Sg Buloh Hospital Lessons From Frontline Of Country S Main Covid 19 Centre


INTERVIEW | Sungai Buloh Hospital (HSB) had been at the forefront of the fight against the Covid-19 pandemic since the day the virus was detected on our shores. Serving as the main dedicated Covid-19 centre, it has treated nearly 50,000 positive patients to date.
While the hospital had been successful in helping the country battle the outbreak, little is known about what has been happening behind the scenes, especially the struggles faced by frontliners who had dedicated their lives for the sake of their patients.
Malaysiakini spoke to HSB director Dr Kuldip Kaur (above) in an exclusive interview recently, during which she revealed some of the biggest challenges they faced.
"Because Covid-19 was something new, the hospital could not only prepare our staff with training and awareness, we also had to prepare them mentally as well.
"Because, back then, we did not know much about the virus. So they (the staff members) were all very fearful. They were worried about themselves too.
"The fear became more and more as they kept reading about Covid-19 and realised the risk of getting infected is very high. Some of them, I must say, got depressed because of it.
"So, during the early stage of the pandemic, we were actually having a lot of challenging times with the staff," Kuldip said.
Besides the fear of the virus, healthcare frontliners were also facing stressful working conditions.
The pandemic requires them to follow certain sets of heightened standard operating procedures (SOPs). These include the need to wear a certain amount of personal protective equipment (PPE) at all times, maintaining physical distance, including among one another, and taking extra precautions to keep clean.
They are not allowed to let their guard down, as slacking may result in infection. And to ensure this, the hospital has what it calls a "Safe-T-Net" team to go around the hospital enforcing the rules.
According to Kuldip, the daily duty rosters had to change too. To lower the risk of staff-to-staff infection, HSB decided to cut down the number of personnel on duty to the minimal workforce needed for each shift.

"We cannot be putting many people on call at the same time. Because we wanted to reduce the exposure level for our staff. So this is one of the ways that we can take care of them.
"So, we tried to make our roster in small groups and (set) shift work. We can’t be doing the same way as our normal duty calls. These calls are different because here our staff are wearing PPE, they are wearing their PPE all day long.
"We made our shifts into 12-hour shifts, so there is a morning and then the evening shift. And in each of the shifts, we tend to keep the number of personnel on duty small. Because we wanted to buffer - if two shifts are working, then one must be in a buffer, in case something happens like infection or outbreak (among staff)," she said.
The new rules also mean that the staff can no longer interact with one another as they had been, prior to Covid-19.
Ward pantries - which usually served as a spot for doctors, nurses and other staff to wind down and chit-chat with one another – were also no more a place of solace.
'We have to be firm'
Enforcing such rules is definitely not something that she enjoys doing, said Kuldip.
To her, it was more of a responsibility for the sake of the frontliners and patients they serve.
"We have to change our working habits. Before this, we could sembang (chat) while eating together. But even this we cannot do anymore.
"People used to say that eating is also a stress reliever. But now we don't even have time to enjoy our meals.
"Talking with friends is another form of stress relief. But now we can't speak with each other in close proximity, not even spend much time talking to each other. So there is a culture change, which was hard to adapt to for some of our healthcare workers.


"It came to a point that we have to play police in the hospital. But all these we did are for safety. We had to, or else, there would be a much bigger problem," she told Malaysiakini.
Kuldip said HSB had to be firm when it comes to SOPs because they are a full Covid-19 treatment facility, where almost every part of the hospital is filled with coronavirus-positive patients.

The fact that the Health Ministry had put HSB as the flagship Covid-19 hospital also meant they have to be a role model, especially to members of the public.
However, it does not mean that they did not see any outbreak inside the hospital. Kuldip said they have recorded cases of infection among frontliners there, but they managed to control the outbreak with little to no disruption to services.
Keeping morale high in tough circumstances
Despite being a firm boss, the public health physician with 29 years of experience knew her human resources are the most valuable in the hospital.
Realising the heavy stress posed by the pandemic on HSB staff members, Kuldip said the hospital administration came up with several initiatives to help them cope and boost the frontliners' morale.

The first thing they did was to rope in the hospital's Psychiatric Department to provide psychological first aid (PFA) to those who needed them. This service was made available to both HSB staff and patients.
As some frontliners may not feel comfortable speaking openly about their problems, the hospital also provides avenues for them to seek treatment anonymously via WhatsApp.
"No name is asked. Not even which department they are attached to. What the hospital wants to hear is the issue or stress that person is facing, to know how big and serious it is.
"Most of the cases were due to stress caused by fear. Not much on issues regarding hospital facilities, or food and such.
"Many of them were fearful of getting infected, afraid to go back to their family due to the risk of Covid-19," she said.
To try to boost the frontliners' morale, Kuldip took an innovative step, given the limited resources. She knew that something needed to be done to make HSB staff feel appreciated from time to time.

"HSB got many well-wishers who contributed gifts for our frontliners. There were a lot of them - some gave creams, cosmetics, shawls, or kain pelikat, soaps and more. We have fantastic gifts. So what I did was manage these gifts for future days.
"We give them out for celebrations like Nurses Day, Mother's Day, Teacher's Day, Hari Raya, Deepavali, Merdeka, and so on.
"Little by little, we give them (HSB employees) some kind of happiness, surprises to keep their morale high. We try to spread it out and make sure the gifts reach all staff, from ambulance drivers to medical assistants, nurses, doctors and administration staff.
"We make sure everyone gets something. We know they cannot celebrate holidays like Hari Raya. So, there is at least something that can make them happy," she said.
Sharing the HSB experience
During the interview, Malaysiakini also asked Kuldip what were among the things that HSB has learned from their experience, and if she has advice for medical facilities that are joining the fray, since the government is roping in private hospitals as well to battle the Covid-19m pandemic.

She said there are four key elements to running a Covid-19 treatment facility.
The most important is to ensure SOPs are adhered to at all times.
"The other thing is that we must keep on learning about the virus. For example, we just learned something new recently, during the third wave of Covid-19, even though it is something that is very basic.
"Ventilation is such an important aspect in managing this virus, and we realised now that even in our isolation wards, we have to open our windows. We realised that good air exchange helped a lot (in the treatment of patients).
"The third is communications. It must trickle down and we must anticipate. We also must prepare for what is going to happen next and communicate with the whole team so as to stay prepared. Sometimes we only communicate at the top level but communication must go down to the teams and grassroots," she said.
And lastly, Kuldip advised against working in silos.
She said the management of a hospital must know how to bring everyone together so they would be able to support one another.
"If your team works in silos, then it is going to be very tough. Because if something were to happen, and only one side acts while the other doesn't, we would still fail." - Mkini

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