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The changing area for the surgical staff at the smaller operation theatre in Penang General Hospital.
The changing area for the surgical staff at the smaller operation theatre in Penang General Hospital.

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The small area for the surgical staff in the smaller operation theatre in Penang General Hospital that handles surgeries for non-Covid patients.
The small area for the surgical staff in the smaller operation theatre in Penang General Hospital that handles surgeries for non-Covid patients.

GEORGE TOWN, Sept 8 — Covid-19 cases that are growing at over 1,000 daily meant wards in the Penang General Hospital (GH) are at almost full capacity, prompting surgeons here to seek direct guidelines for dealing with the spillover.

Some facilities in the hospital have had to be converted into Covid-19 wards and intensive care units (ICU), including the general operating theatre (OT) complex that has between nine and 10 OTs.

The conversion of the general OT complex meant all non-Covid related surgeries have been pushed to a smaller OT, which was previously used for minor surgeries.

All major surgeries such as for serious injuries due to accidents, tumour removal for cancer patients, open heart surgeries or emergency Caesarean delivery are now being held in the small OT, causing a queue for its usage.

“It was not only physical limitations, we have resource limitations too as most of the staff have to help with the Covid-19 wards,” said one surgeon who spoke on condition of anonymity.

The small OT was supposed to accommodate fewer than 10 medical personnel at any one time, but up to 15 must now cram into the area when major surgeries must be conducted.

The changing room in the small operation theatre in Penang General Hospital where up to 10 surgical staff have to squeeze into this small space.
The changing room in the small operation theatre in Penang General Hospital where up to 10 surgical staff have to squeeze into this small space.

This meant it was not always possible to observe the minimum physical distance stipulated under the standard operating procedures, which was also reflected in the surge in Covid-19 infections among the health care workers here.

“There was no room to maintain physical distance, the staff have to squeeze into small spaces to change into their surgical scrubs,” the surgeon said. 

There were a total 304 Covid-19 cases involving the hospital staff between January and August this year, the bulk of which were in August. 

In August alone, 208 GH staff tested positive for Covid-19.

According to the surgeon, the latest report showed that 17 OT staff who have worked in the small OT tested positive for Covid-19.

Despite having almost 600 Covid-19 patients at the hospital, taking up about 80 per cent of its beds, other non-Covid cases also continue to be treated here.

The surgeon said people were still suffering serious diseases like heart attacks, hypertension and cancer, and there has even been a marked increase in these cases in these two years.

The person said the pandemic has led to many follow-up appointments being deferred, causing some patients’ illnesses to deteriorate, with some to the point of needing surgery.

“Some of these surgeries are unavoidable and Penang General Hospital is a tertiary care referral centre for the northern region covering Penang, Kedah, Perlis and Perak,” the surgeon said.

However, the smaller OT and less space for non-Covid cases meant overcrowding, which is a hazard to both the medical staff and the patients. 

The surgeon said three patients who were recovering after successful operations here have also contracted Covid-19.

“These patients were screened before they were admitted for surgeries, so, they were negative when they had the surgery, but post-operation, they contracted Covid-19 and they were not able to fight through due to their weakened condition from the surgery,” the surgeon said.

According to the surgeon, there has been an increased morbidity and mortality rates among urgent surgical patients due to the lack of ICUs, wards, and the shortened operation hours because of full dependence on only one small OT. 

“The lack of space for non-Covid patients also meant congestion and this increased the risk of spread of Covid-19,” the surgeon said.

The situation is now almost at a breaking point, with the surgical team constantly worried about their safety and that of their patients.

The members of the GH surgical directorate submitted a memorandum last month to the Penang General Hospital management in hopes of seeking a solution.

“We do not have any personal agenda in this, we want to protect everyone’s safety in this, the staffs’ safety and the patients’ safety, we do not want more patients to recover from surgeries well but succumb to Covid-19 instead,” the surgeon said.

According to the surgeon, Penang General Hospital or the state health department or the Health Ministry must now come to a decision on how to manage Covid-19 cases in that hospital.

“Admittedly, we have to handle the pandemic no matter what but we have come to a point where the hospital has to admit that it cannot cope being a hybrid hospital where it continues to take in non-Covid patients with limited spaces and resources,” the surgeon said.

In the memorandum signed by the head surgeons from eight surgical departments at Penang GH, they proposed for a clear plan and direction to be adopted in terms of continuing the hospital service as a hybrid hospital handling both Covid and non-Covid patients. 

These included 24-hour operating times at the OT, with staff being paid overtime. 

They also proposed the recruitment of locus medical personnel and OT nurses to assist in running of the OTs and expedite outsourcing measures.

“It would be better if the GH were to be fully converted into a full Covid-19 hospital and all non-Covid cases be diverted to private hospitals with the bills being fully paid by the health ministry,” the surgeon suggested. 

This would allow the hospitals to focus on either Covid-19 or unrelated cases and improve patient outcomes, he explained.

“If the Emergency Ordinance is still in force, it would be helpful as it can compel the private hospitals to take in Covid-19 cases on behalf of government hospitals so that the patients are not charged for it but now that it is no longer in force, the health ministry has to come up with other options,” the surgeon said.

The surgeon said it was time for the GH to accept its limitations and seek a solution so as not to jeopardise the safety of its staff and patients further.

“We are not criticising the management or the ministry, so far, they have been doing very well in managing the Covid-19 cases coming in, we are only pleading for them to do something to ease the conditions for the non-Covid side, for the sake of the staff and the patients who trust us,” the surgeon said. 

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