MANILA (Agencies): For Gio Pineda, a young doctor in the Philippines capital of Manila, the past few days have been among the most harrowing of his life. Pineda has been manning the triage section of his hospital’s COVID-19 emergency unit. With the more than 40 beds occupied by patients in critical condition, and the hallway lined with more patients in wheelchairs, Pineda had to decide who would get treatment and who would not.
He turned away more than half the people who came begging him to take in an ailing loved one, many of them struggling to breathe. Some even knelt in front of him, begging to at least be allowed to wait in the hallway. “Many of them said we were already the eighth or ninth hospital they tried, and if it were up to me, I really would have taken them in,” he said. “But there really was no room left.”
Patients are rushing to hospitals in Manila and its surrounding provinces amid an exponential spike in cases of COVID-19 that began in March. Many hospitals are at maximum capacity and even patients in dire need of treatment are being sent home. Many have died waiting for a hospital to call them back. The health department reported 10,098 new infections, bringing the overall case count to 936,133. Some 15,960 people have now died from the disease in the Philippines. At the hospital where Pineda works, doctors can now only take in a new patient when an earlier one has died. They are forced to choose from among those waiting outside who is most in need of attention.
“I was like playing God. That’s how I felt having to decide who gets a chance to live and who, sadly, will be left to their demise,” Pineda said. Although the Philippines is one of Southeast Asia’s worst-hit countries, average daily cases of the coronavirus had dropped to a more manageable 2,000 in late 2020. But the new wave – thought to be the result of more contagious variants of the virus – appears to have caught the healthcare system unprepared.
Angelo Barrera, a game developer from Manila, lost his father to COVID on March 28, after 20 hospitals turned them away because they had no beds, he told Al Jazeera. “I need you to understand that this is the government’s fault,” Barrera said in a social media post that has gone viral. “Every hospital is full. Home care is the only option. Medical machines are in high demand and in low stocks. Access to emergency care is nonexistent. How can I not blame the incompetence of the people leading us?” Barrera continued.
But even as the pandemic accelerates and people point the finger at his government, Philippines President Rodrigo Duterte has shown little urgency to tackle the surge. “There is nothing we can do about it,” Duterte said in a televised address a week ago. A few days later, when pressed on the slow pace of the vaccination drive, Duterte said: “We have a long way to go. I’m telling you, many more will die because of this, I just can’t tell who.”
Critics have condemned Duterte’s statements, saying they betrayed a defeatist attitude towards the pandemic. “The lack of a sense of urgency – I think that’s the fundamental problem,” said Dr Anthony Leachon of the government’s pandemic response. Leachon is a health reform advocate and a former president of the Philippine College of Physicians. “People are dying in their homes. People are expecting a leader in command, or even just a compassionate leader that they can depend on,” he added.
Duterte has also been under fire for his low profile. Before last Monday’s speech, he had not been seen in public for almost two weeks. To dispel rumours that he was ill, the president’s office released photos of him playing golf and riding a motorcycle, and a video clip of him jogging. All these as the country grappled with its highest-ever daily caseloads of the coronavirus, forcing the capital region and nearby provinces into another hard lockdown. “The messaging is wrong,” Leachon told Al Jazeera. “It may result in Filipinos getting demotivated to put up a fight against the pandemic.”
Duterte insists his administration’s response to the crisis has “lacked nothing”, but experts say the surge in infections could have been better managed if the government had taken steps to improve testing and contact tracing when the local epidemic somewhat stabilised in the second half of 2020. Leachon notes the government task force in charge of the pandemic response lacks members with the right expertise. The COVID-19 testing chief, for instance, is an economist who insists that widespread testing is unfeasible, despite other developing countries managing to do so.
Many of the officials who make up the task force are military and police generals, reflecting Duterte’s preference for taking a law-and-order response. Leachon, who received the Outstanding Filipino Award for Medicine in 2010, used to be part of that task force, but he was sacked in June 2020 after his criticism of certain policies offended some in Duterte’s cabinet. “It’s political. When you actually suggest something, if it is opposite to their opinions, they don’t follow it, even if it’s backed by research,” Leachon said. At the Quirino Memorial Medical Center, one of the largest COVID-19 referral hospitals in Metropolitan Manila, doctors and nurses are steeling themselves as they face an overwhelming number of critical patients every day.
