in a state of disbelief when she got the call from the authorities informing her that she and her colleagues had to be quarantined.
“I was just like, ‘No, it can’t be true lah.' I think I was still in shock,” she said.
Even though she was about to complete her quarantine in a few days when spoken to, the TTSH nurse said she felt apprehensive about what to expect at the hospital after she was released.
“I don’t know how it’s going to be like, how messy or calm the situation will be … it’s not settled yet, it’s all play-by-ear. What if everything changes overnight and they have to implement something new to cope with the situation?”
Indeed, a common refrain among the healthcare workers interviewed is that a big part of the psychological toll comes from not knowing what to expect when dealing with an unpredictable disease.
The new wave of infections has also served as a cruel reminder that there is still no end in sight to the COVID-19 pandemic.
Ms Alice Ng, 59, who manages the 24-hour family clinic at Thomson Medical Centre, said: “I’ve been a nurse for almost 33 years. I’ve been through SARS (severe acute respiratory syndrome) and H1N1, and this is the toughest pandemic I’ve ever met.”
(Are COVID-19 vaccines still effective against new variants? And could these increase the risk of reinfection? Experts explain why COVID-19 could become a “chronic problem" on CNA's Heart of the Matter podcast.)
SERVING THE PUBLIC, SHUNNED BY THE PUBLIC
After months of few community cases, the rising number of local infections in recent weeks - which has Singapore “on the knife-edge”, as Education Minister Lawrence Wong put it - has also seen healthcare workers in several public hospitals coming down with the virus. This, in turn, has once again led to incidents of them being discriminated against by members of the public.
Some healthcare workers have shared on social media their experiences of being shunned in public, with some having difficulties booking a taxi or private-hire ride, and others receiving wary looks or unkind comments from strangers.
Associate Professor Kenneth Mak, the Ministry of Health’s (MOH) director of medical services, said during a briefing held by the Government’s COVID-19 task force that some TTSH healthcare workers had been kicked out of their accommodation after the landlords learnt that they work at the hospital.
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The healthcare workers spoken to also had experienced or heard of similar incidents of discrimination against their colleagues in recent weeks.
One doctor, who works at a public hospital, said she has not been able to have food delivered lately, as delivery riders have been rejecting orders coming from the hospitals. She declined to be named as she was not authorised to speak to the media.
Staff nurse Afidah Aziz, 29, who works at the isolation ward at Ng Teng Fong General Hospital, said she has gotten cold looks from taxi drivers after they found out that she works as a nurse at the hospital.
“I don’t wear my uniform when I go to work … but (the drivers) will ask because they already know that I’m going to the hospital. They will ask, ‘What are you working as?’ Then whenever I say ‘nurse’, I will get them staring at me,” she said.
Ms Jenny Sim Teck Meh, 70, chief nurse at Ren Ci Hospital - which is near TTSH - said a few of her nurses have reported that commuters steer clear of them on MRT trains.
“It’s very disappointing to know that some people can behave like that, I don’t think that’s humane,” she said.
Posting a screenshot showing drivers on ride-hailing app Grab cancelling rides to TTSH, Speaker of Parliament Tan Chuan-Jin said on Facebook earlier this week: “All of us can support our folks at the frontlines. It’s the least we can do.”
Prime Minister Lee Hsien Loong also voiced his concern, saying that it is “distressing to see” the incidents of discrimination against TTSH staff members.
“We cannot let setbacks divide us or wear us down, because if we lose our unity, the virus has won,” he wrote on Facebook on May 7.
Responding to a question by Jurong Group Representation Constituency Member of Parliament Tan Wu Meng on Tuesday, Health Minister Gan Kim Yong said in Parliament that the authorities have been working together with hospitals to provide support for the affected workers.
The Government is also working with hotel operators to provide alternative accommodation for healthcare workers who have been asked to move out by their landlords.
Mr Gan added: “We want to urge Singaporeans to also show their support to these healthcare workers because they are putting themselves in harm’s way to protect us, so let us work together to protect them.”
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In response to these incidents, ride-hailing firm Gojek said it is working with TTSH to provide a S$10 voucher to all hospital employees.
Lien Choong Luen, the firm’s general manager, said Gojek is also stepping up education outreach efforts to its drivers to remind them that trips may include hospital pick-ups, and therefore, they should implement precautions to ensure a safe environment.
