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Surviving surgery in the middle of COVID-19

by Jose Lorenzo Lim

COVID-19 has struck the country’s healthcare system in a major way. The system became too overloaded that healthcare workers in August sought a two-week return to modified enhanced community quarantine (MECQ). Government has since been touting that the country’s active COVID cases are going down and that the healthcare system is unloading. But what was it like having a family member who needed minor life-changing surgery amid this pandemic?

Hospital 1

The night that we decided to take my grandmother to the hospital was when she nearly fainted, was feeling weak, and had a low heartbeat. It was already the second time that this happened. It was a night filled with questions – where do we take her? Is it COVID-19 free? Are they going to accept us? These were the things running through our heads when we decided to take her to our trusted family hospital (Hospital 1). There, even with the growing number of patients, there was an available slot in the intensive care unit (ICU) where they stabilized her. 

My grandmother’s cardiologist said that she needed a pacemaker to stabilize her heartbeat and bring it back to a normal level from 40 beats per minute to around 60 beats per minute. Pacemaker surgery would cost around Php250,000 for a single-chamber pacemaker alone. This does not yet include the professional fees of the doctors that would operate on my grandmother. Prices vary depending on the type of pacemaker – if it’s dual or single chamber, and if it can pass through a magnetic resonance imaging (MRI) machine. Additionally, payment would only be on a cash basis for the pacemaker.

My grandmother decided not to have the surgery and to just go home. She believed that the surgery was costly and not worth it given that she was already old.

Hospital 2

Just a few days after, she had another episode and nearly fainted again. This fell on the month of August when Metro Manila was put back on MECQ. We went back to Hospital 1, luckily was able to get another private room, and planned to have my grandmother get her surgery. Financially, it would cost around Php350,000 for the whole pacemaker operation which would have to be done at another hospital since Hospital 1 doesn’t have the facilities for this type of surgery. Before a surgery could take place, my grandmother had to get an RT-PCR swab test. Since she had to be operated on quickly, we had no choice but to avail of a Php12,000 test at the big hospital nearby (Hospital 2) that would show a result in 24 hours.

Hospital 3

My grandmother tested negative for COVID-19 with Hospital 2’s swab test. A negative result is said to have a validity period of only one week. On the day of her transfer to a medical center and hospital (Hospital 3) for the surgery, we paid Hospital 1 around Php100,000 for the doctor’s fee, private room, and medicines. We decided it was best that she have her surgery since the cost of her one-week hospitalization was like getting a pacemaker already. When we reached Hospital 3, they looked at her charts and found a problem. First, her doctor wasn’t really an affiliate at Hospital 3, and second, her chest x-ray showed some white particulates which is said to be an indication of COVID-19. Hospital 3 gave us two choices, either go home and treat the particulates or have a Php12,000 CT-Scan to check if it really is liquid in the lungs.

We took a gamble and went for the Php12,000 CT-Scan that does not have a senior citizen discount. They confirmed it was liquid in her lungs which could be indicative of COVID-19. We were stunned since she had already tested negative. We had no choice but to get her home, isolate her, find other options and rest.

The next day, we called her former cardiologist from Hospital 1 again. He just apologized and advised us to take her back to Hospital 1 because at her age she needed medical attention. My grandmother returned to Hospital 1 but was told that all COVID-19 isolation rooms were full. The accounting department told my dad that her only choice was to go to a tent that would cost around Php100,000 for a three-day stay inclusive of doctors’ fees. Of course, my grandmother chose to come home and continued her isolation.

Hospital 4

Luckily, we knew someone from another medical center (Hospital 4), a public hospital. Through connections, we were put in the emergency room. The plan was to get my grandmother to test negative for COVID-19 and find her a new cardiologist so she could be operated on. If she tested positive for COVID-19, then she would be admitted to the COVID-19 ward of Hospital 4. It was like going through a limbo of uncertainty.  While waiting for the result, my grandmother and father stayed at the emergency room and were transferred two days later to the COVID-19 isolation ward once a room was available. Eventually, my grandmother tested negative for COVID-19.

Of course, Hospital 4 did not have any private rooms so she had no choice but to go to the ICU where she met her new cardiologist who was affiliated with yet another medical center (Hospital 5). They quoted around Php500,000 for the whole operation with a single-chamber pacemaker.  We immediately agreed and scheduled the operation with the doctor. We left Hospital 4 with a total bill of around P10,000 which was reduced due to PhilHealth and a senior citizen discount.

