"Putting it on is easy. But removing is scary."
It must be in the correct order, yet it’s difficult to do. They must grasp the gown and pull it away so ties break. Then gloves must be peeled at the same time too. They’ll lift the headband, grasp the ties of their masks, and remove it without touching the front. They must remove everything without touching the contaminated parts.
“And if you do the wrong sequence, you can get infected.”
This is how Dr. Edsel Salvaña describes the donning and doffing of PPE, his unusual routine for the past weeks. As an infectious disease specialist, he is seeing suspected COVID-19 patients at the Philippine General Hospital (PGH). He is also a member of the Technical Advisory Group (TAG) that advises the Department of Health and the Inter-Agency Task Force (IATF).
Until March 14, two days after one of his patients died from pneumonia, he became a Person Under Investigation (PUI).
“It took six days for the results to return and I was still coughing,” narrated Dr. Salvaña while completing his 14-day quarantine during our online interview. His typical day though would still be pretty busy, with multiple patient care, teaching, administrative work and research work.
“It's challenging to multitask but we need to fulfill these roles since there aren't enough people with the right skills to go around,” he added. Currently, Dr. Salvaña is the Director of the Institute of Molecular Biology and Biotechnology at UP-National Institutes of Health (NIH). He also serves as a professor and research coordinator at the PGH.
On normal days, rarely do we see health workers express their emotions in caring for their patients. During these times, however, a lot of frontline health workers use different platforms to tell us how they feel being in the frontline in the fight against the COVID-19 pandemic.
As a doctor who has recently been a PUI, Dr. Salvaña has this to say: “It was really scary. Two of my patients died and they both tested positive. When I developed a sore throat, I dropped everything and had myself admitted because I did not want to expose my family.”
Things were a lot different for him though back in 2008, for after serving as Chief Fellow at the Division of Infectious Diseases in University Hospitals of Cleveland, he returned to the Philippines as a Balik Scientist of the Department of Science and Technology through the Philippine Council for Health Research and Development (DOST-PCHRD).
The health community would say that Dr. Salvaña is a very important person in the field of HIV research and medicine. Upon his return as a Balik Scientist, he recognized the HIV epidemic in the country, and was heavily involved in training doctors to treat HIV, raising awareness, and successfully lobbying the policymakers to declare an AIDS pandemic. TED talk even wrote that he has been a “national force in the formulation of HIV treatment guidelines, campaigning against stigma, and raising awareness.”
Despite his numerous experiences in facing HIV patients, and while he knows pandemics in theory, he stressed that there is nothing like a real on to make you appreciate how devastating they can be. He noted “I don't think anything has prepared us for this. My knowledge of infectious diseases enabled me to project very clearly in my head what would happen if we did not act early. If our health system is overwhelmed, thousands could die.” He added that this has helped him advise the IATF, and said he is glad they listened.
This is not his first time working with policymakers. Currently, he is also the head of the subcommittee for HIV of the Philippine Society for Microbiology and Infectious Diseases, and was an institutional representative at the Global Fund Country Coordinating Mechanism. He has led the formulation of local clinical practice guidelines for the treatment of opportunistic infections in HIV, and has established the first HIV fellowship in the country.
“It also helped that I told them [IATF] that every disaster movie begins with everyone ignoring a scientist. They didn't ignore me and they listened. Hopefully we have changed the ending,” Dr. Salvaña, on being a member of the TAG said. He has done research on a pandemic before. He studied the molecular epidemiology of the A(H1N1) influenza, analyzing hundreds of virus samples from the 2009 to 2010 epidemic.
During our interview, Dr. Salvaña mentioned that it’s “super scary” to be a front line health worker during this pandemic. When asked about how he feels during this crisis, he has this to say: “Well, this is what I trained for. It's always scary, but it's also exciting because you know the skills you acquired during training are being put to good use and can potentially save a lot of lives.”
While most must know by now that doctors face a multitude of risks by serving in the front lines, we’re still curious as to why they risk their lives to serve the people. And Dr. Salvana told me, “I've been a government scholar since high school. I am Philippine Science High School Batch 1992, an Oblation Scholar at UP Diliman, and I did my medical training at the UP College of Medicine. After training further in the United States, I came home as a long-term Balik Scientist. So I've always felt the need to give back. I'm just really lucky that what I do is useful and beneficial to the country.”
What should be the right word though, to describe how it must be a happy and sad feeling, for someone to offer his life to his country. He is just one of the thousands of our frontline health workers who repetitively do the donning and doffing of PPEs in the correct sequence to avoid getting infected.
Thankfully, Dr. Salvaña’s test turned out negative for COVID-19 infection. After his quarantine, he will still continue to care for patients, coordinate donations, and do research work just like his routine weeks before.
As of March 31, the Philippines lost twelve of its brave doctors to COVID-19. Despite this, Dr. Salvaña has this to say to his fellow frontline workers: “I know you are scared, just like me. But we are the only thing standing between this monster and our families and friends. This is what we are trained for. Some of us may die. But we die doing our duty and on our terms. Whatever happens, we will make a difference.”