Mr Tan had updated his Facebook post with a response from Grab, which said that it had met with TTSH recently to see how it can support the hospital during this period.
Grab added that it has started recruiting more volunteers for its GrabCare service, which provides round-the-clock rides home for healthcare workers at a lower commission rate.
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SACRIFICES WEIGH ON FAMILY
For healthcare workers who play dual roles of frontliner in the hospital and caregiver at home, the work does not end even after they have changed out of their scrubs.
Dr Brenda Mae Alferez Salada recalled how, during the circuit breaker from April to June last year, she would return home after a long day at work to help her son with his home-based learning.
But unlike other parents who played the role of teacher during that period, the 40-year-old resident physician at the National University Hospital’s (NUH) division of infectious diseases could only coach her son through FaceTime and video conferencing app Zoom, even though they were living under the same roof.
That was because Dr Salada and her husband, who works at TTSH, had chosen to isolate themselves from their son and helper in order to minimise the risk of spreading the infection to them.
At the time, a lot was still unknown about the nature of the disease. They did not want to take any risks since she and her husband worked in the pandemic wards and the emergency department respectively.
Though they eventually reunited after a month when they were assured of the safety of hospital protocols and personal protective equipment (PPE), the family has recently been separated again because of the TTSH cluster.
Since Dr Salada no longer works in the pandemic wards, the family thought it is safest for her husband to isolate himself at a hotel.
“Initially my son was quite okay … but once they announced that (my husband has to stay away) until the end of the month, then it sank in, and he didn’t want to go to school because he didn’t know when daddy would come back,” she said.
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For Dr Crystal Soh, the most challenging period was during last year’s circuit breaker when she and her husband, who is an emergency specialist at TTSH, had to juggle long and draining shifts at work with coming home to care for their children, who were then one and three years old.
As the couple did not want to put their elderly parents at risk of infection, they decided to stagger their work shifts so that either one of them could be with the children while the other was at work.
“The most difficult part was it was very intense. At work we were seeing very sick patients, being in the full set of PPE all day, then we had to quickly bathe, rush home, and then do the kiddie stuff - draw, read to them, do home-based learning with them,” Dr Soh said.
“It was really a full day of work until they slept,” added the 32-year-old associate consultant at NUH’s department of emergency medicine.
Ms Norashinta Mansoor, 39, a clinic assistant and trained nurse with Healthmark Medical Clinic in Punggol, said the long hours mean that sometimes she would have to rush to the infant care centre to pick up her 13-month-old baby.
She has gotten used to the fact that Mondays, Tuesdays and Fridays are busiest at the clinic, which is also a Public Health Preparedness Clinic that conducts swab tests. On those days, she would alert her 11-year-old daughter that she would have to be home alone for a while as Ms Norashinta finishes up at the clinic.
PHYSICAL AND MENTAL TOLL
After over a year of fighting an arduous, seemingly unending battle against an invisible enemy, many of the frontliners interviewed admitted that it is hard to keep their chins up at times.
Many of them said the frequently changing protocols - that can sometimes happen in the middle of a shift - and the logistical adjustments that come with them, can be overwhelming.
For those who work in high-risk wards, the process of gowning up and spending a whole day in PPE is physically draining, especially for someone like Dr Soh, who now has to do this while pregnant with her third child.
Then, there is the stress of dealing with patients and their family members, who at times do not understand why these strict protocols have been put in place.
Dr Praseetha Nair, 33, an associate consultant at Khoo Teck Puat Hospital’s (KTPH) acute and emergency ward, recalled an incident where a critically ill elderly patient with a lung infection had arrived at the hospital with 10 other family members, and all of them wanted to come in and be with the patient.
At the time, the department was not allowing visitors, to curb the COVID-19 spread.
“It was particularly difficult explaining to this family (why they couldn’t visit him) … and unfortunately, it got to a stage where they were quite frustrated, and they took out their frustrations on my team and me,” said Dr Nair.
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Dr Nair said she and her colleagues have encountered a handful of similar cases over the past year, where families would ask the hospital to make an exception to let them see their relatives.
