“I CAN’T do this anymore,” my colleague crumples, her eyes welling up with tears.

“Patients keep deteriorating while admissions pour in. There is just not enough time and staff.

“We left work at 1am yesterday when our shift should have ended at 8pm. Again.” 

She is not alone in feeling this way. None of us can constantly function at full capacity and when we’re forced to do that, what you get is burnout. A deadening of emotion, a feeling of detachment. 

A majority of contract medical officers (MOs) are placed in Covid-19 teams. Since early April, MOs nationwide have been stretched thin. The number of Covid-19 cases have been rising rapidly since March 29. The current third wave, which started in September last year, dipped to its lowest on March but due to public failure to comply with SOPs, among other reasons, the number of cases steadily climbed back up and exceeded the previous peak of 4,571 new cases a day. The new record was 9,020 new cases and 76,218 active cases on May 29.

At the Malaysia Agro Exposition Park Serdang, the biggest Covid-19 quarantine centre in Malaysia currently, new halls have opened but the size of the workforce has remained unchanged.  We recently received a few more workers but our workload simultaneously increased exponentially with the rising number of Category 3-5 patients and the care they require. Our maximum available beds are approximately 6,000 and there is only an average of 55 MOs per shift. That makes for a ratio of one MO to 109 patients per day if we reach 100% capacity (which has happened many times). On multiple occasions we have exceeded our maximum bed count even and patients have had to sleep on canvas beds and even the floor overnight. This has been happening in many hospitals in the Klang Valley and yet it is evident by the number of cars seen on the road daily despite lockdown that the public does not understand the gravity of this dire situation. I implore the public to stay home unless absolutely necessary. Otherwise, we will never flatten the curve.

It is understandable that due to the rapid rise in Covid-19 cases in Malaysia every healthcare facility is struggling to stay afloat. However, with this doctor-to-patient ratio, compromise in patient care and exposure to medical errors is inevitable. We have had some code blues in the last 2 months, when prior to May since opening in November we have had none. No one can say for sure if it was due to lack of staff resulting in less than ideal patient monitoring. However, a study by Z. Or demonstrates a 10% increase in doctors per 1,000 population could result in a 4% reduction in premature mortality in women and 3% in men.(1 Patient care also suffers in other ways when a doctor is exhausted, emotionally detached: there is a lack of connection, a sense of being cared for, of being heard. When patients tell us their concerns, we feel… nothing. When they collapse, there are no tears or heartbreak. When we have to gently explain the situation to their loved ones, we desperately hope they cannot detect the emptiness behind our words.

In addition, we work up to 12 arduous hours each day in hot and stuffy PPE in which we cannot even have a sip of water or go to the toilet. Picture doing this on a daily basis at least half the days in a month and you get a peek into a contract MO’s life. In contrast, WHO recommends that N95 masks be worn for only four hours, which is approximately the median healthcare worker tolerance time.(2)(3) However, this is not feasible with our current patient load. Increasing the number of times PPE have to be foffed also significantly increases the chances of us getting contaminated. At the time of writing, seven MOs at my workplace have active Covid-19 infections, undoubtedly due to the long hours of exposure to Covid-19 patients every day.

To repay us for working long hours in the day and throughout the night for the past year, putting not only our own lives but also those of our loved ones at risk, all whilst having no job security and uncertainty for our future with no clear pathway to specialise, our on-call claims which amount to roughly RM1,000 a month that were previously promised to us have been unpaid since January 2021 up to now. To some this amount may be little but to others they could be the sole breadwinner of their family, especially during these trying times where businesses are struggling to make ends meet. The heavily discussed but not amended issue of medical officers on contract burdens us daily. Many of us are nearing the end of our contract.

All of this makes for very low morale on top of already being burned out. The risk of major depressive disorder is greater when the level of burnout is more severe. On a daily basis, many of our colleagues fall sick or cannot bring themselves to get out of bed and face yet another distressing day at work, leaving those present with an even more daunting workload. Yet the answer, we are told, is resilience. Fix the doctors, get them to manage the workload. The fact that the workload is not manageable is not addressed. The management has provided counselling and psychology services, but unfortunately that does little to nothing to solve the issues. 

While everyone is focused on the Covid-19 pandemic, other healthcare departments such as orthopaedics, general surgery have had to cope with understaffed clinics and increased number of on-calls per month. A majority of these departments are staffed by contract MOs who have to sacrifice quality time spent on their own wellbeing and family. Many say this is part and parcel of a doctor’s life, that we signed up for this. It is third-world mentality to think we should not strive for constant improvement and progression, to enable production of more specialists and consultants resulting in better work-life balance and greater patient outcomes. There needs to be a strong support framework for doctors so that we can cope with burnout and  persevere in our career. 

While we are tirelessly taking care of patients, who is taking care of us? – July 5, 2021.

* Dr J reads The Malaysian Insight.

1. Or Z. Determinants of health outcomes in industrialised countries: a pooled cross country time series analysis. OECD Econ Surveys 2000; 30: 53-75
2. World Health Organization (2020). Rational use of personal protective equipment (PPE) for coronavirus disease (Covid-19): interim guidance. WHO/2019-nCoV/IPC PPE_use/2020.2 
3. TM Cook. Personal protective equipment during the Covid-19 pandemic – a narrative review. doi: 10.1111/anae.15071

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.