The Big Read: Fighting Covid-19 for over a year, healthcare frontliners face burnout risk

Filipino staff nurse Princess Joyce Aguas went through a tumultuous time when her family members, who live in Mexico, Pampanga in the Philippines, contracted Covid-19 last month. ― TODAY pic
Filipino staff nurse Princess Joyce Aguas went through a tumultuous time when her family members, who live in Mexico, Pampanga in the Philippines, contracted Covid-19 last month. ― TODAY pic

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SINGAPORE, May 15 — It has been about eight months since Dr Wong Choo Wai ended his volunteer stint taking care of Covid-19 patients at Singapore Expo, but the 50-year-old sometimes wakes up in panic, thinking that he has overslept and is late for work.

The senior family physician is still reeling from his experience of working almost 24/7 from April to September last year — pulling 12-hour volunteering shifts at the community care facility, while also still running his two clinics and seeing his regular patients. 

Getting only three hours of sleep each day, Dr Wong said that there were days where he almost dozed off at work due to the mental and physical exhaustion. 

“I will say that I haven’t had a good break for a long time, and as much as I’m trying to go on every day without thinking too much about the past, I think I’m a bit burned out. And I think most of us (frontliners) are, but what to do?” 

Dr Wong Choo Wai was overworked and burnt out when he ran his clinic and volunteered 12-hour shifts at the community care facility last year. Now he is preparing to possibly volunteer at the emergency department at NCID. ― Photo by Raj Nadarajan for TOD
Dr Wong Choo Wai was overworked and burnt out when he ran his clinic and volunteered 12-hour shifts at the community care facility last year. Now he is preparing to possibly volunteer at the emergency department at NCID. ― Photo by Raj Nadarajan for TOD

Like Dr Wong, many healthcare workers on the frontline have been in overdrive for over a year fighting a pandemic which has infected over 160 million people and claimed more than three million lives globally.

Not only are they working longer hours to contain the far-from-tamed outbreak, they also shoulder the mental stressors of being away from loved ones, getting infected, or passing on the infection to those around them. 

These fears became very real for a Tan Tock Seng Hospital (TTSH) nurse, who was among the healthcare workers there served with quarantine orders after a 46-year-old nurse tested positive for the infection last month. 

The young nurse, who did not want to be identified as she was not authorised to speak to the media, recalled being in a state of disbelief when she got the call from the authorities informing her that she and her colleagues had to be quarantined. 

“I was just like, ‘No, it can’t be true lah’. I think I was still in shock,” she told TODAY.

A common refrain among the healthcare workers interviewed is that a big part of the psychological toll comes from not knowing what to expect when dealing with an unpredictable disease. 

The new wave of infections has also served as a cruel reminder that there is still no end in sight to the Covid-19 pandemic.

Ms Alice Ng, 60, who manages the 24-hour family clinic at Thomson Medical Centre, said: “I’ve been a nurse for almost 33 years. I’ve been through Sars (severe acute respiratory syndrome) and H1N1, and this is the toughest pandemic I’ve ever met.” 

Serving the Public, Shunned by the Public

After months of few community cases, the rising number of local infections in recent weeks — which has Singapore “on the knife-edge”, as Education Minister Lawrence Wong put it — has also seen healthcare workers in several public hospitals coming down with the virus. This, in turn, has once again led to incidents of them being discriminated against by members of the public.  

Associate Professor Kenneth Mak, the Ministry of Health’s (MOH) director of medical services, said during a briefing held by the Government’s Covid-19 task force that some TTSH healthcare workers had been kicked out of their accommodation by their landlords after learning that they work at the hospital. 

As of yesterday (May 14), TTSH has Singapore’s second-largest active coronavirus cluster, with more than 40 cases so far, after the Changi Airport cluster. 

The healthcare workers whom TODAY spoke to also had experienced or heard of similar incidents of discrimination against their colleagues in recent weeks.

Staff nurse Afidah Aziz, 29, who works at the isolation ward at Ng Teng Fong General Hospital, said she has gotten cold looks from taxi drivers after they found out that she works as a nurse at the hospital. 