“But the responsibility falls on us to make sure that all our patients, and their relatives, are taken care of. Because there just needs to be one slip somewhere, and it can have repercussions down the road, like a domino effect, and we don’t want that to happen.”
She added that such incidents can take a toll on her because it leaves her constantly thinking what could have been done better to help patients and their families in the situation.
Dr Jansen Koh, chief and senior consultant at Changi General Hospital’s (CGH) respiratory and critical care medicine, said there are times when he and his colleagues struggle to hold back their emotions while caring for patients who are critically ill with COVID-19.
“They would not be able to have family members and friends at their bedside. Understandably, this makes the journey to recovery even harder for them. As healthcare workers, we try our best to be with them though we are all fully gowned up and have to minimise unnecessary contact,” he said.
For the young TTSH nurse, the gravity of her situation finally sank in halfway into her quarantine, and she found herself breaking down after a video call with her colleagues who were also in isolation.
“We weren’t even talking about anything specifically about (the cluster) ... I don’t know why but that was when it dawned on me that, okay, this is really happening to me,” she said.
“I think that was when the fear set in. I was thinking, ‘Oh no, what if I have (COVID-19)? What do I do next? What if I have to be hospitalised?’ I don’t think I can deal with being in the hospital on my own,” she added.
She had spent the days before trying to remain calm and staying strong for her family, but the isolation and psychological stress eventually became too much to handle on her own.
“Because I see that (my family) is so scared, I cannot be scared ... even though I’m the one facing it,” said the nurse.
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Another frontliner, Filipino staff nurse Princess Joyce Aguas, went through a tumultuous time when her family members, who live in Mexico, Pampanga, in the Philippines, contracted COVID-19 last month.
Her father was in critical condition after contracting the disease and her family was in crisis mode going around to different hospitals trying to secure him a bed.
“It was 6am and I was sleeping when my sister called me and told me, ‘Papa wants to be rushed to the hospital right now,’” the 33-year-old nurse from Farrer Park Hospital said.
“I got so worried that I cried … Over the phone I was telling them it’s going to be okay and to not be scared, but deep in my heart I knew it was bad.”
Ms Aguas, who has not seen her family since February last year, said she felt helpless at not being able to be there with them.
She had considered flying back then, but the next flight to the Philippines was a month away. That, combined with the lengthy quarantine period there and in Singapore, made it pointless to return home.
So she could only assist her family over video calls - giving instructions to her siblings and checking up on her father’s condition virtually. Her father has since stabilised.
Asked how she managed her emotions while keeping up with the daily barrage of work, Ms Aguas said that although she sometimes could not stay focused, she tried to remain positive and left her personal problems behind when she tended to her patients.
“It motivated me more that whatever care I wanted to give my family, I just gave it to the people who were in front of me. So that’s how I treated our patients here,” she said.
WHAT KEEPS THEM GOING
Getting through the tireless, long days can be difficult, but healthcare workers said they find strength in the camaraderie of their fellow frontliners.
While all of them expressed endless gratitude for the support from loved ones and friends, the healthcare workers said it is sometimes difficult for others to relate to the unique experiences of being on the frontline.
This is especially so when there are parts of the job that have to be kept confidential.
Dr Nair said: “I think as a result of this entire experience, I kind of bonded and got close to a few of my colleagues at work. It helped us that we were able to sound off each other and talk to each other.”
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Similarly, the young TTSH nurse said getting through quarantine has been made easier knowing that all her other colleagues are going through the same experience and rollercoaster of emotions.
Her bosses also schedule twice daily Zoom calls to check in with everyone’s mental health. She also has video call sessions with her closer colleagues in the ward three times a day to keep each other company.
“Unfortunately, I would say it’s a lucky thing where most of us are quarantined so we do have people who are going through the same thing during this period,” she said.
“Sometimes we will just video call to keep each other company, but we would all be doing our own thing.”
Dr Soh said at the peak of the pandemic last year, her colleagues would offer to take over her shifts, or offer their days off if she needed more time with family. They also reassured her that it was okay to be late for work if her husband did not come back in time to take over with the kids.
Dr Wong, the family physician, said his friends would offer to run errands for him. Some even offered to help him fight gym leaders on the mobile game Pokemon Go on his behalf, he quipped.
“It’s good to know that people are holding your back when you need them to,” he said.
