Our hospitals need help

Today marks the 5th SONA of El Presidente Duterte. Dios magauban kanimo. You will need all the protection today both physically and spiritually because our countrymen is no longer happy. We continue to suffer. And the sad part is that government has not made it any better.

Let’s see if there will be anything new in what the President will say today. In the meantime, I am printing this letter of my late father’s kidney doctor, Rose Marie O. Rosete-Liquete, MD, FPCS, FACS. She is the Executive Director of the National Kidney and Transplant Institute. She wrote this “open letter to all those concerned” last July 21, 2020.

The COVID-19 pandemic has shaken our health care system as well as the operation of all hospitals in the country. What were once reliably functional health institutions, one by one, have reached their limits and operating capacities. While we catered and had provided “mass testing” to overseas Filipino workers and locally stranded individuals, we have failed to give attention to those “medically vulnerable” and are in need of immediate assistance of the Government.

Everyday, the NKTI’s doorstep is flocked by patients who have nowhere to go for their dialysis treatment. This is because of various reasons, such as refusal of the dialysis center due to being COVID-19 positive or having symptoms thereof; closure of dialysis center due to resignation of nurses fearing the virus; closure of dialysis centers due to depleted funds. Most, if not all, of these dialysis centers have not received their reimbursements from PhilHealth for a very long time.

We, at the NKTI, have the most vulnerable patients. Just imagine numerous chronic renal patients with comorbidities – commonly with hypertension, diabetes, and often also with heart diseases – inflicted with the Corona Virus Pulmonary Infection, all trooping to NKTI. If I were to show you X-Rays of these COVID-19 positives/ suspects, with practically no lung segment aerated, you would say, “How could anyone live with this?”. These are the extraordinary patients we cater at the NKTI.

Not one of the officials came when our tents bloomed to the maximum and scorched under the sun, and later, stormed by Typhoon Ambo. But we survived. Kaya ng NKTI ‘yan. Yes! Kaya kung kaya! Kinakaya!

But now, we have a lot of healthcare workers who tested positive for the virus, currently averaging at 4-6 HCWs a day; from yesterday’s 164 workers to today’s 174. Most of these workers are our nursing fleet, nephrologists, internists, and MedTechs. Yesterday alone, 4 of our anesthesiologists tested positive. Would anyone be safe being taken cared of by probable carriers at the NKTI? Whether the virus has come about from caring for positive patients or from the community is now moot and academic. The reality now is that our manpower is dwindling. We could have threatened to close down our facility like other government offices, but we could not as almost all patients who come to the Institute are dialysis patients. And a day or two of missed dialysis would mean death.

For many weeks now, our COVID-19 facility has had 100% occupancy and dialysis patients from other centers keep flooding our already congested emergency room. Our COVID-19 tents, for some time, have decongested the emergency rooms but now that the rainy season is here, they have to be dismantled.

The Emergency Room remains congested. The hot zone is full. This is a call for your help to solve the situation. (1) To All Emergency COVID-19 (Suspect or Probable) or Non-COVID-19 Patients: please find a way to transfer to your hospital of choice. If you are positive, please go to the Lung Center of the Philippines or to the Jose Rodriguez Memorial Medical Center – our quadrant referral center for positives. Again, NKTI is already full.

(2) Capacitate the Local Government Units and the hospitals in the NCR to increase their bed capacity for COVID-19 patients as well as increase their dialysis stations; (3) Encourage /mandate the opening of free-standing dialysis centers for COVID-19 positive patients. This is only feasible at this point by reimbursing them of their PhilHealth claims and advance for their services. Today, dialysis expense has increased due to extra precautionary measures such as the purchase of PPEs and the use of hemoperfusion cartridges (costing around P25,000.00) to filter impurities and cytokines; (4) For the swabbing centers in the localities and/ or barangays, please prioritize patients especially those on dialysis, with or without symptoms. In most centers, dialysis patients are asked for the results of their swab, and are further required to submit two negative swabs, should they test positive, before they are taken in for treatment. Better still, find a way to swab patients in all dialysis centers.

For the NKTI, one of our plans is to build a temporary dialysis facility. However, this will not be realized until the illegal occupants in our property are ejected. If constructed, NKTI will need additional 50-60 personnel for 30 new stations. Where do we get them? It would take another long process to secure the DBM’s approval for additional plantilla positions. Currently, we have already closed a ward to install additional dialysis machines.

Still at NKTI, it is not possible to convert our non-COVID-19 rooms to COVID-19 isolation rooms. We already closed down 3 non-COVID-19 wards because we already lack nurses. On top of that, we have other non-COVID-19 patients to attend to, most especially transplant patients who are already immunocompromised. The Hospital “hotzone” is already like a petri dish, steeming with COVID-19; we don’t want HCWs to cross from one area to another. The most plausible plan would be to close the second floor (hotzone – 32% of our occupiable beds). But this would mean defying the Memorandum Order of the DOH. Aside from controlling COVID-19 in our facility, this move will also address our shortage for manpower.

Capacitate our Quadrant Referral Centers: Jose Rodriguez Memorial Medical Center, Lung Center of the Philippines, and the Philippine General Hospital, so they can accept not only COVID-19 positive patients but also those who are suspects and probables, on dialysis or not.

At the onset of the pandemic, NKTI patients suffered from the longest waiting time for the result of the PCR tests. We recently got our license to operate with RT-PCR and the GenExpert using our own machines and procured consumables. However, the PHIC will only pay a miniscule amount (P3,409.00) without allowing us to collect co-pay. This alone will deal a great loss to the Institute – finances which could maximize our operating capacity. We appeal to the PHIC to increase the charge to P6,400.00. At this point, it is noteworthy to state that the PHIC does not reimburse GenExpert expenses.

Many government facilities have donated to different facilities, one way or another. And while NKTI has practically knocked on all doors but still, our letters, our pleas, have not been fully answered.

Do you think the President, the DOH and the 70 famous congressmen can do something about this? Will they heed the call of our government hospitals? The numbers are rising. Shouldn’t they be decreasing?