Hospital 5

The transfer from Hospital 4 to Hospital 5 was smooth since there was proper coordination between the two hospitals. Of course, before being operated on, my grandmother had to undergo her third and hopefully last swab test. After getting her swab test, she was transferred to the COVID-19 isolation room and got her result in 24 hours. The test cost around Php2,500, which was way less than at Hospital 2.

After her negative result, her new cardiologist immediately decided to push through with the operation. The operation was successful. However, there were no private wards available and she ended up at the ICU again. After two days, she was discharged from the hospital and allowed to go home.

Health neglect

The experience of going back and forth to various hospitals was hell. This is what patients who need surgery are going through. If you have symptoms of cough or colds, then you are immediately tagged as a COVID-19 suspect and would have to go through anxieties on top of being sick. If you don’t have money, you won’t be fixed. We were very fortunate enough to have my aunt, uncle, and other family members to financially support us through this.

A family of five living under minimum wage wouldn’t be able to afford getting a pacemaker. While I do understand that each hospital has its own set of protocols, the additional cost of swab tests is really hard especially if you don’t have enough money. I can’t imagine the number of patients who have to delay their life-saving surgery due to the overcrowding at hospitals and the burden of producing money for the operation itself. I would even call it criminal negligence on the government’s part for not immediately addressing the COVID-19 situation of patients who need surgery.

PhilHealth and a senior citizen discount really helped to lower my grandmother’s hospital expenses, but then again the situation at Hospital 4 was that they didn’t have the facilities to carry out pacemaker surgery. The government should invest in our public hospitals so that they are able to do these minor surgeries. Patients are forced to go to private hospitals just to get a pacemaker implanted. We were shocked at the Php10,000 bill of Hospital 4 and I think that if government invests funds in our healthcare system then more patients would be able to access and afford life-saving operations.

In the end, its priorities will still depend on government’s political will or lack of it. The government could invest in social services, especially health, instead of allotting Php19 billion to fund a deceptive and destructive National Task Force to End Local Communism and Armed Conflict (NTF-ELCAC). The latter, which has been on a spree of terrorist-tagging activists and progressive personalities and institutions, appears to still be the government’s priority even while COVID-19, typhoon relief operations, and even the economic downturn, warrant much urgent and greater attention. #

Jose Lorenzo Lim is a researcher at IBON Foundation. His research topics include Build, Build, Build, the oil industry, and social services. Prior to IBON, he served as Editor-in-Chief of the UPLB Perspective for the academic year 2016-2017. When not in the office, Jose Lorenzo enjoys writing with his fountain pens and trying out new ink.

STATE OF PHILIPPINE MEDIA 2020: Journalists Struggle to Cover the Pandemic as Space for Media Freedom Shrinks

The shutdown of ABS-CBN, the country’s largest media network, is the latest in a series of attacks and threats against the Philippine press.

BY ANGELICA CARBALLO PAGO/Philippine Center for Investigative Journalism

MEDIA freedom and free expression have become casualties of the “war” against the Covid-19 pandemic that has led to severe restrictions on news coverage and economic difficulties for newspapers, media advocates said on Monday.

Members of the Freedom for Media, Freedom for All (FMFA) Network cited arbitrary arrests and a growing crackdown on dissent on social media amid enhanced community quarantine measures, in a virtual forum that tackled the annual “State of Media Freedom in the Philippines” report.

The forum was held a day after the commemoration of World Press Freedom Day, and on the eve of the shutdown of ABS-CBN, the country’s largest media network, by state regulators.

‘Not just a metaphor’

Speaking at the online forum, Melinda Quintos-De Jesus, executive director of the Center for Media Freedom and Responsibility (CMFR), noted that the government response to the pandemic has been depicted as a war.

“But that is more than just a metaphor because the military and police have been put in the frontlines as visible implementors,” de Jesus said.

‪International media watchdogs have noted that all over the world, the pandemic has restricted space for freedom of expression. The Philippines is no exception, with Congress passing Republic Act 11469 or the “Bayanihan to Heal as One Act,” which gave President Rodrigo Duterte emergency powers to quickly respond to the Covid-19 outbreak.

The emergency law penalizes “fake news” under a general provision that is open to misinterpretation and abuse.