Ms Jenny Sim Teck Meh, 70, chief nurse at Ren Ci Hospital, said a few of her nurses have reported that commuters steer clear of them on MRT trains. 

en Ci chief nurse Jenny Sim Teck Meh (left), 70, checking in on a nursing home resident who received his vaccination on Jan 20, 2021. ― Photo courtesy of Ren Ci
en Ci chief nurse Jenny Sim Teck Meh (left), 70, checking in on a nursing home resident who received his vaccination on Jan 20, 2021. ― Photo courtesy of Ren Ci

Posting a screenshot showing drivers on ride-hailing app Grab cancelling rides to TTSH, Speaker of Parliament Tan Chuan-Jin said on Facebook earlier this week: “All of us can support our folks at the frontlines. It’s the least we can do.” 

Prime Minister Lee Hsien Loong also voiced his concern, saying that it is “distressing to see” the incidents of discrimination against TTSH staff members.

“We cannot let setbacks divide us or wear us down, because if we lose our unity, the virus has won,” he wrote on Facebook on May 7.

Responding to a question by Jurong GRC Member of Parliament Tan Wu Meng on Tuesday, Health Minister Gan Kim Yong said in Parliament that the authorities have been working together with hospitals to provide support for the affected workers. 

The Government is also working with hotel operators to provide alternative accommodation for healthcare workers who have been asked to move out by their landlords. 

Sacrifices weigh on Family

For healthcare workers who play dual roles of frontliner in the hospital and caregiver at home, the work does not end even after they have changed out of their scrubs. 

Dr Brenda Mae Alferez Salada recalled how, during the circuit breaker from April to June last year, she would return home after a long day at work to help her son with his home-based learning. 

But unlike other parents who played the role of teacher during that period, the 40-year-old resident physician at the National University Hospital’s (NUH) division of infectious diseases could only coach her son through FaceTime and video conferencing app Zoom, even though they were living under the same roof.

During the circuit breaker, Dr Brenda Salada (left) had to juggle working in the pandemic wards with coaching her son through his home-based learning. ― Photo courtesy of NUH
During the circuit breaker, Dr Brenda Salada (left) had to juggle working in the pandemic wards with coaching her son through his home-based learning. ― Photo courtesy of NUH

That was because Dr Salada and her husband, who works at TTSH, had chosen to isolate themselves from their son and helper to minimise the risk of spreading the infection to them. 

At the time, a lot was still unknown about the nature of the disease. They did not want to take any risks since she and her husband worked in the pandemic wards and the emergency department respectively.

Though they eventually reunited after a month when they were assured of the safety of hospital protocols and personal protective equipment (PPE), the family has recently been separated again because of the TTSH cluster. 

Since Dr Salada no longer works in the pandemic wards, the family thought it is safest for her husband to isolate himself at a hotel.

For Dr Crystal Soh, the most challenging period was during last year’s circuit breaker when she and her husband, who is an emergency specialist at TTSH, had to juggle long and draining shifts at work with coming home to care for their children, who were then one and three years old.

As the couple did not want to put their elderly parents at risk of infection, they decided to stagger their work shifts so that either one of them could be with the children while the other was at work.

“It was really a full day of work until they slept,” said the 32-year-old associate consultant at NUH’s department of emergency medicine.

Physical and Mental Toll

After over a year of fighting an arduous, seemingly unending battle against an invisible enemy, many of the frontliners interviewed admitted that it is hard to keep their chins up at times. 

Many of them said the frequently changing protocols — that can sometimes happen in the middle of a shift — and the logistical adjustments that come with them, can be overwhelming to take in.

For those who work in high-risk wards, the process of gowning up and spending a whole day in PPE is physically draining.

Dr Jansen Koh, chief and senior consultant at Changi General Hospital’s (CGH) respiratory and critical care medicine, said there are times when he and his colleagues struggle to hold back their emotions while caring for patients who are critically ill with Covid-19.

For the young TTSH nurse, the gravity of her situation finally sank in halfway into her quarantine, and she found herself breaking down after a video call with her colleagues who were also in isolation. 

“We weren’t even talking about anything specifically about (the cluster)... I don’t know why but that was when it dawned on me that, okay, this is really happening to me,” she said. 

She had spent the days before trying to remain calm and staying strong for her family, but the isolation and psychological stress eventually became too much to handle on her own.

