COVID-19: Support staff at Singapore hospitals work quietly behind the scenes as cases increase
SINGAPORE: Somewhere within a sprawling hospital complex, a troop of personnel are hard at work.
Gloves, goggles, masks. They have different roles.
There’s Mr Chakshu Malhotra, a fresh face just over two months into the job. There’s Mr Issac Asirvatham, a seasoned hand with over two decades of experience.
They transport swab samples, clean the wards, escort the patients, change the laundry.
Porters. Housekeepers. Security officers. Linen services.
They are the ones you see but don’t always hear much about.
'MY ROLE IS TO MAKE THE PLACE SAFE'
As night turns into day, housekeeper UM Pushpa Kumara begins his shift at the National Centre for Infectious Diseases (NCID). He is miles away from his home in Sri Lanka, far from his wife and his three-year-old daughter.
But he has assured them that he will be fine.
"They told me to be safe. But I already told them, we have proper training and wear PPE (personal protective equipment). I video call them every day ... so they are not so worried about that," he said.
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As part of his role, Mr Kumara has to don the full PPE - this includes an N95 mask, goggles, a shower cap, gloves and a plastic gown. And this gives him the assurance that he can do his job well.
"I clean the rooms, the toilet, the ward area and the corridor area," explained Mr Kumara, who is employed by ISS Facility Services. "When the patients are discharged, we help to provide thorough cleaning (so that the ward is ready).
"When there are more patients and more discharges, we have to clean the wards as soon as possible for the next patient," he said. "We have extra workload but we have to manage it."
On some days there can be between 15 to 20 patients being discharged from the NCID wards, meaning Mr Kumara is being constantly kept on his toes. He has an hour-long lunch break, but this can be cut short at times.
"It's true but that's nothing to worry to about - we have to do our job," he explained simply. "I am happy to help sick patients."
There's also the "high-touch areas" that need wiping down several times a day - these include countertops as well as the staff pantry.
"It's mostly used by doctors and nurses," Mr Kumara explained. "My role is to make the place safe for everybody and I help clean everywhere."
The role potentially puts Mr Kumara in close proximity with COVID-19 patients, but he isn't fazed. "I'm very confident in what I do," he told CNA. "When the place is clean and tidy, then I am happy.
"Everybody who works in the hospital is a frontliner. We are helping each other and we are frontliners. I believe that I also should do my part as part of the team."
'IF WE DON'T SUPPLY LINEN, PATIENTS WOULD BE NAKED'
Mr Issac Asirvatham manages a team of 22. Combined, they handle the needs of a whopping 1800 beds - 1500 in TTSH and 300 at NCID.
"Bedsheets, blankets, towels, pyjamas for patients, curtains, anything to do with linen in the ward is all under us," explained Mr Asirvatham, who oversees linen operations. "I make sure the schedule is properly drawn up, all the linen is supplied to the required wards.
"We outsource to two laundry companies and we have to make sure that they wash according to our infection control standards. It's part of my job to look into these things."
With more beds filled at the hospital due to the COVID-19 outbreak, there is more demand for linen, explained Mr Asirvatham. The hospital is also working with its outsourced laundry service partners to ensure that the turnover of laundry is done within 24 rather than 48 hours.
"I now work 12 to 14 hour shifts, depending on the day," he said. "The usual was about nine hours ... I want to make sure that everything is properly done, nothing is missed out, before I leave."
Mr Asirvatham and his team do not need to enter the wards to collect linen. This is a duty is done by the housekeepers, and the linen is then sent down in a chute system in laundry bags. Members of Mr Asirvatham's team are stationed at the basement and will load these bags onto lorries.
When the clean laundry is sent back to the hospital, another team sorts it out, before making use of an automated trolley to send linen back to a dedicated laundry stall. When the trolley reaches the stall, the nurses then remove the linen and bring it to the ward.
Working in a similar role during the 2003 SARS outbreak, Mr Asirvatham said that things have changed at the hospital since then.
