The 2020 Tokyo Paralympic Games may have ended more than a month ago (September 2021), but the sweet memories of this international sporting competition still remain strong.
It was indeed a remarkable event given that the Games were at the risk of cancellation due to the Covid-19 pandemic.
And it ended on a high note for the Malaysian contingent, who clinched an outstanding three gold and two silver medals, surpassing the previous haul of three golds and one bronze in the 2016 Rio Paralympic Games.
Represented by 23 athletes and competition partners, our Paralympics team participated in nine of the 23 sports contested at the Games.
They were archery, athletics, badminton, boccia, cycling, powerlifting, table tennis, swimming and wheelchair tennis.
On a personal level, this was my first Paralympic Games as the Chief Team Physician.
Although I have served previously as the chief medical officer for our differently-abled team at the 2017 Asean Para Games and the XXI Commonwealth Games in 2018, nothing could be better than taking care of these athletes at the pinnacle of sports competition – the Paralympics.
Training in full quarantine
This edition of the Paralympic Games was certainly no ordinary one, thanks to the Covid-19 pandemic.
Months prior to the start of the Games, we were made aware that many adjustments would have to be made in our preparations and during the Games itself.
We would face restrictions on the places we could go during the competition, and high emphasis on hygiene and physical distancing measures would be in place.
These “safety first” decisions were meant to protect us, the Games’ participants, as well as the people of Tokyo and Japan.
This meant that countermeasures to ensure that all the Malaysian athletes and contingent members were not exposed to Covid-19 infection and enabling them to compete successfully and safely, were paramount.
Ever since the start of the pandemic last year (2020), our national athletes had been training under full quarantine at a designated athlete training complex.
This meant they had strictly limited access to outside exposure with full-on infection countermeasures in place.
The programme was designed to emulate the anticipated hardship we would face in Japan.
The National Sports Council led the programme under the Road to Tokyo initiative, with a committee joined by the National Sports Institute (ISN) and other stakeholders.
This committee observed all the athletes, coaches and support services through to the final phase of Games preparation.
Covid-19 countermeasures, such as providing medical advice, monitoring screening and testing, and supporting exposure control interventions within the “bubble system”, were undertaken by ISN’s sports medical and sports science departments.
Meanwhile, the high performance medical and sports science team delivered the necessary medical treatment, rehabilitation and performance support.
Nearer to the competition, Covid-19 countermeasures were amplified.
Extra precautions included daily reporting of the health of athletes and coaches as required by the Japanese government via a special health monitoring app.
Exposure control was tightened to further minimise social interactions, vaccinations were completed for all, and regular Covid-19 testing was conducted as prerequisites for travel prior to departure.
Flights were staggered and individual seats specifically assigned to ensure appropriate physical distancing.
Everyone was excited to go to Tokyo, but remained vigilant to avoid the risk of exposure to Covid-19.
Upon arrival, compulsory Covid-19 tests and activation of a close contact monitoring app were done to fulfil safety checks at the airport.
Strict measures maintained
During the Games itself, daily saliva PCR (polymerase chain reaction) testing, regular hand-sanitising, compulsory face mask wear, physical distancing restrictions and strict crowd control in the Games village and sports venues, were required.
In the Games village, communal areas were equipped with abundant hand hygiene facilities and physical barriers to help decrease exposure among the residents.
Our athletes and contingent team seemed to have no trouble following the “new normal” as they were all used to these practices during their full quarantine training programme back home.
The organising Paralympic medical committee monitored any daily Covid-19 cases among athletes, games-related personnel, media, employees, contractors and volunteers.
Regular communication was established with all the participating contingents, and the latest news or statistics could be easily checked on the official Paralympic website.
Each country also had their own Covid-19 Liaison Officer nurse who helped manage the daily testing for athletes and contingent members, as well as being the first to attend and manage any Covid-19 patient and their close contacts in the team.
Throughout the whole Games, we were constantly on our toes, ready to act should we learn of any Covid-19 cases detected among our athletes or games-related personnel, as this would lead to close contact investigation.
A close contact declaration would be a disaster to any athlete involved as the long weeks of quarantine required would render him or her unable to compete.
Indeed, some affected athletes and team personnel from other countries were not allowed to train and participate in their events because of this.
Throughout the Paralympics, more than 300 positive cases were reported, with 13 of them being athletes.
Fortunately, no cases were detected within our contingent, and no complicated cases or death were reported among the positive cases during the Games.
Handling disabilities
Aside from keeping our athletes safe from Covid-19, we also had the added challenge of looking after Paralympians.
Working with gifted athletes who had a wide range of disabilities was a unique experience for me as a sports physician.
The main disabilities in our national contingent ranged from wheelchair-bound spinal cord injuries, cerebral palsies, limb deformities, amputations, visual impairments and intellectual disabilities.
