These men, at the helm of two of the country’s biggest private hospitals, are directing their teams by charting the most efficient plans of action with what they have at their disposal. Day by day, they keep morale as high as possible while struggling with certain government constraints.

Dr. Ramos shares that he has no choice but to be on top of the situation, in order to motivate and mobilise the entire team at The Medical City (TMC), preparing them for the worst. “This crisis is unprecedented; no doubt, everybody is scared. People known to us have died, and they died so quickly without any time to prepare. As the president & CEO of The Medical City, the load is heavy and the pressure is sustained" shares Dr. Ramos, sternly. 

Speaking with Dr. Javier truly revealed that the weight on his shoulders is indeed heavy as he shared that “there are a lot of challenges to be at the hospital amid a pandemic, especially a prestigious one like Makati Medical Center (MMC). The challenge lies in making sure that all sectors under one's wings are duly protected and their welfare, safeguarded.” Not only the physical dangers of protecting his team, but the emotional or mental burden of trying to make a plan for everybody is grueling.

Dr. Javier passionately shares that he constantly thinks how to protect, “not only the patients who entrust their health and lives to MMC - but also the community of healthcare professionals working here, including the corporate individuals, the auxiliary staff, the paramedical personnel, everyone from top leadership to the last member of the housekeeping team.” 

Repurposing TMC facilities to contain the spread of the virus, triaging patients according to their clinical history and symptoms, streamlining medical and administrative processes, monitoring people’s movements, protecting the healthcare workers at the front lines, to providing sustenance like food or ample rest, and boosting staff morale and managing supply inventory are amongst the tasks that keeps Dr. Ramos’ mind constantly running. After a long day at TMC, Dr. Ramos confessed that he ends late at night with no time to worry as he is too tired and that he seems to wake up feeling like he has not slept at all.

What makes it even more challenging and terrifying to Dr. Javier in MMC are the many unknowns and the uncertainties about COVID-19. “We are going to battle with an enemy that one does not fully know and understand; it is a good formula for apprehension” he shares.

Clearly, the mental fatigue is burdensome. Dr. Ramos shared his true emotions as he said: “I see death and grief everyday, I see the manpower dwindle as those staff who are possibly exposed go under quarantine. I am scared.”

I wanted to know how they are able to put on a brave and confident face to uplift an entire hospital, despite feeling overwhelmed. For Dr. Javier the motivation comes from diverse origins, but most especially from his inherent commitment as a healthcare professional. He shared with me that he takes his Hippocratic oath very seriously; he is sworn to protect and save lives. As a doctor, he believes that you have to be realistic and pragmatic. He and his fellow physicians are unfortunately well aware that as frontliners, (especially against a virulent, highly infectious and contagious microorganism) they can become just another number in the growing statistics of deceased medical professionals. He explained to me though, that this sentiment is always counteracted by an equal, if not greater, number of infected individuals who recover from the disease.

Amidst his new norm of daily frenetic highs and lows, Dr. Javier shares that he feels relief and happiness when MMC is able to take someone out of the respirator in the Critical Care Unit and can see that patient recover favourably. For this medical director, prayers and divine guidance are essential tools that help him get through this crisis - every hour of the day. 

Over at Medical City Hospital Dr. Ramos assures his staff by saying that they will win this war, pointing out that there is an end to it all. He shares that his team has acquired a new sense of purpose from being in the trenches, so to speak. Dr. Ramos has found that as of late many of the frontliners are feeling good about staying longer hours at TMC and oftentimes even sleep in their offices.

One way he tries to keep spirits high is to make sure that every piece of good news, however small, is communicated. “Seeing peers distributing food and drinks to their colleagues, serenading one another, or any simple gestures to show that they are taken care of, plus regular communication from me to boost morale, all the way to putting soothing music on over the hospital sound system” are some of the ways the TMC team gets through the day shares Dr. Ramos. He adds that “a COVID-19 patient who recovers and gets discharged is big deal to everyone.”

Now, a lot of the hospitals are reacting and playing catchup to hourly changes and government updates. I wondered, were we prepared enough? What could or should have been done and what would they have done if they had their way? 

“Even if this COVID-19 crisis was something that we could have predicted, the health system of our country could not have prepared adequately to handle the surge of patients or the scale of contagion” Dr. Ramos says frankly. Both men are in agreement in that they would have established clear, efficient channels of communication and collaboration between hospitals and government facilities.

Could lapses in judgement, possibly the mismanagement of funds, or political agendas have gotten in the way of The Philippines’ success in preparing for battle? Interestingly enough, similar patterns seem to be occurring in a rising number of states around the globe.

“If I had my way and I had resources and manpower of the government under my power and influence, I would have identified government healthcare facilities as designated COVID-19 centres. I would have then invited all private medical centres and marshall all their support to combat the outbreak as well and maybe even pursue a collaborative framework between the government and private sectors in anticipation of the outbreak” Dr. Javier explains. 

In concurrence, Dr. Ramos adds that he would have started establishing collaboration and coordination with the local government units, government and private hospitals in order to achieve better integration of a unified health system. To him right now, he feels like each hospital is fending for itself in this war and that they are not equipped enough to share information in as fast a manner as he’d like and nor share the needed resources.

When it comes to supplies, Dr. Javier would have stockpiled hundreds of thousands of testing kits and enlisted personnel from the Research Institute for Tropical Medicine (RITM) so that mass testing could have been carried rapidly and immediately, everyday. In his eyes, internal red tape and bureaucracy stemming from weak planning has prevented the speedy approval of the much needed kits, procurement of supplies, and the green lighting of drug importation. Through Dr. Javier’s words, I feel his frustration and passion as he shared that he would have acted on all these things, not today, not yesterday - but months ago - when China, South Korea and Italy’s numbers were steadily climbing.

Speaking in a concerned and serious manner Dr. Ramos says that “once this is over, we should take stock, confront the state of our country's healthcare system and overhaul it. This crisis has unmasked miserably serious gaps in leadership. People in leadership positions who failed to rise to the occasion, and worse, contributed to the malady, should go or be removed.”

These leaders leave much to think about in these uncertain times as new challenges emerge, frequently. We at Tatler are one with these frontliners in spirit as we aim to foster a deeper understanding of all issues at hand.