Lifeboat

Day 13. We stay home, keep our distance and wait. Outside, the uncertainty can be smothering. Stay disciplined and we will get through this. For now, we rely on the sublime sacrifice of doctors, nurses, technicians, lab personnel, orderlies, hospital aides and other health workers in the front line.

As professionals, they are sworn to help the sick to the best of their ability and judgment; devote themselves to the welfare of those committed to their care. But, in truth, no law compels them to put themselves in harm’s way.

The Philippine Medical Act, R.A. 2382 provides 12 grounds for suspension/revocation of medical licenses. Under the statute, no physician is penalized for refusing to attend to a patient in danger of death should there be a risk to his own life.

We’d like to make their burdens lighter and help in every way. They’ve never asked for anything. However, after the events of the past days, there is one clear request from the front line. Kindly deliver them from the “feeling entitled”.

These heroes have embraced danger out of a sense of honor and duty. They do this without reservation nor bias toward any man. But they did not sign up just to prioritize the psychosis of those who believe themselves privileged. “The PMA thus calls upon our government officials to please refrain from being treated as VIPs and, better, please follow protocols as we are all in this fight together.”

The great equalizer. Truly, COVID-19 discriminates against no one. In Spain, as in Wuhan, they nationalized private hospitals. The Malacanang certified Bayanihan Bill initially spoke of “temporary take over” of private hospitals. The final version says the President can “direct the operation” of private hospitals with management retained by the owners. Taken over or directed, the intent is to maximize all the space and to burden the already overstretched doctor/nurse to patient ratios as necessary. They need all the help.

Statistics.Doctor to patient ratio: 1:33,000. Nurses: right now, in Metro Manila public hospitals, its closer to 1:30 and can go higher. In private hospitals, the ratio can go down to 1:4. Hospitals: 1,071 Private and 721 Public. 1 bed for every 1,121 patients. Ventilators: 1,572 nationwide. 423 are in Metro Manila. Unaccounted for are the commercially available units.

Private medicine focuses on the diagnosis, treatment and care of the patient. Public health emphasizes the prevention of disease and promoting the health of the community.

The role of governance. We spoke with our great friend, top vascular surgeon and scientist Dr. Ricardo DT. Quintos, who has served in high office in both public and private health institutions, on what we’ve learned so far.

The pandemic is not just a medical problem to be solved medically by medical experts. For a pandemic, we need much more than an epidemiologist who will call for the lockdown in the interim while scientists scramble to find a cure or at least a treatment to allow for management of symptoms.

We do need a “whole of society” approach with coordination between: (1) a mature political leader who executes the call for the lockdown and forms the pandemic agency which harmonizes all efforts; (2) a health agency which manages all proactive measures including monitoring census, medical developments, and directing good practices and protocols; (3) a capable police force to enforce the lockdown and maintain peace and order; (4) logistics/supply experts that guarantee health equipment, food and economic resources continue to reach targets; (5) a trade and industry agency to monitor and direct manufacturing and service industries to maintain viable production; (6) an active information office which serves as a credible, ready source of information so as to avoid resort to informal sources of untrustworthy information; (7) a well-funded social welfare agency to provide benefits preferentially but not only to the marginalized, but also to those severely affected by the lockdown; (8) the leagues of local government units for more cohesive policies across territories; (9) business groups, non-governmental organizations, the medical associations and the academe to provide perspectives of partners in nation re-building.

Without a unifying head to oversee the coordination, all efforts would be small and piecemeal, relying on the initiatives of the private sector and the citizenry. This will not be sustainable over the long term.

The task of the coordinating agency on the surface will be to find solutions. Ultimately, it will be to lay down the groundwork on how things may be better done in the future.

Heal as one. The Bayanihan Law is a major step. We welcome the appointment of Ret. General Carlito Galvez, former AFP chief of staff with a background in crisis management. Please see to more widespread testing, immediately. Thank you, Dr. Rosario Vergeire and Cabinet Secretary Karlo Nograles for the good job as faces of our Health and IATF efforts.

This is a time for solidarity moving forward. Lets all row our boat to the same beat, with some tasked to plug leaks, some to throw out the water, some to set direction, and some to steer. We can’t be merely passengers now as we have the greatest stake in making the crossing in one piece.

We share this excerpt from NYT opinion columnist David Brooks on the Moral Meaning of the Plague:“Victor Frankl, writing from the madness of the Holocaust, reminded us that we don’t get to choose our difficulties, but we do have the freedom to select our responses. Meaning, he argued, comes from three things: the work we offer in times of crisis, the love we give, and our ability to display courage in the face of suffering. The menace may be subhuman or superhuman, but we all have the option of asserting our own dignity, even to the end.”

Passages.Our heartfelt condolences to the family of Dr. Kiko Lukban. We thank you and your fallen colleagues. We hope to deserve your ultimate sacrifice.

Senate President Ernesto M. Maceda would have turned 85 last March 26. Thank you to all dear friends who remembered.