The Department of Budget and Management (DBM) has proposed to slash P1.2 billion from the 2022 budget of the UP Philippine General Hospital (PGH), leaving one of the country’s major COVID referral centers short of funds for its infrastructure and equipment.

In DBM’s submitted budget proposal to Congress last August 23, there has been no allocation for PGH’s capital outlay (CO) projects which cover the hospital’s building, structures, and equipment outlay.

Under UP’s 2022 budget proposal, the PGH has included in its CO a P90-million budget for its fire protection system in the central block after a fire incident last May razed the hospital’s operating room supply area. The fire caused an estimated P200-million damage, Dr. Jonas Del Rosario, PGH spokesperson, told the Collegian.

The hospital has also requested funds for some machines costing a total of P320 million under its proposed equipment outlay. This includes the planned purchase of an angiogram suite, robot-assisted surgical system, and portable CT scans.

But with no CO allocation for the PGH in DBM’s proposed budget (see sidebar), the hospital may not be able to roll out its infrastructure projects and procure equipment and to expand services that are more urgent during a pandemic than ever.

Expanding Capacity

The hospital has already exceeded its 230-bed allocation for COVID-19 cases after reaching a record-high admission of 320 COVID patients as of August 23.  Although the PGH had opened more COVID wards, the high number of patients coming in prompted the PGH to temporarily stop admitting patients to its emergency room starting August 25. The hospital had also ceased to accept non-COVID patients since August 14.

To accommodate more patients, the hospital is building a 40-bed isolation facility, Del Rosario said. Expected to open before the month ends, the facility will be primarily used for COVID-19 patients to avoid turning other areas, supposedly for non-COVID patients, into a COVID ward.

While the hospital continues to work on its expansion of services and capacity, it still faces issues with its ongoing renovation and construction projects. They could not be finished all at once due to the PGH’s need to operate continuously.

“We cannot totally shut down the hospital and change everything. We do it in stages, identify areas, otherwise, titigil lahat. There [is] a lot of construction going on in PGH, pero nakakainis lang kasi meron tayong pandemic so it’s harder to mobilize people,” Del Rosario said.

Yet not only does the hospital face problems with its capacity and infrastructure, it also needs to deal with the manpower required for these additional areas to operate.

Insufficient Manpower

One of the struggles with expanding the hospital’s capacity is the lack of health care workers who will attend the additional wards. This situation forces a lot of nurses and doctors to remain on duty longer than their assigned hours.

Under normal circumstances, a resident doctor reports to the hospital following three simultaneous duty cycles—pre-duty, during which they need to work for 10 hours a day before reporting for a 24-hour duty, and then post-duty for another 10 hours.

But Dr. Ven Ponce, a first-year resident at the PGH, spends much longer time in the hospital than her required hours. With the shortage in health care workers that could attend to the hospital’s many patients, Ponce has no other choice but to stay behind to accommodate all her patients.

Since the onset of the pandemic, she has lamented the severity of the patients’ cases that she handles. This, according to Ponce, is one of the reasons why health care workers could not easily leave the hospital after a day’s work due to the longer hours of treatment that these patients need.

“I’m thankful for the support that we have from the government when they give us our machines or the help from other hospitals by giving us new beds. But it’s not about the bed capacity anymore, I think it’s about our patient-to-doctor ratio. The staff is very overworked,” Ponce said.

The hospital administration has also acknowledged this issue of stretched manpower. Even Del Rosario has stressed that they “hope” to get more volunteer doctors, nurses, and medical technologists from the Department of Health (DOH) following their expansion of their COVID-19 wards.

“If we do not have a doctor or nurse who can monitor our patients, then it’s going to be unfair, it’s a disservice, and it’s very dangerous to our patients. Any expansion, in terms of infrastructure or in terms of bed capacity has to be augmented properly by manpower,” he said.

Health care workers like Ponce, however, believe that the tough situation in the PGH could not be resolved just by mere expansion. Increasing the hospital’s capacity to treat patients should go hand-in-hand not just with staff augmentation, but with additional medical equipment as well. 

Arduous Procurement

As COVID-19 cases continue to rise, the PGH’s expansion would result in more patients needing the essential medicines and machines such as ventilators and antiviral medication like Tocilizumab. According to Del Rosario, they could easily purchase these using their budget and the donations it gets from private individuals and institutions, if not for the problem of procurement.

The lack of resources arises from the scarcity of supplies worldwide, worsened by the threat of the more virulent Delta variant. Some of the equipment and medicines needed in the hospitals are sourced abroad, thus some delays in their delivery.

Ponce recalled that, earlier in the year, they came to a point where they needed to assess the situation of each patient and determine their chance of surviving due to a shortage of the mechanical ventilator.

“Parang ethical dilemma, kasi pumipili talaga kami ng mga patients who would best survive or who would most deserve the [mechanical ventilator],” she said.

Aside from the lack of supplies, another cause of the shortage in the hospital’s resources is the stringent process that the hospital must follow in purchasing their needs.

“It takes a while sometimes because government procurement has a process. It’s not just like buying it from a store, and that’s it. It has to go through sometimes bidding, although if it’s an emergency purchase, it’s going to be sooner,” Del Rosario said.

A provision in the UP’s 2021 budget provides for the purchase of medical equipment for COVID-19. But some of these machines have not been received yet, said Del Rosario, due to delays in procurement.

In fact, when the Procurement Services of the DBM sold supplies to the DOH, the Commission on Audit flagged irregularities in transactions and reported some “noted delays” in the delivery of supplies to some hospitals.

The lapses in the procurement of supplies greatly affects the PGH’s patients, including its workers who try to make do with the scant resources they have—all while enduring the exhaustion brought to them by these shortages.

“Everyone thinks they should salute the health care workers because we’re doing our best, but the reality of it is we’re very tired already,” Ponce said. “At the end of the day, I just want to go home to my family, but I can’t even do that.”

Ultimately, Ponce added that the solutions to the country’s current situation should go beyond expanding capacities and fixing procurement issues, because the hospital administrations could only do so much. “It’s not really something that we need to manage as a hospital, but it’s really something we need to address as a country,” she said.

While Ponce lauds the PGH admin’s efforts, she believes that the government could have been improving its vaccine rollout and educating its constituents on the threat of COVID-19 instead of going through a lot of lockdowns. Through these, she said, their burdens could have been eased.

“It would’ve been easier if we had something to look forward to as health care workers, like seeing our patients sent home,” she said. “But more often than not, we are unable to, because we’re faced with death every day. We cannot save them all, and this is all we can do.” ●