Article Summary by Brabaharan Subhani and Dilushi Wijayaratne

Sri Lanka is a low middle-income country which has a dominant state-run health service that provides free healthcare. The high rates of literacy and welfare orientation have enabled the country to achieve favourable health outcomes at a relatively low cost. However, the COVID-19 pandemic has stretched our health services to the limits. This article describes the experiences of the first author (BS) during the first wave of COVID-19 in early 2020 and describes some of the lessons learnt along the way.

Narrative

As a house officer involved on the front line of patient care, I (BS) had a front-row seat to the pandemic. Worldwide we saw the crippling failure of nearly all health systems. Locally we witnessed the fear and helplessness of the public, often coupled with desperation as their sources of income were cut off. Despite strict lock downs and strong efforts at quarantining contacts, the medical wards became a hotbed for patients suspected of having COVID-19. There was palpable fear among health workers. Limitations were placed on staff rotations so that service could be continued even in the face of exposure and quarantine of health staff. None had received training in the use of personal protective equipment (PPE). Polymerase chain reactor (PCR) results were often delayed by days. This meant that we endured great difficulties in making timely and accurate clinical decisions due to delays in referrals, investigations and interventions. But despite of this many healthcare workers demonstrated selflessness in care of these patients.

Personal reflections

The pandemic has been and continues to be a unique working experience. At the time of the first wave, we were still beginning to understand the disease and our own personal anxieties and weaknesses. Reflecting at the end of my internship, I have often wondered about the extent to which the quality of care of patients has been affected during this COVID-19 pandemic as we tried to balance our own ideals of good patient care amidst staff shortages, resource limitations, disruption of routine care, and our own fears and concerns. We had learned of ethical principles in the classroom. The application of these during the pandemic has been a true test of our mettle. We have battled and still do battle with the moral distress and the burden of the decisions that were made. Sometimes I wonder if our patient care focused more on the safety of the public than on the welfare of the individual patient? Did we truly respect patient autonomy and the principle of justice in care? I wonder if this approach is acceptable in a pandemic where the risk to millions might supersede the well-being and comfort of the one? Perhaps our consolation is that we have done the best we can in these unprecedented times and hopefully not done too much harm to our patients in the process..

Lessons learnt

COVID-19 is taking a huge toll on the mental well-being of health care workers, more so as the condition continue to wax and wane. Understanding the empathetic distress experienced by the health staff and coping with it through compassion training is important for the well-being of both staff and patients. Formal psychosocial support needs to be made available to the staff.

There is a need for major structural changes in the wards in our hospitals so that systemic adherence to infection control measures can be instituted. There is an inequality in the distribution of health services, especially at tertiary-care levels across the country which were magnified by lock downs and loss of access to care. Thus, the pandemic has placed the urgency of developing quality care across the country in a new light.

The COVID-19 pandemic has been a learning experience to healthcare systems around the world. It has brought out several weaknesses in our own system that need to be developed further so we can tackle the current pandemic and be better prepared for more such calamities in the future. As this wave recede, we must avoid the trap of complacency and maintain our focus on improving the structure and delivery of health services so that we will be able to provide quality healthcare to our patients, come what may.

Read the full article on the Medical Humanities journal website.

Brabaharan Subhani was an intern in internal medicine at the University Unit at the National Hospital, Colombo, Sri Lanka during the first wave of COVID-19 (whose narrative would form the background to write the article) and is currently attached to the Neurology critical care unit of the same hospital. She obtained her MBBS from the University of Peradeniya, Sri Lanka in 2019.

Dilushi Wijayaratne qualified as a Consultant Nephrologist in 2020. She works at the National Hospital of Sri Lanka and is a Lecturer in Clinical Medicine at the University of Colombo.