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Miscommunication seems to rule the day at Tan Tock Seng. Vicki Yang.

The Khaw Strategy – myth or fact?

Vicki Yang

Vicki Yang gives a first-person account of her experience in getting tested for the H1N1 virus at Tan Tock Seng hospital.

I was at Butter Factory with some friends on June 17. None of us suspected anything amiss until the 22nd where, thanks to Twitter updates, a friend and I realized that at least 7 out of the 13 of us who had gone to Butter Factory that night had fallen ill.

While I was down with a cough, headache, and body aches, a few of my other friends told me that they were suffering from raspy throats, flu, and fever. Fear struck the heart of one of my sick friends when she discovered  that we had possibly been among the same crowd as the 140th H1N1 case that very same Ladies Night at Butter Factory (and where the 96th, 117th, and 118th case had been before).

Cursing our possible fates in quarantine, we pondered our chances of contracting H1N1, and decided that a check-up would be the best course of action. None of us wanted to spread the possible infection to people at our workplaces and more importantly, to ailing members of our respective families. Two friends from that night out were already at TTSH getting tested. This was before the Pandemic Preparedness Clinics were established.

An ambulance took us from one end of Tan Tock Seng Hospital (TTSH) to the carpark that had been cordoned off for possible H1N1 suspects to be tested. A male nurse demanded the reason for our arrival and asked if we were there to see the doctor.  My confused friend replied with a statement that echoed her genuine sentiment, "I don't know". We had no idea how the proceedings of a screening were to take place.

Finally when I told him that the ambulance brought us to the testing area as we had requested for a H1N1 check-up, he growled angrily: “So you're here for a check-up to see the doctor, then just say you're here to see the doctor.”

He disappeared back into the testing area, leaving my companion and I slightly taken aback with his attitude.

The holding area looked like a detention class. Classroom tables and uncomfortable white plastic chairs (usually used in funerals and functions in community centre halls) were placed more than two arms' length apart from each other.  A small television with very bad reception sat on one end of the holding area, apparently to provide some form of entertainment for the 4 to 12 hours that H1N1 suspects had to wait, for the outcome of their test results. I sat behind two of my friends who had come earlier, but mingling was apparently disallowed.  Our communication was limited to making exaggerated physical gestures across the distances between us, and via text messages on our cell phones.

All H1N1 suspects are supposed to have their blood samples, two swabs of mucus and fluids taken from them to be tested, as well as X-rays. After an hour and a half of waiting, none of my samples had been taken. Another ninety minutes passed before a nurse came to ask me and my friends some health-related questions. For some inexplicable reasons, the nurse  insisted that my friend and I were pregnant, despite our assurances that we were not.

"It's for the X-ray. We have to know whether you're pregnant," the nurse said.

"Yes okay, but no I'm not pregnant," I said.

"Do you want to take a urine test, to make sure?"

"No, it's okay. I'm pretty sure I'm not pregnant," I replied, rather amused at the prospect of sudden pregnancy.

My friend was more forthcoming with her replies. "I can't be pregnant," she said to the concerned and well-intentioned nurse, "I'm a virgin".

Shortly later we were called in separately into the testing area for our X-rays to be taken. Half an hour after we returned to our seats, the same determined nurse came along with a small empty container packaged in a plastic bag labelled "Biohazard".

"I think you better take the urine test to make sure," she said.

I realized that the delay in the test was inevitable from the seeming lack of communication between the medical staff there. Our X-rays had already been taken, and hence there was no need for the urine test. Yet, the nurse – commendable for her insistent effort – did not know that. This lack of information among the staff regarding which tests each of the patients had or had not gone through, was glaring when it came to the issue of my delayed blood test.

After four hours had passed from the time of my entrance, I informed a nurse that my blood sample was yet to be taken despite an initial effort to do so.  The surly male nurse earlier had stopped by to poke around – but failed to take a blood sample thanks to fine veins. He did however promise that "someone else" would come by to do it later. However, after affirming that I had had my swab tests, she proceeded to dismiss the necessity of the blood test. I was still skeptical, citing that the others present at the holding area had had theirs taken, but she assured me the accuracy of her answer. When I asked the same question to a doctor when I finally saw him, the overwhelming priority of the swab tests was once again indicated, and the event of taking a blood sample was dismissed. Yet, at the end of 7 hours of waiting, another nurse informed me that a blood test was necessary, to ensure that I did not have other ailments such as dengue.

