From the Front Lines: The Philippines

I am a primary HIV care physician, called in for duty to serve suspected, probable or confirmed COVID-19 cases. I have been working in our HIV clinic for years now and I have to admit that I am not used to doing ward duties and ER duties anymore. But I have to. Our people need us health care workers. And so, we set aside our HIV care, to give service for COVID-19 care.

Our institution acts as the referral laboratory for the whole country for the SARS CoV-2 PCR test. But when it comes to patient management, we have a very limited number of beds in our ER and in our ward. A lot of people come to our institution for evaluation and testing. But due to the limited capacity of our hospital, we cannot accommodate all of them who have to be admitted and have to transfer some to other hospitals for care. For those waiting 24-48 hours for a vacant bed or for other hospitals to accept their transfer, it’s hard seeing some of them just sitting or lying down on our metal benches, especially the elderly. We try to think of ways to give them a little more comfort, but I guess we also just have to accept our real situation.  

I guess it’s a good thing that I’m used to counselling in my HIV clinic, as we have noticed that patients who got infected with COVID-19 are also prone to mental health problems such as anxiety and depression, and they experience stigma from getting the virus. During rounds one time, we were very excited to tell the patient that his latest swab turned out negative for the virus and that he has already recovered. He showed a little smile upon hearing this. Curious, we asked him if he is not happy with our news. He told us that he is scared to go back home because he heard from his family that they got death threats if they do not leave the village and relocate. Wondering how their neighbors found out he got infected, thinking about their safety and the stigma he is now facing, made him worry more than being happy that he is now recovered from the virus.

This is not the only story about fear of going back home, fear of their neighbors’ threats and fear of other people’s stigma. As much as we want to explain it to them medically in an understandable way, we still sometimes feel helpless because the problem now lies in the society.

My part in the current COVID-19 response may not be handling and saving the critical ones fighting for their lives. I may not be the one intubating the patient, pronouncing deaths of patients and explaining it to their families. It is still exhausting, however, physically and emotionally. Out of nine doctors in our team, two have been tested positive though they are asymptomatic. I am not afraid of getting the virus. I am actually afraid to be the carrier of the virus, especially with our family.

But in the midst of it all, we still try our best to smile, and be happy in our hospital duties especially during our ward rounds. We may never know if a simple smile, a simple “how are you”, or maybe a gentle touch, can go a long way with our patients.  

Dr. Anna Maureen (Mau) Dungca-Lorilla is a D43 Fellow in an HIV and mental health research and training program in the Asia-Pacific region. She is practicing as a primary HIV care physician at the Research Institute for Tropical Medicine, Philippines. Her D43 research training is focusing on integrating mental health services and research into HIV care.

D43TW011302 (Sohn, Wainberg): CHIMERA (Capacity development for HIv and MEntal health Research in Asia)

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