Life’s probably a little weird right now if you live in Singapore. With activities suspended, gatherings rainchecked, people jittery about shaking hands, coughing and pressing lift buttons, and folks working from home, things are in a strange state of limbo.
But if you think not being able to get a delivery slot on RedMart and having to wash your hands for 20 seconds every time you touch a questionable surface is bad, there’s a group of people who have it much worse — healthcare workers. As the number of Covid-19 cases in Singapore rises, along with the number of suspected cases, doctors, nurses, cleaners, drivers and others working in hospitals, clinics and healthcare providers across the country are feeling the heat. And as if caring for the sick and the stress of possibly exposing themselves and their loved ones to the virus aren’t bad enough, there are heartbreaking stories of healthcare workers being shunned in public and denied service.
8days.sg came across Dr Jade Kua’s blog post, cheekily titled “DORSCON Orange Is The New Black”, which is filled with humorous yet thoughtful anecdotes about life on the hospital frontlines, peppered with selfies and photos with fellow mask-wearing doctors and nurses. We thought she might be able to offer a different perspective into the fight against the Coronavirus, one that isn’t all gloom and doom and rising infection numbers. So here we are.
8days.sg: Thanks for helping to fight COVID-19 on the frontlines. We understand you just got off a 12-hour shift — thanks for talking to us.
Dr Jade Kua: No problem. Yes, we pull in 12-hour clinical shifts now. And because I work in A&E (Accident & Emergency), it’s pretty intense.
Are the shifts longer than usual?
Usually they’re about 10 hours, and there’s usually some overlap — every couple of hours, there's someone fresh coming in, say at 8am, 10am, 1pm. So usually the shifts are a little shorter and the teams overlap, but in this specific time, we are on modular shifts, so there's no overlap. So one team goes in from, say, 8am to 8pm, and the next team comes in at 8pm.
It’s because the teams are not supposed to meet?
Something like that, yes. So it's quite tiring.
Is a typical day now different from before the virus outbreak?
Other than the shifts being longer, we also have on more protective gear in certain areas. I mean, obviously on a usual day, if we have patients with infectious diseases, we would put on protective gear. But now, if a case comes in for resuscitation, for example, I might wear goggles, whereas usually I would exercise my own judgment about whether goggles were required. And the masks we’d wear typically would be surgical masks, unless there was an infectious disease patient, but now we need to be quite careful. So I’d say that the level of protective gear is increased and almost mandated in certain areas.
You mentioned in our pre-interview correspondence that there are different hospital zones — fever zones and fever-free zones.
Yes, so we take turns to man different zones. Patients are cohorted to facilitate contact tracing and to reduce spread. So we have, for example, a patient with a high risk which would be seen in a certain area and then the patients who are at risk will be in another area. Patients who are at low risk of infectious disease who are in for, say, a broken arm or a broken ankle will be seen in a completely different area.
The intensity level would be different in different zones, right?
If you're seeing someone who was at a high risk of infection, then I guess just physically knowing that you're in a certain space would help, and I guess being aware of the mental stress that might be there for some doctors. You know, just physically putting on all that gear — it gets quite hot. Obviously it’s not that being in the low risk area means that you’re stress free, because you’re then only seeing patients that might require procedures. So you may spend the whole day reducing fractures or stitching up wounds and stuff like that. So there are different kinds of stresses placed on different doctors at different times.
As you go into this situation every day, no matter which zone you're in, does it feel a lot harder than usual?
I think it’s definitely mentally a little bit more tiring because you're sort of very aware all the time about what you're doing. And the stress is not so much that I’m worried I’ll bring germs home, because I'm very careful when I'm at work and we have very clear instructions about how to protect ourselves and our loved ones. So as long as we adhere to those things, then it's really just a matter of getting used to them. So there are things that might not be so routine as compared to before, like wearing our goggles or wiping down our stethoscopes after every single patient. We used to walk around with stethoscopes around our necks, now I don't really do that. It's just, you know, the little things like that.
As a mum of young children [her kids are four, seven and nine years old and her step-children are 18, 20 and 21], is there some additional burden despite all the precautions, as compared to somebody who goes home to, you know, not young children?