An example is the case of an overseas Filipino worker in Taiwan, Elanel Ordidor, whose deportation was sought by labor attaché Fidel Macauyag over a social media post criticizing the President. Taiwan has since rejected the request.

The forum also took note of accreditation measures imposed by the Inter-Agency Task Force for Management of Emerging Infectious Disease, which have expanded bureaucratic control over the media.

Nonoy Espina, president of the National Union of Journalists of the Philippines (NUJP), said local governments were implementing their own media accreditation schemes, citing Negros Occidental province and Bacolod City.

“This added requirement affects how we gather and how we deliver news, because (if access to) information is controlled, it can be very difficult to do journalism,” Espina said.

During the open discussion, Pulitzer Prize winner Manny Mogato said: “One of the biggest threats to journalism is government propaganda when it hijacks the narrative of the public health crisis by making it appear it was doing a good job of responding to the coronavirus pandemic.”

Attacks on media

In the annual media freedom report, the CMFR and NUJP documented 61 incidents of threats and attacks against the press, including the deaths of three journalists, for the period January 2019 to April 2020.

The State of Media Freedom in the Philippines report also covered the release of the December 2019 ruling that convicted those behind the Ampatuan Massacre, which claimed the lives of 58 people, including 32 journalists, in November 2009.

MindaNews’ Antonio La Viña, former Ateneo de Manila School of Government dean, said the long-delayed court decision on what is considered the world’s single deadliest attack on journalists, was a “good ruling, with a lot of shadows — the role of political families in the Philippines that is linked to impunity.”

“We need to make sure another massacre will not happen again,” he said.

Apart from CMFR, NUJP and MindaNews, the FMFA network includes the Philippine Press Institute (PPI) and Philippine Center for Investigative Journalism (PCIJ).

An epidemic of experts

Tech entrepreneur and data ethics advocate Dominic Ligot, a member of the PCIJ board, urged journalists to counter Covid-19 disinformation by being on the lookout for politicization, “armchair epidemiology,” the mushrooming of experts, and the need for critical discourse.

Journalists, he said, should challenge experts and even question the assumptions underlying disease transmission models and projections.

“We are in an interesting time when everyone is in a physical lockdown and at the same time, everyone is wired up digitally,” he said.

For the first time, he noted, the public has been given access to a barrage of scientific and technical information on social media, pointing to numerous policy notes published on Facebook.

Ligot warned that journalists scrambling for expert opinion could contribute to disinformation by highlighting imprecise data or incomplete forecasts.

“We are in an environment where everyone is suddenly an expert,” he said.

Journalists need help, too

NUJP’s Espina also raised safety issues and economic difficulties confronting journalists, particularly freelancers and provincial correspondents, since the start of the lockdown.

“The biggest problem, especially for freelancers and correspondents working in small outfits, is the lack of support in covering the pandemic,” Espina said.

Espina said these journalists were left to pay for their own personal protective equipment, vitamins, and other out-of-pocket costs.

“One correspondent I have talked to said, ‘I have no idea if we’re getting a hazard pay,’ and the outfit that she works for made no mention about it,” he said.

The drastic cutdown in television programs and operations was also a huge blow to contractual media workers in the broadcasting industry who are usually under a “no work, no pay” arrangement, Espina said. With the crisis cutting on already falling revenues, closures and layoffs might be inevitable, he warned.

This was echoed by Ariel Sebellino, executive director of the Philippine Press Institute, who said that about half of the organization’s members, mostly family-owned community papers, have ceased printing due to economic losses caused by the lockdown.

“We must all get our acts together and respond to the needs of community journalists during this pandemic,” Sebellino said. “There must be a concerted effort to help improve the situation of our journalists in the provinces.”

Espina said he had received complaints from journalists who were unable to receive cash aid from the government’s Social Amelioration Program, the Tulong Panghanapbuhay sa Ating Disadvantaged/Displaced Workers (TUPAD) of Department of Labor and Employment, and other forms of government assistance, because of misconceptionsthat media workers were making a lot of money.

An overlooked aspect is the pandemic’s toll on the mental health of journalists who are, in a way, also frontliners in the Covid-19 response, Espina said.

“None of us is immune to the fear and uncertainty that the pandemic brings,” Espina said. “We need to recognize that we are not superman. We need to take care of ourselves.”— PCIJ, May 2020