By Dr Mingchang Wang

I stood beside my patient in my sweat-soaked personal protective equipment (PPE). It was a sweltering 35 degrees Celsius in the shade and he was attempting to do a standing gastrocnemius stretch while I supervised him.

“Hold for 20 seconds, do three sets each leg”, I told him. He nodded in acknowledgement, beads of sweat rolling down his forehead and soaking his cloth mask. He had insertional Achilles tendinosis, a common condition encountered in my sports medicine clinic.

However this was no ordinary clinic, it was the frontline of Singapore’s war with COVID-19. My battlefield was a makeshift tentage on a basketball court, within a migrant worker dormitory. The worker to whom I had just taught calf stretches also had COVID-19.

Masking my deficiencies 

I practise sports medicine in a public hospital in Singapore. In January 2020, I was looking forward to the deliveries of a new focussed-shockwave device and platelet-rich plasma system.  Outside of hospital, I was delighted to be assigned a role at the upcoming Tokyo Paralympic Games. It was a good start to 2020.

Singapore saw its first imported case of COVID-19 on 23^rd January 2020.[1]  A fortnight later, there were signs of community spread and the national alert level was raised.[2]  My hospital ceased non-essential services to stem the virus’s spread. Sports medicine clinics were closed and I was seconded to the orthopaedic service of another hospital.

I ran general orthopaedic clinics, treating wounds and fractures. I saw inpatient referrals and assisted in surgeries. It was mandatory to wear a surgical mask at all times, which was important not only for protecting myself but also for hiding my look of apprehension in front of patients. Being non-surgically trained, I was out of my depth: managing patella fractures instead of patellafemoral pain; wielding a scalpel instead of an ultrasound probe over the knee; aiming a drillbit instead of a shockwave applicator at a patient’s tibia.

Deluge of the dormitories

Singapore has 323,000 migrant workers, most of whom hail from countries like Bangladesh and India.[3] They do work vital to the economy that most locals are unwilling to take up, e.g. construction and sanitation. They live in privately-run dormitories all over the island-state, in rooms cramped with as many as 12 men.[4] Under such conditions, COVID-19 spread like wildfire. As of 17^th May 2020, we had 28,038 cases of COVID-19, of which more than 90% were migrant workers.[3]

Government agencies took over dormitory operations and public hospitals were tasked to provide medical support in three areas: managing COVID-19 cases onsite to prevent our hospitals from becoming overwhelmed; mass swabbing to identify and isolate positive contacts; and attending to the migrant workers’ primary care needs.

My hospital was assigned three dormitories. I volunteered as I believed I could contribute more in the dormitories than in the orthopaedic service. My colleague, a spine surgeon, also volunteered despite having to re-learn how to use a stethoscope.

Tales from the trenches

Thankfully, most of the infected workers were young and only mildly symptomatic. They could be managed within the dormitory and not require hospital care. However, to quote one of them, “my body okay but my mind not okay”. Many were worried after reading reports of mounting COVID-19 deaths worldwide. Some were uncomfortable as they were isolated with others of a different ethnicity. They were catered local food that was culturally unacceptable and unpalatable. Their rooms lacked basic amenities like toiletries and cleaning equipment.

Medical consultations became an avenue for many to vent their frustrations and policemen had to be prophylactically stationed beside us. The workers’ first language was not English and rapport-building was tough. They could not see our PPE-covered faces and we relied on shoulder pats and smiling with our eyes to convey empathy.

We spent more than 4hours each shift in full PPE under the tropical sun. Sweat would pool and leak from our sleeves and gloves, soaking our clerking sheets as we wrote or dripping onto the workers as we auscultated them. I recall feeling light-headed at the end of one shift, my breaths rapid and shallow—clear signs of dehydration and heat exhaustion.

Small victories

Over the past month, we optimised our pre-shift hydration regime and also got acclimatized to working in the heat. The workers received a deluge of donations from good Samaritans. Simple gifts like sachets of 3-in-1 coffee powder went a long way in building rapport and boosting morale. There was also an overhaul in the quality of catered food.

It has been a month at the dormitory. I do not know how I will maintain my clinical skills or when I will return to practising sports medicine. For now, I am thankful for being able to make a difference in the outcome of this pandemic in my country.

***

Dr Mingchang Wang is a Sports and Exercise Medicine Physician practising at the National University Hospital in Singapore. He has interests in exercise prescriptions for chronic diseases as well as in interventional ultrasound. He hopes to get reacquainted with them as soon as the pandemic settles.Email: mingchang_wang@nuhs.edu.sg

Competing interests: none declared

References:

1. https://www.moh.gov.sg/news-highlights/details/confirmed-imported-case-of-novel-coronavirus-infection-in-singapore-multi-ministry-taskforce-ramps-up-precautionary-measures (accessed May 2020)
2. https://www.moh.gov.sg/news-highlights/details/risk-assessment-raised-to-dorscon-orange (accessed May 2020)
3. https://covidsitrep.moh.gov.sg/ (accessed May 2020)
4. https://www.channelnewsasia.com/news/singapore/coronavirus-covid-19-s11-westlite-dormitories-workers-12614988 (accessed May 2020)