The hospital has a 50-bed emergency ward especially for COVID patients, but there have been so many cases in the last three weeks that at some point, they have had to squeeze in 57 patients, said Mylene Mangalindan, the facility’s head nurse. “That was despite very stringent screening at triage,” Mangalindan told Al Jazeera. “There’s too many of them, and we are understaffed.” Hospitals have had to reduce the number of doctors and nurses on each shift to allow time in quarantine for those who get exposed to the virus. This means those on duty now have to work longer shifts – 12 hours in Mangalindan’s case – and watch over more patients than they used to.
Many of the younger nurses have quit on orders from their worried parents. Some doctors in training have put off their residency for when the pandemic ends. Those left behind are forced to make up for the shortfall. “I’ve noticed the doctors are getting exhausted. Maybe it’s because there’s been a lot of casualties among us, and the majority were doctors,” said Mangalindan, who also came down with COVID-19 last August. The emergency ward staff soldier on, but Mangalindan worries that patients might be receiving less-than-ideal care and attention. Meanwhile, their patients’ despair is starting to get to them.
“Compassion fatigue is becoming a threat to us. It hits us hard when we lose a patient. People think we have no emotions, but we’ve actually run out of tears. We’ve cried ourselves dry,” Mangalindan said. It is hard to have one patient die, but lately, the average has been four to six deaths every shift. Once, Mangalindan had 13 patients die in the hours she was on duty. “I had to ask my boss for a break because, suddenly, the fatigue set in, and I started to feel really weak,” she said.
The Philippines is also suffering the consequences of being the world’s leading exporter of doctors and nurses, said Dr Jose Rene de Grano, president of the Private Hospitals Association of the Philippines. Salaries of medical staff in the Philippines are so low that most of them find jobs overseas after a few years of working in local hospitals. From January to October last year, even as the pandemic took hold, some 10,000 Filipino nurses left the country to work abroad, according to government data.
At home, government hospitals offer relatively higher salaries than private ones, so nurses at private hospitals tend to quit as soon as they find jobs at public institutions. Without the medical staff, hospitals are unable to make more beds available for coronavirus patients even if they wanted to. Meanwhile, the pandemic has discouraged people from going to hospitals unless they absolutely have to, causing revenues to plunge.
Worse, de Grano says the government’s health insurance agency, called PhilHealth, owes private hospitals billions of pesos in reimbursements of COVID-19 patients’ hospital bill claims from the past year. The country’s public health system depends largely on PhilHealth covering a fraction of Filipinos’ hospital bills. The extremely poor and the elderly get automatic coverage, while the rest pay a small premium for membership of the system. PhilHealth works by guaranteeing hospitals it will reimburse the costs of members’ medical treatments, albeit often at a much later date. PhilHealth is in arrears to the roughly 700 hospitals in de Grano’s group for an estimated 6.6 billion pesos ($140m) in coronavirus-related claims, the doctor said.
“These are reimbursements. These aren’t debts. We’ve already spent that money for patients who are [PhilHealth] members, but they refuse to pay us,” de Grano told Al Jazeera. PhilHealth has been the subject of a government investigation for corruption, after 15 billion pesos ($310m) was allegedly embezzled from the agency. It has denied rumours of bankruptcy. PhilHealth declined to comment to Al Jazeera on the situation.
According to local media reports, PhilHealth said it postponed the payments because it found a number of hospitals’ claims to be fraudulent. In any case, de Grano says many private hospitals will be forced to further downsize or close down if PhilHealth does not pay them back soon. To cope with the still-rising number of COVID-19 patients needing hospitalisation, in late March the government hired more agents for its hospital command centre, to take calls from patients and direct them to vacancies. But unable to provide aid beyond 1,000 pesos ($20) for poor individuals, the government has slightly eased lockdown rules in the capital region to allow people to get back to work.
Local scientists like Leachon worry that will leave the country in COVID-19 limbo, especially given the slow rollout of vaccines. Only 1 percent of the 110 million population have received at least one dose so far, and the stock is dwindling fast. The remaining doses needed are only expected to trickle in throughout the year. Pineda, the young doctor, says he understands the desperation of patients and their families. Although he tries to explain why he has to send them away, often they are convinced only when he takes them over to the emergency ward and shows them the grim reality of the situation through the small window in the door. And then they continue their desperate search for a hospital bed and life-saving treatment. “At those times, my only prayer is that they find an institution that can take them in, that they find a hospital or clinic with a bed, medicines, and a doctor or nurse who can attend to them,” Pineda said. “And that hopefully they won’t die at home or on the road.”