Q&A and transcript for webinar "Care For Vulnerable Populations during COVID-19 Pandemic"
1. Do you think there is a need for us to assess the acceptance of our patients towards these new norms in the healthcare system?
Dr. Rozita: Of course, we will need the feedback from our community. So, we have conducted Google Form questionnaires, and we have submitted the questionnaires through WhatsApp platform to the community in Putrajaya and Kuala Lumpur. Currently, we have yet to analyse their feedback for now.
2. How are patients faring with virtual consultations? Are there any preparations needed, e.g. training for both staff and patients?
Dr. Rozita: For virtual clinics, we have started in August 2019. Throughout those months, we have continuous feedback, and also distributed Google Form questionnaires for these patients. The feedback was very good.
Patients like virtual consultations because they don’t have to come to the clinic. There were no problems in getting parking space, some patients would be able to breastfeed during virtual consultation. Some would be able to attend virtual clinics in the car or even at pantry at workplace. Thus, it will save time for them. However, we will be selective in choosing patients who are suitable for virtual clinics.
As for training part, initially when we recruited our patients (ie. patients who have taken blood tests and started on ACEI with clinic appointment in 2 weeks’ time). So, we will prepare the patient, got their consent on virtual consultations and teach them how to do it. They would have to download Skype for Business on their laptop. Majority of our patients use their mobile network. So, they downloaded the software on their phone. Younger patients are more IT savvy, so, no problems with them. However, for older patients, we would need to train their children.
During this MCO, training was done over the phone, we would call the patient and tell them what to do, step-by-step.
3. How about vaccination for school children? How do we reschedule and redirect vaccination for school programs to go back to (already busy) clinics?
Dr. Rozita: Right now, for the vaccinations, we are planning for a session where the patients would come to the clinic with their parents. We will give them appointment dates, and they will come and get their vaccination in the clinic. This is in the pipeline, and we plan to start in June 2020.
4. Did the frequency of home visits / phone calls reduced during this pandemic? How far does this pandemic affect hospice care, such as access to painkillers?
Dr. Vanitha: Yes, the number of home visits decreased by a lot. Phone calls actually increased because we have been conducting daily phone calls. Usually, our home visits would be 3-4 patients in a day, but when it comes to phone calls could reach up to 10 patients in a day.
As for the care of the patients during this pandemic, from what I can perceived as well as the feedbacks obtained from family members, I do not think that this has affected the care, because if a patient is dying, video calls have allowed us to see and assess the patient. If there is a need, we as a hospice medical team can make a difference to make a patient comfortable at home, we will be able to provide direct care at home. If they want to die at the hospital for their final hours, we will make the necessary arrangements as well and would contact the hospital to see the best ways to bring the patient to the hospital with ease.
5. Do you think the "quality of death" is affected during this pandemic, since the provision of palliative care is challenging?
Dr. Vanitha: I don’t think so, because if a patient is dying, we would make sure that there would be no pain and no symptoms. Even if there is a pandemic, we will still go in if there is a need to ensure that the patient has a good death.
6. Do you perform COVID-19 test for palliative care patients who would like to return home to their family before their departure?
SN Sunita: When patients are discharged and are allowed to return home, we would have a set of questionnaires for patients or caregivers
ie. COVID-19 screening questionnaire: any recent symptoms like fever, cough, flu, diarrhoea; any recent mass gathering; and recent exposure to COVID-19 patients; any family members or relatives who have recently returned from overseas
We would not conduct the COVID-19 RT-PCR test itself.
These tests would only be conducted at hospital on patients with severe acute respiratory illness according to MOH SOP.
Therefore, we rely on the checklists alone, and we require patients to be very truthful in answering the questions.
7. Dr. Tan, you have done a wonderful job in discussing liver diseases amongst COVID-19 patients. What is your advice to other specialists who care for patients with chronic diseases (ie. stroke patients, chronic heart diseases, kidney diseases)?
Dr. Tan Soek Siam: I think COVID-19 is a new disease and certainly, there is a lot to learn. Malaysia being a country with multi-ethnicity, and we have non-communicable diseases (NCD) and infectious diseases. I think that this is the time to look at COVID-19 in different categories, different specialties and subspecialties. This is the time to learn and to identify new things and also how to improve our care for these groups of patients. I am sure that different patients would require different care and different prognostic information. By knowing this, we can improve our care for this arm of patients.
8. Final Messages and Summaries by the panellists
- Dr. Rozita bt. Zakaria
In summary, we are still seeing our maternal and child health patients. We are doing it as usual but in a different manner. We are embracing the new norm. Remember to practice the 3Cs and the 3Ws not only outside the healthcare facilities, but within the healthcare facilities as well.
- Dr. Tan Soek Siam
When it comes to liver disease, it is a double edge sword. COVID-19 patients can develop deranged liver function and liver biochemistry. Patients with pre-existing chronic liver disease would fare worse when they are diagnosed with COVID-19. So, we would have to look after this group of patients as well.
- Dr. Vanitha A/P R. Thangaratnam
Hospice care still persists during this pandemic, whatever challenges we face, we would still persist on.
- Sunita Kaur A/P Manmohan Singh
Despite the challenges we face as mentioned by Dr. Vanitha, we at Kasih Hospice will do our best in trying to provide hospice services within our areas of coverage.
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