These disabilities mean that each athlete has specific individual needs in facing the challenges of daily life, social interactions and the requirements for participating in high level sports.
The physician attending these athletes must have adequate and appropriate awareness, knowledge, skills, competencies and experience working with them, as well as their coaches, support personnel and the multidisciplinary healthcare team, to provide holistic care.
This is in addition to the sports doctor’s main duty of advising on an athlete’s health or injury issues, providing emergency and acute treatment, arranging referrals, and ultimately, making the decision on the athlete’s fitness to compete.
The main challenges for us in the 2020 Tokyo Paralympic Games was adapting to the dynamic demands of the high performance sporting environment, as well as devising a bulletproof pandemic control protocol.
As the Covid-19 countermeasures were meticulously planned and dealt with by everyone onboard the full-quarantine training programme, that was one problem solved.
As for the former, being the Chief Team Physician meant that I had to oversee the entire team and ensure that everyone work-ed together to solve any issues around each athlete’s readiness to compete in their sports event or match.
The last thing we wanted was any unnecessary medical problems hindering the potential success of an athlete.
Realising that each individual sporting event presents with its own issues or requirements, we took the initiative, as well as adopted a “learning on the job” approach, to get as much information as we could and carefully plan appropriate strategies to deliver the necessary services.
We quickly familiarised ourselves with the needs of each sport’s training and competition processes, and worked closely with the athletes and the coaches, so that we could get their feedback quickly.
During the Games, I carried a portable ultrasound machine around to help us provide better point-of-care diagnosis for any limb injury complaints.
Any clinical work was performed at the team medical facility, together with medical and science support staff from ISN.
Our team consisted of sports doctors, nurses, physiotherapists, masseurs and psychologists – all of whom had long years of experience working with Paralympic athletes.
At other times, we dealt with the injury or illness at the training or competition venues.
Teamwork is the top priority and the good networking we had with the host medical service team helped to provide the best treatment support for our athletes during referrals.
In addition to physical health, psychological services were provided to address stress-related issues experienced by the athletes.
On top of that, our sports performance analysts back at ISN’s headquarters in Kuala Lumpur were standing by in the “war room” to send live feedback to the athletes and coaches on sporting strategies.
But no matter how much we prepare, people are bound to get injured in sports.
Experience had taught us to prepare for the worst and we did.
Physical injuries among Paralympic athletes tend to derive from technical or biomechanical errors, and that was certainly the case for some of our athletes during the Games.
Extrinsic challenges in Japan, such as environmental heat and cold or rainy weather that risked health problems and created competitive disadvantages, were also considered and handled appropriately.
Overall, we had cases of acute medical conditions, acute on chronic musculoskeletal pain and acute muscle tendon tears.
Some of these conditions caused our athletes to retire from their match or event, and in some cases, unfortunately prevented them from breaking personal records.
A life-changing experience
It was a truly exciting experience working with my medical team during the Games.
Enthusiasm was high and we couldn’t wait to get to each match as solving problems and issues during competition and really putting ourselves to the test was really satisfying.
No doubt it was quite stressful at some points, especially during the heat of the competition, but this experience only further strengthened our work skills and team-bonding.
I also appreciated the opportunities we had to discuss and exchange opinions with colleagues from the host country and around the world.
We learnt new practices with regards to athlete preparation, the use of state–of-the-art equipment and technologies, and current sports performance strategies.
These experiences will help improve the management of our Paralympic athletes in the future.
In addition, we learnt the new system introduced by the Paralympics organising committee to collect data for a comprehensive prospective injury study that, in my opinion, helped improve the on-the-ground clinical work as well.
On a personal level, a particularly heartwarming moment was when I attended to T20 long jumper Abdul Latif Romly after he sustained a severe pain in his groin after his fifth jump attempt.
Although he was unable to continue on, he had done well enough to win a gold medal!
The injury was severe at that point, and although it seemed too painful for him to stand or walk, he still needed to attend the medal ceremony.
I was filled with pride and happiness for his achievement, and eventually managed to provide the support and treatment he needed to stand for the event.
It was truly an extraordinary experience handling this case, especially as it was the targeted third Malaysian gold medal on the very last day of our participation in the Games!
The medical team witnessed the Jalur Gemilang being raised and sang Negaraku with tears in our eyes.
As part of their support team, we too share the emotional roller coaster with our national athletes as we stand by their side through both the pain of losing and the glory of winning.
These athletes with disabilities are all from humble origins and have endured so much hardship in life to get to the pinnacle of sporting achievement.
For them, winning a medal in the Games after years of preparation is nothing short of a wonderful life-defining moment.
To be there helping them to achieve this is as life-changing for us as it is for them.
Dr Azril Syazwan Mohd Ali is a consultant sports physician with the ISN. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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