"During the SARS time, we didn't have the NCID building, only the main building here," he said. "The SARS outbreak was short-term - six, seven months. This one is still unknown. So that is a challenge."
To prevent cross-contamination when handling the dirty linen, which could potentially be from COVID-19 patients, members of the team wear t-shirts and medical scrub pants rather than usual uniforms.
They also don a mask, apron, gloves when performing this task.
"At the beginning there was concern, but I slowly taught them that we'd done this during SARS before ... We can manage," said Mr Asirvatham. "We are very important. If we don't supply linen, patients would be naked!"
'IT'S JUST PART OF MY JOB'
Mr Chakshu Malhotra's role sees him stationed at the NCID screening centre.
He helps collect swab samples from the screening centre and bring these samples to the laboratory. He also helps to wheel COVID-19 patients to their wards.
"Before I go into the screening centre, I have to wear (full) PPE," he explained. "We have to remove the PPE once we come out to send the specimens (to the laboratory) ... If the patient is confirmed (to have COVID-19), we also wear full PPE when sending them to the wards."
And having only joined the hospital in February, he knows nothing other than this new normal.
"To be very honest, it was very uncomfortable (to wear the PPE) at the beginning," he added. "When we are wearing the N95 mask, it's very hard to breathe. We have to take a break after every two hours to relax ... Now it's fine, but in the beginning, it was hard for me."
And in the last few weeks, work has become increasingly busy for Mr Malhotra even as more patients are being admitted.
"(At first) it was worrying that I am working in a 'high-risk' area," he explained. "But ... our colleagues like doctors and nurses, they are also working here to help patients. So it will be fine ... That's what motivates me to keep working."
While the job can be tiring at times, Mr Malhotra said he has got used to its routines and demands.
"I am very proud to work here to help people who are facing this problem (of COVID-19)," he added. "Sometimes it feels like (being a) hero, but it's just part of my job."
'WE ARE SUPPORTED BY THE PUBLIC'
When it comes to security operations, Mr Jason Tan runs the show at TTSH and NCID.
Mr Tan's duties include conducting PPE training for security officers, as well as updating officers on routes for COVID-19 patient transfers within the hospital.
There are a team of 18 officers under his charge, as well as a number of outsourced officers.
"Our duties started to change in February when Singapore raised the level DORSCON (Disease Outbreak Response System Condition) Orange. We did a lot of 'locking down' because our hospital is an open concept so people can come from anywhere and at any time," he said.
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"So, once we turned DORSCON Orange, we locked down a lot of the entrances ... At the beginning we had to do a lot of barricades and signages to ask people to use the main entrance, and make sure that people who came to our hospital were being screened."
But as the COVID-19 outbreak escalated, the number of patient transfer duties has increased drastically, said Mr Tan.
Currently, the hospital performs about 150 COVID-19 patient transfer duties per day - this includes escorting them to ambulances where they are sent to Community Isolation Facilities, as well as transfers within the hospital.
Officers have to put on full PPE when they carry out these tasks, said Mr Tan. Two officers usually accompany a porter and a nurse when patients are transported within the hospital.
"Our duty is to clear the way so that the patients don't get into contact with our staff or the public," he explained. "Normally we plan (transfer routes) together with the infectious control or the different departments and I communicate this with officers on the ground performing a transfer.
"We have to inform people before patients pass by. Sometimes it's necessary that we do some blockage or put up signages to inform people that patient transfers are in process."
The amount of hours spent on shift has also increased, up to 12 a day, said Mr Tan. The security officers also now work on weekends.
But he believes that his officers remain motivated, with the support they receive from members of the public particularly helpful.
"Currently, everybody is tired. But we are supported by the public - they give us gifts of appreciation, they thank us and support us," he explained.
"Some support us with food, so our people are very happy that they are appreciated in these ways," he added. "So this is what gives them the morale to continue with their jobs."