By Tedler D. Depaynos, MD
The patient never had significant difficulty in delivering her two children. Her first was assisted by their municipal midwife and her second by their municipal MD at their municipal health center (MHO). Together with her husband, they came to sell their vegetable products but because of the Covid lockdown, they were not able to return immediately. The barangay were they stayed was under strict quarantine because of the unexpected Covid cases in their neighborhood. It was one early morning after breakfast when she felt painful abdominal contractions which were getting worse. Although it was not yet her time, she suddenly felt herself to be on labor so that she was rushed to a nearby hospital.
It was very unfortunate that the hospital just recently disinfected their OB-GYNE delivery rooms and wards because of an asymptomatic patient who delivered but turned out to be infected with the Covid virus. All the health personnel who assisted her were all under quarantine so that during that time they were only admitting patients with a negative Covid test done prior to their admission. The health personnel became limited and they have to acquire new Personal Protection Equipments (PPE) because all the used ones were placed in the trash.
Since the patient came from the rural area and expected to deliver at their MHO clinic, she had no Covid test. They could have referred her to another hospital if not for the urgency to give birth. She was then placed in the hospital triage where she delivered her baby. Although the delivery was effortless she has to be admitted in the isolation ward however, while waiting for her Covid test which they were all hoping to be negative. She was somehow fortunate, because she was then the only OB-GYN patient brought to the hospital.
As a rule nowadays, before a month or two before the expected delivery, OB patients are advised to undergo the Covid test. Surgical patients who will undergo elective surgery are likewise required to undergo the Covid test prior to scheduling. Patients suddenly delivering are treated like emergency surgical patients and placed in isolation after but their huge disadvantage is the care of their newborn. Suppose their mother turns out to be positive?
Admitting on labor asymptomatic patients that are suddenly discovered to be Covid positive is very disadvantageous to the hospital. They may be isolated after the procedure but the hospital staff exposed would be placed to quarantine and would undergo also the Covid test. The hospital service would then be sacrificed and becomes limited as they also do disinfection in trying to control the Covid dissemination. They have to make sure that it would not spread to the other admitted patients. Those on duty would have to double their time and efforts. One could then imagine how over worked they are.
It is also expensive because the hospital may be forced to limit their patients and refer them to other hospitals for better care. All their Personal Protective Equipment (PPE) has to be placed in the trash and with Covid exposure, the new once has to be used only once. From a patient, the Covid test may cost just less than 4 thousand pesos if it would not be shouldered by Philhealth. The specimen is sent to an exclusive laboratory that has the testing facilities.
In another hospital where an emergency surgery was done and later after 4 days, the patient revealed a positive Covid test result, all their surgical residents were isolated in their quarters for the usual 14 days. Surgery was then severely limited. Before returning to work they should all have a negative Covid test result.
A retired administrator in a hospital in a nearby province mentioned that their hospital is presently having a hard time surviving financially. It is not because there is an increase of confined patients that hospitals appear to be making good. The Covid problem is giving them a hard time. Their other sources of income which are sometimes used to support their charity patients like associated schools might close down with no enrollees. Now with the Philhealth under investigation, the problem the Covid brought might double.
The patient that delivered in the triage was Covid negative so that she was discharged with her new born without any problem. They were with all smiles despite the severe depletion of their collection. **