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In response to queries, the hospitals said they have introduced various initiatives to boost morale and take care of the mental well-being of their healthcare workers.
For instance, TTSH has introduced a helpline and chatbot for staff who need counselling and emotional support.
The hospital is also working with MOH to provide staff who require alternative accommodation with a temporary place to stay. These are staff members who live with elderly parents, young children or immunocompromised individuals.
A National University Health System (NUHS) spokesperson said it has offered free counselling sessions for staff members to provide them with emotional support.
Resilience workgroups have been formed to strengthen staff wellness and mental health. NUHS staff members have also been provided with meals and refreshments during this period.
Mr Stephen Chong, CGH’s chief human resource officer, said it has run virtual health and wellness programmes - such as yoga, piloxing, and qigong exercise classes - to help staff members keep fit and stay emotionally resilient.
“Meals were also provided to frontliners whose movements may be restricted for infection control purposes,” he said.
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Meanwhile, Sengkang General Hospital and KTPH have a dedicated peer support team which staff members can reach out to when they need a listening ear.
Some healthcare workers have also pitched in with efforts to cheer up their peers and colleagues.
One of them is Ms Azrina Imran Tan, 26, an in-patient pharmacist at TTSH. She is part of the social committee in her department, where she looks after her colleagues' welfare.
When the TTSH cluster broke out and her colleagues had to be quarantined, she and the other committee members reached out to those in isolation to check in on their well-being.
Over the Mother's Day weekend, they prepared care packages for the children whose mothers were in quarantine to explain to them why the women could not celebrate the day with them.
Ms Azrina recalled that one colleague cried after she received a card with messages from their other co-workers.
“She said that she’d been feeling quite down… so when she received the card, she cried because she felt that even though she was physically alone, there were people looking out for her,” she said. “That touched me quite a bit.”
Ms Sim, the Ren Ci chief nurse, said she would often buy breakfast and snacks for her nurses to give them an energy boost, especially since they cannot dine together during or outside of work.
Aside from their colleagues, the frontline healthcare workers said they also felt encouraged by the love shown to them by members of the public and their own patients.
For instance, when the COVID-19 outbreak was at its worst last year, the hospitals received many care packages containing food, drinks and notes of encouragement.
Remembering that period, Dr Nair said: “I think those gestures were far from small because it’s a reminder that you’re being looked out for and that there are people out there who appreciate what you’re doing.”
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Dr Wong said his patients, who knew that he had cut back his clinic hours to volunteer at the community care facility, also gave him food, goodies and words of encouragement when they came to see him at the clinic.
Some of them would also plan their schedules around his by coming for their appointments earlier so that he could leave on time to make it for his volunteering shift.
At the community care facility, the migrant workers were also very appreciative, always expressing gratitude when they were being examined.
“It makes us feel good … at least we know that we are making a difference,” he said.
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GEARING UP FOR WHAT’S NEXT
Looking back on his experience, Dr Wong said he found it “quite incredulous” how he managed to survive those six months volunteering and running his two clinics in Bedok and Jurong.
Yet, he is now ready to head back to the frontline again.
Just last week, he received a call from the National Centre for Infectious Diseases (NCID) to help out at its emergency department. Of course, he said yes.
“I’m very blessed to be given this opportunity to help out, because I know that even among medical professionals, a lot of people want to do something and help, but they may not be given an opportunity, or may not be suitable to do so,” he said. “So even though it’s demanding, I’m also very fortunate that I was picked to help.”
This sense of duty was echoed by other healthcare workers interviewed.
Though the work can be tough, they are prepared to take on the challenges arising from a crisis, such as the COVID-19 pandemic, as this is what they have signed up for as medical professionals, the frontliners said.
Still, like everyone else, they, too, are looking forward to the day when the pandemic will be finally over.
When asked what is the first thing they want to do when everything is back to normal - albeit a new one - many of them cited much sought-after pre-pandemic luxuries, such as travelling, and being able to visit relatives living abroad.
But for some - such as the frontliners currently in quarantine - what they look forward to can be something as simple as the thought of finally going out to have a nice meal at a restaurant.
“Honestly, (I’m looking forward to) going out to places to eat. Or maybe just walking around shopping,” said the young TTSH nurse.
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