“Because I see that (my family) is so scared, I cannot be scared for their sake, even though I’m the one facing it,” said the nurse. 

Another frontliner, Filipino staff nurse Princess Joyce Aguas, went through a tumultuous time when her family members, who live in Mexico, Pampanga in the Philippines, contracted Covid-19 last month. 

Her father was in critical condition after contracting the disease and her family was in crisis mode going around to different hospitals trying to secure him a bed.

“I got so worried that I cried Over the phone I was telling them it’s going to be okay and to not be scared, but deep in my heart I knew it was bad,” the 33-year-old nurse from Farrer Park Hospital told TODAY.

Filipino staff nurse Princess Joyce Aguas speaking to her father via a video call. When her family members in the Philippines contracted Covid-19 last month, all she could do was to assist virtually with advice. ― Photo by Raj Nadarajan for TODAY
Filipino staff nurse Princess Joyce Aguas speaking to her father via a video call. When her family members in the Philippines contracted Covid-19 last month, all she could do was to assist virtually with advice. ― Photo by Raj Nadarajan for TODAY

Ms Aguas, who has not seen her family since February last year, said she felt helpless at not being able to be there with them.

Asked how she managed her emotions while keeping up with the daily barrage of work, Ms Aguas said though she sometimes could not stay focused, she tried to remain positive and left her personal problems behind when she tended to her patients. Her father’s condition has since stabilised. 

What Keeps Them Going

Getting through the tireless, long days can be difficult, but the healthcare workers told TODAY they find strength in the camaraderie of their fellow frontliners.

The young TTSH nurse said getting through quarantine has been made easier knowing that all her other colleagues are going through the same experience and rollercoaster of emotions. 

Her bosses also schedule twice daily Zoom calls to check in with everyone’s mental health. She also has video call sessions with her closer colleagues in the ward three times a day to keep each other company.

Dr Soh said at the peak of the pandemic last year, her colleagues would offer to take over her shifts, or offer their days off if she needed more time with family. They also reassured her that it was okay to be late for work if her husband did not come back in time to take over with the kids. 

In response to TODAY’s queries, the hospitals said they have introduced various initiatives to boost morale and take care of the mental well-being of their healthcare workers.

They include free counselling services to their staff members, wellness programmes and workshops, as well as providing meals for those working in infectious wards.

Aside from their colleagues, the frontline healthcare workers said they also felt encouraged by the love shown to them by members of the public and their own patients.

Dr Wong said his patients, who knew that he had cut back his clinic hours to volunteer at the community care facility, too, gave him food, goodies and words of encouragement when they came to see him at the clinic.

Some of them would also plan their schedules around his by coming for their appointments earlier so that he could leave on time to make it for his shift.

A banner outside the NCID building cheering on frontline healthcare workers and patients at TTSH, on May 12, 2021. ― Photo by Raj Nadarajan for TODAY
A banner outside the NCID building cheering on frontline healthcare workers and patients at TTSH, on May 12, 2021. ― Photo by Raj Nadarajan for TODAY
Gearing Up for What’s Next

Looking back on his experience, Dr Wong said he found it “quite incredulous” how he managed to survive those six months volunteering and running his two clinics in Bedok and Jurong.

Yet, he is now ready to head back to the frontline again. 

Just last week, he received a call from the National Centre for Infectious Diseases to help out at its emergency department. Of course, he said yes.  

This sense of duty was echoed by other healthcare workers interviewed.

Though the work can be tough, they are prepared to take on the challenges arising from a crisis, such as the Covid-19 pandemic, as this is what they have signed up for as medical professionals, the frontliners said. 

But they are also looking forward to the day when the pandemic will be finally over.

When asked what is the first thing they want to do when everything is back to normal — albeit a new one — many of them cited much sought-after pre-pandemic luxuries, such as travelling, and being able to visit relatives living abroad. 

But for some — such as the frontliners currently in quarantine — what they look forward to can be something as simple as the thought of finally going out to have a nice meal at a restaurant. 

“Honestly, (I’m looking forward to) going out to places to eat. Or maybe just walking around shopping,” said the young TTSH nurse. ― TODAY

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