2nd
National Convention on Health Emergency Management
DOH and WHO
December 3-5,
2003
Bayview Hotel,
Ermita, Manila
Before
anything else, I like to thank the organizers of this 2nd National
Convention on Health Emergency Management for the honor and privilege to be a
reactor. I like also to thank Dr.
Remigio Olveda, Director of Research Institute for Tropical Medicine (RITM) for
allowing me to react to his talk on SARS.
At
the outset, let me say that my reactions will be guided by the objectives of
the convention, specifically, on how to strengthen a health disaster
preparedness program and how to strengthen coordination and networking between
and among institutions in managing a disaster.
Also, my reactions will be from a perspective of a hospital
administrator rather than from a clinician’s or a practicing physician’s point
of view. Lastly, my reactions will
include a critical analysis of the hospital SARS experience with recommendations
as much as possible and sharing of my experience as the former head of Manila
Doctors Hospital Task Force SARS.
Essentially, Dr. Olveda presented
RITM’s response to stop a SARS attack, its outcome, its problems and
limitations. He also presented the role
of DOH hospitals and RITM against SARS and future outbreaks including emerging
and re-emerging infections. I will use
these two topics as take-off points for my reactions.
|
Topics |
Convention’s
Objectives |
|
1.
RITM’s response to stop a SARS attack |
How
to strengthen a disaster preparedness program |
|
2.
Role of DOH hospitals and RITM against SARS |
How
to strengthen coordination and networking among institutions. |
On
the first topic of Dr. Olveda, how RITM responded to a SARS attack, let’s focus
our attention on how a hospital can strengthen a severe infection or epidemic
control preparedness program. Please recall the presentation of Dr. Olveda,
particularly, on the definition of the role of RITM, organization of the
anti-SARS team, designation of roles and responsibilities of the anti-SARS
team, strategies and procedures on prevention and control of SARS, such as
triaging, patient management, and infection control measures, and the coping
and problem-solving strategies in the light of problems and limitations in
terms of MAN, EQUIPMENT, and MONEY.
The
RITM experience is practically the same as that of MDH. The input and output
are practically the same. The difference lies mainly in the process or
throughput, specifically, in terms of managerial strategies and coping or
problem-solving activities.
Before
I go any further, allow me to share with you very briefly the experience of MDH
Task Force SARS.
1.
It was created April 2, 2003 and officially terminated on
August 10, 2003, totaling 4 months of operation.
2.
NO SARS patient admitted in MDH.
2.1 8 patients with possible SARS
detected at the ER and referred to DOH referral centers.
2.2 2 patients with possible SARS
detected inside hospital, one isolated in Floor 11 and one referred to
RITM. Both later turned out to be NOT
SARS.
3.
A level 3 preparedness was achieved by May 16, 2003, about 6
weeks after the organizational meeting of the task force. Level 3 preparedness means completely
prepared with policies, strategies, and procedures; physical facilities, and
training with at least a drill.
4.
Construction of a triage-isolation-holding room in the ER
which can be used for other cases of infectious diseases.
5.
An expense of about PhP 200,000 in the preparedness program.
6.
NO downturn in hospital business development and stability
associated with SARS scare and panic.
7.
A transition phase for one month prior to phase-out of the
Task Force in the form of admitting patients with pneumonia only to single
private rooms for isolation and monitoring.
As
I said earlier, the difference between RITM and MDH experience lies in the
managerial strategies and coping or problem-solving activities towards certain
challenges peculiar to SARS or any severe infectious disease for that
matter. These challenges were:
1. Whether
to admit patients with possible and suspected SARS or not.
MDH decided not to
admit SARS patients at all cost because of the economic repercussion that would
be brought about by the stigma of a SARS-infested hospital.
RITM, being a
national government institution and part of DOH, had NO choice but to admit
SARS patients despite its scarcity of resources.
2. How
to deal with the hesitancy, if not refusal of the health professionals in the
hospital to handle patients with possible SARS.
MDH decided to use
non-confrontational strategies and persuasion at the same time ensuring safety
of staff. It did not create special
health professional team to handle SARS.
It trained staff of departments and units which are potential contact
points with SARS patients, such as staff of ER and a ward that will be used for
isolation.
I don’t know exactly
how RITM successfully dealt with the problem of manpower.
RITM, being a
referral center, decided to create a team of staff dedicated to handle SARS.
3. How
to control the panic and stigma of SARS when a patient with a possible SARS was
admitted for observation.
MDH decided not to admit SARS at all
cost after an initial and stressful experience with panic and stigmatization of
SARS when a patient with possible SARS was admitted for observation.
I don’t know exactly how RITM
successfully dealt with the problem of discrimination of its hospital and its
staff.
From my MDH experience and from my
deduction from the RITM experience, I venture to say that the ultimate
processes that are important in strengthening a SARS preparedness program or
any disaster preparedness program for that matter consist of two elements:
1. Strong leadership with unity of
command coupled with support from top management
2. Competent leadership with
systematic, innovative, and decisive way of problem-solving and utilizing
multisectoral cooperation and empowerment.
This includes being resourceful in the face of scarcity of logistics.
On
the second topic of Dr. Olveda, the role of DOH hospitals and RITM against
SARS, let’s focus our attention on how to strengthen coordination and
networking among institutions working against SARS.
Dr.
Olveda presented the blueprint of the network and hierarchy of DOH referral
hospitals for SARS. The objectives of
the networking and the functions of the different levels for referral hospitals
have been clearly spelled out. It is
now my hope that the blueprint be made operational and tested for effectiveness
and efficiency. Once proven to be
effective and efficient, the collaborating and networking system should be
institutionalized and should always be ready for use any time it is
needed.
I
did not notice the use of private institutions in the networking system. Although it is difficult, at least at the
moment, to involve the private hospitals in a networking system for a serious
infectious disease, because of stigmatization, eventually these hospitals
should be prodded to be part of the networking and collaborating system. DOH
should find a way to get the private hospitals involved. I know it is already doing that as seen from
the training the trainors workshops on the management and infection control of
SARS conducted in RITM last September and October, in which I was one of the
panelists.
On
that note, I thank you for your attention and I hope I have contributed to the
objectives of the convention with my short reactions.