I appreciated the “Nestle-like” 3-in-1 strategy in testing for the virus, but I would have appreciated it much more had I not been misinformed and falsely assured earlier. My former suspicious probing had not motivated the medical staff in question to check the proper proceedings of the check-up, leading to another hour’s wait for the outcome of a blood test.

When asked about the misinformation and the seeming lack of consistency in the medical proceedings among the staff, the nurse's answer was, "I'm really sorry, but I don't know what they told you or what happened earlier. I only started work at 9 pm". It was a fair answer and I really could not blame the nurse, but I wondered at the proclaimed high level of preparedness of our medical staff in face of a pandemic announced by the authorities and the media, especially with The New Paper on Saturday 30 May 2009 proclaiming our preparedness as "The Khaw Strategy", stating that "the ground was well prepared".

Was there not a methodical system of testing being adhered to? When even the communication between staff and patients, or amongst the staff themselves, did not seem to hold up very strongly, I could not help but discern a slightly messy randomness in the delegation of duties to members of the staff on the job.

My companions were understandably bewildered by the amount of effort they had to take in trying to get the attention of any member of the medical staff. When one of my friends felt giddy after the blood test was taken, she was unable to get any help for a long while as the staff hurried around with no attention paid to the patients in the holding area.

Another patient seated in a wheelchair waved mournfully at passing nurses several times, indicating to his leg that seemed to be giving him a good amount of pain, but he was largely ignored. There was barely anyone attending to the already-ill patients sitting in the holding area. When nurses did pop by intermittently to pursue information from a patient, we were simply told to wait, in response to any of our questions regarding what all this waiting was leading to.

Any possible MOH statement assuring that our doctors were more than prepared would have been refuted, when a doctor's questioning revealed the lack of updates TTSH was providing its staff during this pandemic.

"So you went to the Butter Factory on the 17th, and there was... one case there."

"No, there have been four cases so far," I reminded him.

"Four cases?"

"Yes, four cases."

"And what were you and your friends outside doing at the Butter Factory? Are you working there?"

"No, I don't work there."

"What brand of butter does this factory produce?"

I stared at him, utterly perplexed at the question and unable to react instantly, only managing to croak out a "What?"  He asked again.

"It.... it doesn't produce butter... It's a club," I stammered.

"Oh, it's a club!" he exclaimed, as he scribbled away on some sheet of paper, enlightened.

That was the very moment where it became apparent that the doctors did not seem to know the situation on the ground. One would have expected that TTSH could at least update their medical team regularly on the new cases of H1N1, and some idea of the third infected cluster. Yet, it seemed that barely any updates trickled down to the medical team on the ground, which was supposedly very prepared to combat a pandemic.

Granted, it perhaps may not be fair to come down hard on the medical staff regarding their lack of knowledge of current situations especially when the third infected cluster (Butter Factory) was identified less than 24 hours prior to the time of my screening. In fact, sitting in the testing area, we heard the doctors discussing and checking cases with each other and that possible infected Butter Factory goers were not even supposed to be at TTSH, but at the Communicable Diseases Centre (CDC) situated on the next street! Yet the ambulance had unwittingly brought us from one end of TTSH to another.

What about the management of TTSH then? Was it not necessary to keep abreast of current situations and update the medical team on the ground? What did the lack of coordination among the staff, and lack of information reflect upon Singapore's readiness to combat H1N1? Perhaps my experience was an exception in the larger scheme of H1N1 testing so far.  "The Khaw Strategy" was a myth for the 9 hours I was at TTSH. Yet, the long-asserted conviction that the ground is well-prepared, seems to have fallen through that night.

Read also: The minister who got S'pore prepared - The New Paper.

And also: Gerald Giam's account of his experience at the CDC.

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