Nurse Cayen Cabiguen during one of her daily rounds. She is carrying an oxygen tank that will be administered to a patient. | Photo from Cayen Cervancia Cabiguen

Nurse Cayen Cervancia Cabiguen performs an 18-hour duty daily as a nurse in one of Puerto Princesa City’s quarantine facilities. In a hotel retrofitted as a government quarantine facility, she works with two other nurses and one nursing attendant, taking care of over a hundred patients.

The hotel is supposed to be only a quarantine facility, but the surge of cases in the city has already filled up all available hospital beds they had no choice but to retain over 20 patients who are confirmed cases.

“May total of 111 patients kami dito now, at mahigit 20 out of that 111 ay RT-PCR positive at mayroon pang ilang naghihintay ng results. Ilan ang toxic at bantayin na pasyente, marami, at isa dun ang isang lola na ang oxygen level ay bumababa ng hanggang 65-70%, pero hindi magawang mailipat dahil sa punuan ang mga isolation rooms [sa] hospital,” she told Palawan News in an interview after posting a public rant on Facebook. (We currently have 111 patients, 20  are RT-PCR positive and several others are still waiting for their results. We have many “toxic” patients needing special attention – including a grandmother whose oxygen level is down 65-70% but we can’t move her to a hospital because they are already full.)

Cayen’s story laid bare the city Incident Management Team’s (IMT) predicament in handling a surge of COVID-19 cases currently sweeping the city. It began in early March, drawing a steep trajectory of cases from nearly zero (with only three known cases in late February) to over 600 cases.  In the context of the city’s limited medical care capacity, such numbers are overwhelming.

The city has been desperately looking for additional frontliners, particularly doctors to help manage its expanded isolation facilities, but is struggling to find job applicants.

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“We are already offering as high as P39,000 per month sa mga nurses and lower ng kaunti sa mga under board pa na nursing assistants. We are ready to hire pero kaunti talaga ang applicants,” city administrator Arnel Pedrosa told Palawan News.

Overwhelmed health frontlines
Venting her frustrations on social media, Cayen in a Facebook post called the attention of the city government to her plight and that of her colleagues in the pandemic frontlines. She essentially points out that there are simply too few of them — 2 doctors and 45 nurses overall — to manage over a thousand patients and counting.

“Ang IMT ay mayroon lamang na dalawang doctors who are managing all the 1,000 plus cases of both RT-PCR positive and antigen reactive,” she said. (The IMT has only two doctors managing all 1,000 plus cases, both RT-PCR and antigen reactive cases).

“We are only 45 contractual nurses and handful of nurse assistants. Imagine how tiresome it is for just less than 70 people managing Covid inside the facility. Sobra pa sa exhausted ang lahat ng medical frontliners ng IMT kung alam ninyo lang,” she added. (If you only knew, all medical frontliners are more than exhausted.)

She said that their hotel quarantine facility is already a makeshift hospital.

“Nasa quarantine facility kami oo, pero hindi na ganun ang set-up. Para na rin kaming hospital, dahil sa mga pasyenteng biglang bumabagsak ang oxygen level,” she said. (Yes, we’re in a quarantine facility, but that’s not the set-up. It’s like we’re in a hospital because of patients whose oxygen levels are suddenly dropping.)

Working while in isolation
Nurse Cayen’s risk exposure had her testing reactive to antigen that she had to be quarantined. But even while in isolation, she found herself needing to continue working simply because there was no one to take her place.

“One month ago, April 8, I tested reactive sa antigen test. I was housed in one of the eight active quarantine facilities managed by IMT. I was on quarantine but I never stopped working. Every day, I was on my phone answering queries. It was a work from quarantine set-up and I’m not the only contractual nurse who was on the same page, lahat kaming mga nag-positive and those who were also quarantined were doing the same,” she said.

Apart from her contracting the virus, she said that her two teammates were also COVID survivors who went through the same ordeal as her.

Nurse Cayen reacted strongly against the city government’s plan to put up additional quarantine facilities without ensuring there are enough personnel to man these facilities.

“Sobra pa sa exhausted ang lahat ng medical frontliners ng IMT kung alam ninyo lang. How can we be as efficient as we want to be kung kami mismo ay may mga sakit na at pagod na pagod na?” she said.

Grasping for solutions
Admitting that their hands are already full, city health authorities recently considered breaking protocols and sending home asymptomatic patients, an option they also withdrew after only several days due to rising fears it could only worsen the spike of cases.

At the city council, two resolutions were also adopted and are waiting for committee deliberations. One is the revival of a plan to build a new hospital and the allocation of additional incentives and allowances for those who will serve as health workers.

Nurse Cayen demanded that the city government first look into the plight of frontliners like her.

“May planong magbukas ng mga schools para gawing facilities sino ang mag-mamanage? Sino ang mag duduty!? Ang dali daling sabihin yan on your end, tinanong nyo po ba kami kung kaya pa?! Maganda ang plano pero papaano? Again, baka po gusto nyong tingnan ang tunay naming kalagayan,” she said.

City IMT response
Palawan News sought Dr. Palanca, head of the city IMT, to clarify the issues raised by nurse Cayen in her social media post. Dr. Palanca admitted that they were caught off guard by the sudden surge of cases in April when they were confronted with a lack of manpower.

Dr. Eunice Herrera, IMT Branch 2 director, separately confirmed to Palawan News nurse Cayen’s statement that there are still only two doctors and 45 nurses staffing the city’s overbooked quarantine facilities.

Dr. Palanca, however, said they have already filled up their shortage of nursing assistants and have already begun deploying them to their facilities.

“Puno na kami, ok na kami,” he told Palawan News in an interview Thursday, May 13. He explained that nurse Cayen was not aware of their recent new hires because she had just come out of quarantine.

“Wala siguro siyang masyadong information doon kasi nasa Branch 2 siya. Noong lumabas siya [after quarantine niya], nakaka-one week pa lang siya sa Branch 2. By last week of April we were already hiring,” he said.

However, he said they are still in need of additional doctors and there are currently no applicants.

“Hanggang ngayon, dalawa pa rin. May isang papasok na bagong regularized namin na doctor, so madadagdagan na nyan sa Branch 2. Pero kulang pa rin talaga. Kahit nakalagay naman doon na nagha-hire kami ng additional doctors, wala namang nag-a-apply. Kasi nga, COVID yan, talagang very stressful sa katawan, sa mental and physical,” he said.

Dr. Palanca said he also felt bad that the complaint of Cayen “made it look like walang ginagawa ang city government.”

“Sana nagtanong muna siya kung ano ang mga puwedeng gawin ng IMT sa Branch 1 bago pa niya nilabas ang post,” he said, but added that he understood her frustration.

“Nakita ko naman yong frustration niya kasi noong time na yan parang nahimatay ang isang kasama namin na nurse. Mataas kasi ang blood pressure. Hindi nga lang makapagpahinga agad,” he added.

Surge continues
Meanwhile, the surge of cases in the city has yet to plateau since its steep climb beginning in March.

From nearly zero cases before the surge began, the city currently has 583 confirmed and suspect cases in its various facilities as of May 12.

On Thursday, five new deaths were reported, bringing the city’s total deaths to 38 since the pandemic began last year. (with reports from Patricia Laririt and Celeste Anna Formoso)

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