Hospitals face hard choices amid pandemic

Hospitals face hard choices amid pandemic

Siriraj forced to delay, cancel some treatments after Covid-19 patients surge

Medical staff with makeshift face shields at Siriraj Hospital in Bangkok. (Photo by Chanat Katanyu)
Medical staff with makeshift face shields at Siriraj Hospital in Bangkok. (Photo by Chanat Katanyu)

Anyone who visited Siriraj Hospital before the global Covid-19 outbreak will remember the number of people at what is one of the country's top medical facilities.

There were crowds of people reminiscent office buildings in the central business area or malls. The hospital's entrance road was always jammed with traffic during the day and its hallways filled with patients, nurses and doctors.

Today the number of outpatients has fallen by about 30%, an abrupt drop for a hospital that used to have more than 8,000 registered daily visits, an outcome of a policy to cut the number of outpatients amid the outbreak.

"It is critical to limit the number of daily outpatients because we have limited medical resources," hospital director Dr Visit Vamvanit told the Bangkok Post.

"A part of our medical team was diverted to take care of patients affected by the novel coronavirus disease," he added. "We need to prevent disease transmission in the hospital."

The hospital has closed three wards and turned them into areas with 80 beds for Covid-19 patients, including an ICU with eight beds, while its supply of protective equipment is limited.

Most outpatients are told to postpone visits unless they require urgent surgery. Some appointments have been put off for two months.

Earlier this month, the hospital introduced measures to prevent patients from arriving without a scheduled appointment.

Necessary waits

Pearl, 55, said she is affected by the new measures because her son is a cancer patient.

Her son had an appointment to have a brain scan two weeks ago, but she recently received a phone call from the hospital telling her the MRI was postponed because the facility was temporarily closed.

"I was informed that the imaging centre had to be closed temporarily because some of its staffers had been placed under quarantine after coming into contact with Covid-19 patients," Ms Pearl said.

However, despite the hospital not being able to fulfil the appointment, the mother said she understands.

"The hospital has to limit the risk of infection to medical staffers and other patients," Ms Pearl said.

She said Covid-19 affects cancer patients differently because their immune systems are weakened, particularly during treatment.

"I've spoken to the oncologist who treats my son and he says we can afford to wait a little longer for the planned treatment without too many negative effects. That has given us a feeling of relief," Ms Pearl said.

Chayanit, 77, a patient with diabetes, said she decided to skip a checkup appointment to avoid a potential infection.

"A staff member at the hospital called me and told me that if I don't need urgent medical help, it would be better for me not to go to the hospital during this period as I belong to an at-risk group [elderly and with the underlying health condition of diabetes]," Ms Chayanit said.

She noted that as she waits for the outbreak to subside, her grandson picks up her medication as this is a safer option for her.

"In my opinion, the risk for elderly people at this time is greater than any benefit they can get from routine checkups," Ms Chayanit said.

"I have told my friends to avoid going to hospitals if it is not an emergency," she said.

"Hospitals are high-risk places, at least for now."

Telemedicine to rescue

Regardless of Covid-19, other patients need to communicate with doctors. Siriraj Hospital plans to launch its telemedicine service that enables doctors to examine patients online, instead of making them wait.

Dr Visit said the hospital by this week will begin remotely checking non-coronavirus patients using this method.

He said patients will need to download the Siriraj Connect mobile application on their smartphone to be able to communicate with doctors. Patients are required to make an online appointment with a medical professional first.

Returning to normalcy

As the number of virus patients declines over time, the hospital is considering how to resume normal operations, which is expected to come in May.

Yet, Dr Visit said urgent cases, especially cancer patients, will be given top priority. To ensure safety, all outpatients will be tested for Covid-19 before meeting a doctor to prevent medical staff transmission.

So far, Siriraj Hospital and its affiliated medical facilities have treated 103 Covid-19 patients and 44 of them have fully recovered and been allowed to go home.

One of them was infected with the novel coronavirus after transmission occurred during medical treatment.

Despite pressure from work and risk of contamination, Dr Visit said staffers have been buoyed by support from their patients.

One Chinese patient sent positive feedback to the hospital's medical team and thanked its members for taking care of her. Others have sent food to make sure the team eats well.

"Some patients say they do not want to meet doctors because they do not want to add an unnecessary workload for the hospital's staff," Dr Visit said, adding support from the public boosts morale.

"There is no playbook, there is no right or wrong," he said. "The important thing is we need to be positive. We have to believe that this crisis must end."


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