San Lazaro Hospital (SLH) is a Special National Hospital Medical Centre for Infectious Diseases in Manila, Philippines. It is where the first case of COVID-19 in the country was confirmed and treated.

MSF boosted SLH’s COVID-19 testing, data management, and COVID-19 case management through the support of additional healthcare workers, biomedical equipment, medicines, medical supplies, personal protective equipment, training for infection prevention and control, and some infrastructure improvements.

In SLH, MSF staff witnessed first-hand the fear that the pandemic caused in patients. Ryan Jopia, MSF nurse said, “COVID-19 incites fear in everyone, including healthcare workers like us. When patients see nurses and doctors, all they see are people in protective suits and not the people inside. It was a challenge to fully connect with our patients.

“I saw how COVID-19 prevented people from seeking consultation and hospital confinement, perhaps due to quarantine protocols in their communities, or out of fear of contracting COVID-19 in healthcare facilities.”

Patient-centred care

Despite the challenges, the staff provide more than just care for the patients – they offer hope and joy. MSF nurse Rhomina Suan said she was fortunate to care for both patients and SLH staff. “When this patient was admitted last August, she was very worried for her two kids, aged nine and 15. Upon admission, the only symptoms she had was a fever and sore throat. Her swab test, even after a week of hospitalisation, remained positive,” said Suan.

“A few days later, her oxygen saturation declined, requiring the use of a Non-Rebreather Mask (NRM). We started her with another dose of antibiotics. She became more anxious, frustrated even.”

However, the patient was very grateful for the care that Suan provided. “She always recognised my voice when I entered her room. She always said, ‘Mina, you’re very cheerful, aren’t you? You’re so carefree!’ I responded, ‘Of course, ma’am, I want you to be as energetic as I am! Just remember, our goal is for your oxygen levels to go up, so we can remove the NRM.’

“I just wanted her to be more positive regarding her condition. I advised her to talk to her kids often and to call her twin sister in the US. I always reminded her to take her medicine, to gargle with the prescribed mouthwash, and to try walking around her room without the oxygen support,” adds Suan.

Although Suan wasn’t present for the discharge, the patient made sure to send a personal message to say she was going home, grateful for the care she received.

Support beyond medicine

Marlon Silorio, who worked as a hygiene agent at SLH was also very sensitive to the needs of patients. “I was a COVID-19 patient, and I know how difficult it is to have the virus. I felt that I was alone, and nobody wanted to come near me. It was so hard to feel really alone. I was so thankful that I recovered from COVID-19,” Said Silorio.

Silorio could empathise with the pain and loneliness of the patients at SLH: “I thought about what I could do to help them in my own way, especially since I didn't know anything medical. So in every room I cleaned, I made friends with the patients. I talked to them, I tried to understand them.”

He decided to do what he could to ease their discomfort. “As a hygiene agent, it is not my job to bring food to the patient's rooms, but I did it anyway because I wanted the patients to be able to eat right away, especially since they have no visitors who can bring them food. When I entered their room to deliver their food, I see them smiling, saying ‘thank you.’ When they are discharged from the hospital, they want me to be the one to take them down to their relatives.”

Learning and collaborating

Working at the hospital also proved to be a great learning opportunity for the MSF team. MSF nurse Chevi Sestoso worked in triage. “We were exposed to different kinds of communicable diseases, so we had to be more vigilant, and to practice strict Infection Prevention and Control (IPC) procedures. Even a minuscule breach can result in infection,” she said.

Sestoso learned that patient care meant more than checking for symptoms. “We served as the support system of patients. COVID-19 wreaks emotional havoc on patients and their relatives. We worked to uplift and support patients, addressing their concerns, but also to provide comfort to distressed relatives.”

Dr Robby Reyes added, “It is important to work as a team and to closely collaborate, not only with fellow doctors but also with other healthcare workers, to provide the best care possible for the patient and at the same time protect the healthcare workers.”

Support, in numbers

San Lazaro Hospital initially had two COVID-19 Intensive Care Units that could cater for ten patients each. There was also one ward with 20 beds, one adult male ward housing 20 patient beds, and one adult female ward with 20 patient beds. The number of cases peaked in the last week of July.

MSF supported SLH with eight staff to assist at the Departments of Laboratory and Epidemiology. MSF also recruited five doctors and nine nurses, who supported the COVID-19 wards, COVID-19 triage and the Tuberculosis ward. In addition to staff, equipment and medicine, MSF also supported SLH with infrastructure improvement.