The medical care system was the most affected by the Covid-19 pandemic. Hospitals in the Philippines suddenly grew ill as they had to deal with the huge number of people with Covid-19 brought to them daily. With the constant influx of Covid-19 patients, they became worried about how to take care of the non-Covid-19 ones as well.
The non-Covid patients themselves became anxious. How will they go to the hospital for treatment or consult their doctor without getting Covid-19?
The hospital in the limelight last year was the Philippine General Hospital (PGH) in Manila. When it was chosen as one of the country’s Covid-19 referral hospitals last March 2020, it was unprepared to deal with Covid-19.
During the most recent webinar organized by the University of the Philippines titled “Hospital Design: Nakakatulong ba sa Pandemya,” under its “Stop: Covid Deaths” series, Dr. Gerardo “Gap” Legaspi, PGH Director, said they now intend to use their experience with Covid-19 as preparation for future pandemics.
He credited the PGH personnel at that time for their able handling of the hospital’s operations. Looking back, Dr. Legaspi said for a hospital to effectively respond to a pandemic like Covid-19, special attention should be given to infrastructure elements.
The most important part was ventilation, since the PGH is a non-airconditioned facility. The PGH has high ceilings and big windows. They had only seven days to prepare the wards so they knocked on the doors of exhaust fan makers to supply PGH with almost 250 fans.
Together with architects and engineers, they studied the airflow design to optimize the air flow as it passes through the wards. They came up with the “unidirectional natural air flow” system where fresh air is sucked from one side. This causes a negative pressure effect, then pushes the air to the other side or upwards, which was done through the fans.
“To know if the air flow is really directed towards the open garden area, we only used strips of tissue paper to show us that windflow to the wards is adequate. We’ve done this since March last year, and it is still operational up to now,” Dr. Legaspi said.
Another element to consider were the open spaces in terms of storing equipment, food, donations, PPEs. He said the PGH was fortunate enough to have a lot of open spaces which they utilized to their advantage. The Atrium, which was built in 2019, became a bike parking area and drop-off point for mostly donated supplies. “We even used the atrium as venue for our Christmas party last year amid the pandemic that allowed us to enjoy the camaraderie, and vaccination site as well.”
With regards to isolation, Dr. Legaspi admitted it was all makeshift at the start, mostly plastic and wood. Now it is all aluminum and glass. As a response to long-term Covid-19, the PGH came up with the “Bayanihan Na! Isolation Unit,” an isolation ward composed of 42 beds, 11 of which are ICU-capable, with a negative pressure ventilation system, and air is Hepa filtered and UV treated. It is separated from the main pavilions to make them Covid-free and with no disruption in operations flow and processes. Visibility was also increased through windows so doctors can see the patients, limiting PPE use.
Refuge areas were also provided to deal with health-care workers’ longingness, anxiety, stress, overall mental health. The garden was refurbished with a coffee shop in the middle of the hospital. “This is not something we’ve had in the PGH in the past, but our health-care workers needed intervention, including accommodation facilities.”
Structures are not enough, he said, so the PGH provided a human touch to the refuge areas to make caring for health-care workers complete, from reminders to moisturize after prolonged wearing of face masks, including psychosocial and spiritual/emotional care.
Also in the offing is the construction of a 15-storey multispecialty building designed to be pandemic-ready, with features that can be activated during a pandemic.
Dr. Legaspi also said the PGH came up with a proposal for a Service Delivery Network (SDN) called “One Ward,” a model composed of hospitals in the National Capital Region (NCR). The network is composed of a “Command Center” that will dictate which patient goes to what hospital, a link that connects all the hospitals. What will also make the SDN concept work is through common “financing,” an assurance that they will get paid for whatever services they rendered.
“The concept was borne out of the ability of hospitals to commit what type and how many beds they can to a common pool of beds that will be used as a virtual, NCR-wide hospital that will assure patients they have a hospital to go to,” he explained.
Another option is to have an actual hospital facility, where one hospital in the SDN can be closed down completely and turned into a “Mega Covid Hospital” to relieve other hospitals of Covid patients so these hospitals can serve the non-Covid ones, with the Mega hospital being provided with pooled resources such as manpower, logistics and training coming from the other hospitals.
“What we learned from this pandemic is that we can never do it alone. For us to get through this, let’s fight our fears, believe in good science, not put our guard down any time and let us take care of each other. Maybe then, we can be really resilient against anything that comes our way.”