I mean, it's definitely on my mind. And I have so many dependents. I know that the people that would be affected by my actions aren’t just me and my patients, or their families or their community, but my family as well. There’s always that possibility whenever you talk about any kind of infectious disease. I mean, we're finding out new things about this virus all the time. For example, when we found out that you could be a carrier of the virus even if you didn’t have symptoms, that just made everybody very, very aware that you just have to be vigilant all of the time. I'm still staying at home with my family. I haven't isolated myself or anything. I don't think there's any real need to do that. But it’s certainly on my mind.
You spend time with your family and you meet your friends when you get off work, right? These things are necessary.
I think all the stress that we carry at work — the physical, mental and emotional stress — all that is really so we can be safe when I come home. ’Cos I'm so extra vigilant at work, I know that I don't have to be stressed when I come home to my family.
With all these checks in place, the public has nothing to worry about when they meet a doctor, nurse or healthcare worker.
If the public understands that we are trying our very best, that we’ve been doing so much for surveillance monitoring, and just being extra careful with how we cohort the patients and whom we admit, and trust that we're making decisions to keep the public safe, then it makes things easier. But if people panic and then you have the situation with people sweeping the supermarkets, it creates a problem where there isn't enough for everybody. But if they would calm down a little bit and understand that a lot of the stress that healthcare workers and, I suppose, the government is facing is so we can let everyone have as normal a life as possible.
Any advice for folks out there on how to maintain a normal life in a rather abnormal situation?
Just take the normal precautions that anybody would take, say with a HFMD outbreak or chicken pox outbreak. We don’t have to wear double surgical masks in every space all the time. Just the normal precautions would make sense. It's very helpful if the public trusts us. There’s also honesty. Like if we were to ask a parent whether their child has a fever or cough, if they’ve come in for a broken ankle. If you trust us, and your kid does have a fever or cough, just tell us. Then we would know how to manage and to place you and your child in the correct area. But if you are a little bit dishonest because you're so stressed, and you decide that your fever and cough are of no threat to anybody and don't tell us about it, then you put the patients around you at risk. I know it must be quite scary for a layman to wake up to all this news about the virus spreading, but you have to trust that the government knows what they’re doing to handle the situation and that as healthcare workers, we’re trying our best.
There’s been news about healthcare workers being treated shabbily. And on the flip side, healthcare workers are also being celebrated and thanked by the public for all that they're doing. What's the mentality of someone like yourself working on the frontlines?
I think initially, there was quite a lot of negativity when people were very frightened about what was happening. And along with that, people panicking whenever they came in contact with healthcare workers or someone in [healthcare] uniform. They basically just freaked out and that was obviously not very nice and there wasn’t that trust.
Was it hurtful for you personally? Like did you get angry?
I'm not sure angry is the right word, I think maybe just a bit sad. Once again, there’s the issue of trust. I think if you see a healthcare worker wearing a uniform, you have to trust that this person has had the good sense not to wear a dirty uniform out. I think initially, the stories we were hearing about healthcare personnel being shunned and you know, nurses and paramedics being told to get off a bus or MRT, I think most of us felt quite sad because on top of everything and all the hours we were putting in, it just felt like we were very isolated. There was an “us and them” sort of thing.
But there’ve been some bright moments, too.
Yes, I was just going to put up a blog post about how Valentine's Day was very uplifting. Because I had commented in my last blog post about how bubble tea deliveries were being cancelled on us at the hospital all the time, and this was before we went to DORSCON orange. A lot of people were really panicking and canceling our food deliveries, and we would be quite sad, ’cos we don’t get our little treats. And then a bunch of mummies treated us to bubble tea. It was coordinated by someone I did know, but the rest of the mummies I didn’t know. They had the bubble tea delivered to my house and then I bought it into the hospital, because it's easier that way. My colleagues were beaming and the nurses were so grateful. They also sent round some sunflowers and I gave them to my pharmacists, the people in charge of admissions, my porters, my cleaners, the housekeepers… they were so happy to get them.
That’s amazingly sweet.
