Introduction
As I drank from the tap, I thought about the people at the water works, keeping a close watch in real time, and about the pioneering work that put fluoride into our water.1 It prompts me to think about things that happen While We Were Sleeping,2 so that in the morning, things work.
Like the shoemaker who left pieces of leather in his workshop and woke up to find a perfectly made pair of shoes, I am curious about the many little elves working tirelessly away from the public eye, keeping COVID-19 infections at bay.
Ostensibly, this article is about preparedness in the healthcare community for such crises. Truth is, swooping in like the cavalry is glamorous. Preparedness is not. Preparedness is endless hours of menial, repetitive, and often unnoticed and unappreciated work. This article is a tribute to the many who are involved in the business of preparedness.
Over the past few months, I visited areas affected by the pandemic. I saw many little elves in action; from public and private sectors, from hospitals, polyclinics and ministries, from the Singapore Armed Forces (SAF), Singapore Civil Defence Force and the Singapore Police Force. They came, did their work without fanfare and left each place a little better than they found it.
This is an invitation to peek at three such little elves. One from the Army who was thrown into the deep end, to set up a hitherto unheard-of “swab isolation facility (SIF)"; another from the Navy, plucked from his neurosurgical residency and plunged into the world of isolation at a “community care facility". The third, from the Air Force, reminded us that despite COVID-19, other medical emergencies, including those on the high seas, continue unabated. Each accomplished much by way of preparedness and rose to the occasion.
Isolated in place, yet united against adversity
CPT (Dr) Lim: The concept was elegant – swab all suspect cases, house them in Quarantine Order-level facilities, then disperse them based on swab results. The execution was anything but. Cherryloft Resorts was set up with plans to be operational by week’s end. But with burgeoning spikes in cases, the call was issued to stand up Loyang by day three.
Constant readiness ensured that logistics, manpower and support was prepared within half a day transforming the idyllic resort at Civil Service Club @ Loyang into a full-fledged SIF, ready for battle.
SIFs bore the brunt of isolation patients, with hundreds arriving by the busload daily. They came from dormitories, hospitals and clinic island-wide. It was a challenge being commander, doctor, counsellor and liaison officer all in one. Handling anxious, unstable patients, food and security concerns made SIF management uncertain and stressful. Daily, even hourly changes to policy meant that ground processes had to be updated frequently, sometimes with incomplete information – a real challenge when wearing personal protective equipment (PPE). The experience harkens back to house officer days when one’s phone would be ringing constantly – from superiors, peers and employers requesting for information. Unfortunately, the volatile situation meant that answers were anything but certain. Many sleepless nights were spent fine-tuning processes on the ground and gathering information.
Our efforts bore fruit, and SIFs mushroomed throughout the island, modelled after our processes. I am immensely proud of our medics and the Army’s efforts in safeguarding our nation from this invisible threat.
Standing on the shoulders of Harvey Cushing
MAJ (Dr) Teo: I have been inspired by senior neurosurgeons to mould myself in the likeness of Harvey Cushing – the father of modern neurosurgery – as the epitome of excellence in medicine. I anticipated similarities in our journeys, featuring obsessions with the pituitary. However, I never imagined being thrust into the command team for the "field hospital" effort at the SAF Community Care Facility (CCF) @ Expo3 in the fight of my generation against COVID–19, just like Cushing did in World War I of his generation.4
When the call of duty came, we were ready to serve at short notice. But the realities of the challenges that lay ahead were daunting. Mission success meant providing a robust standard of care to patients while achieving zero safety incidents, including zero healthcare-acquired infections. Leading the team in the "trenches", we needed to provide our men with the information, training and resources to succeed. In the COVID–19 "fog–of–war", we had to draw clear boundaries for safety, be punctilious with our processes and engender trust in our men through our decisions.
Similar to Cushing's fight in the "Battle of Boston Common",5,a we faced challenges mobilising our fight for preparedness. While Cushing's solo effort failed, "we" as a team succeeded. "We" comprised Tri–Service (Army, Navy and Air Force) Full–time National Servicemen, Regulars and Operationally Ready National Servicemen who stepped forward on the back of earlier deployments (within SAF and/or in public hospitals) and readily threw our weight behind our teams to keep each other motivated and focused on the tasks ahead, as well as our partner agenciesb who provided the resolute "tail" to our "teeth".
I may never be as accomplished as Cushing in my lifetime, but I consider myself far more privileged to have witnessed our sense of common purpose and commitment to the nation's defence play out before my very eyes.
Flying over seas – one life saved
CPT (Dr) Ang: I had just taken over the Search and Rescue (SAR) duty from my colleague on 8 June 2020, when the call came for the day's duty team to respond. A severely ill individual on board a commercial vessel within our flight information region had radioed for medical help.
I was filled with both excitement and apprehension. This was my maiden SAR mission. It was also the first time the newly developed COVID-19 protocols would be carried out in a live SAR mission. Prior to this, we had identified the risk areas when conducting winching operations and medical resuscitation on board a helicopter, while in full PPE. We recognised that performing a helicopter–medevac was already challenging, and doing it in full PPE makes it a lot harder. Throughout the preparations, I witnessed first-hand what team excellence was – the collective desire to ensure mission success and safety outcomes, from both the medical professionals and aircrew, was evident. It was no surprise that the SAR mission was completed safely, without much fanfare.
When I was informed that I was the first female medical officer to be involved in a SAR operation for the Republic of Singapore Air Force, I was pleasantly surprised at this significant milestone. I have always felt that women are given equal opportunities to serve in all roles in the SAF. For that, I am truly honoured for the opportunity to serve in 1 Medical Squadron, to be able to provide medical assistance to people in distress out at sea and ensure the continued safety of our aircrew as they take to the skies.
Conclusion
The reward for their good work is more work. Some people see it as a curse, like Sisyphus, but I see it as merely our lot – eternal vigilance, as a way of life. Not a siege mentality per se, but certainly not resting on our laurels. At the time of writing, there is neither a second wave of infections nor the prospects of a repeat circuit breaker. Crossing fingers doesn't work, preparedness does.
And to our healthcare colleagues who toiled in the past months and many who are still facing the drudgery of the pandemic work, it is cliched but certainly timely and timeless to quote Gandhi: "Every worthwhile accomplishment, ... has... a beginning, a struggle and a victory." We cannot decide the beginning, nor are we ever confident of the victory, but we can certainly own every bit of the struggle.
Seek Save Serve.c