You know, the guys who are in these lines, sometimes they get a lot of flak as well. The screeners get yelled at sometimes when they detect that people have fevers and ask them to go to certain areas. And you know the housekeepers are actually at quite high risk, right? Because they are cleaning up all the fluids and everything. I mean, you don't really see the patients thanking them or anything like that. And the porters have to transport everybody — they don't get to choose. So I when I gave them the flowers, they were so happy.
There are good people out there.
It was very uplifting and wonderful, and I think now there's a little bit more awareness as well. Some people are writing notes and posting them online and it's very lovely to see. It's nice to just feel the love. We definitely feel some positive vibes.
Stuff like that keeps you going, I’m sure. What else keeps you going in a tough time like this?
This is really why a lot of people want to be in healthcare, to be able to help and use our skills to do some good. We have a special skill set and we’re very proud of being able to help. So even if it puts us in a situation where we have to be physically uncomfortable and have quite a bit of mental stress, we do it. Something like this does remind us why we signed up for this in the first place — it was never for fame or money or anything like that. And it really unifies the healthcare community, that we’re all in this together. It’s very powerful.
We see from your blog and your Instagram that you are dealing with this with some humor. Things like taking OOTDs while wearing surgical gowns and selfies with fellow doctors and colleagues, and joking about how the masks are giving you bad skin.
I think the humour does help, if just to keep the morale up, because while I think the physical exhaustion is certainly there, it's the mental exhaustion that makes people feel burned out. And we don’t want that in this time. I think burnout is something frontline workers are at risk of, and that's just on a regular day. So with the added stress of this current viral outbreak, I think I just want to make sure that everybody feels okay.
We might be in for a long fight.
I mean, this is just the beginning of DORSCON Orange. It’s only been a week or so. We obviously don’t know how long this is going to go on for, but you have to make some assumptions that we're at the beginning of things. So I think it's quite important to try to keep the team morale up when you are, you know, one of the seniors. I look on all of my young doctors as an extension of my family, so bringing them snacks or flowers or even shower gel is nice. ’Cos sometimes when you shower with handwash, it’s just moisture stripping! And you leave the hospital feeling like, you know, this was not fun! (Laughs)
So everyone has to take a shower before they leave the hospital?
That’s not mandated — it's just something that I personally like to do. I just want the doctors to know that if they would like to also shower at work, that there's some nice shower gel for them. But it's not compulsory.
Your blog posts and Instagrams are light-hearted and funny — does it come quite naturally for you, even in a stressful time like this?
I’m not trying to be funny lah. (Laughs) I think I try to be honest with how I feel about things and I try to be honest about the situation with my Instagram and my blog posts. These are my personal experiences. I try to be authentic and paint pictures that are as real as possible. I’m also careful about the words that I choose. I suppose that if I can see some humor in it, then I would share that. If it was a situation in which I felt quite bad, I suppose I would share that authentically as well.
You shared about how your fake eyelashes were taking a beating ’cos of the googles you have to wear all the time. That’s hilarious. How are your eyelashes currently doing?
Funny that you should say, but when I realised that the number of virus cases were going up, I did actually go to fix my eyelashes. You know how you go fix your lashes just before you give birth so you’d still look good? Before we went into DORSCON Orange, I got my lashes fixed. (Laughs)
(Laughs) I was like, okay, I'm forseeing a period in which I may not be able to come out or if things get worse very, very quickly, then I shouldn't be coming out, so I gotta go get them fixed. Despite my best intentions, these goggles are getting the better of me. I think today alone, I lost like 10 percent of my fake eyelashes. (Laughs)
Eyelashes! Priorities! But seriously, whatever helps you feel just a bit better, right?
That's right. Anyway, you know what? I'm not doing it for myself, man. Other people have to look at me, right? (Laughs) Dude, let's just say I'm really glad this interview is over the phone and isn’t a face-to-face or video interview. I’m not sure I’m camera ready now! (Laughs)
Thanks so much Jade for talking to us. Appreciate you taking the time out despite how tired you must be.
Thank you for being interested!
Dr Jade Kua's blog can be found at https://www.drjadekua.com/.