Malaysian surgeon recalls challenges performing surgery during the pandemic


We survived: Dr Mohammad Shukri, Dr Tee (right), who is now based in Penang General Hospital, had to literally operate out of another hospital during the pandemic. — Photos: DR MOHAMMAD SHUKRI JAHIT

A DOCTOR’S primary role is to treat the sick and save lives.

That was what senior consultant upper gastrointestinal (GI) and general surgeon, Dr Mohammad Shukri Jahit was busy doing at his former workplace in Hospital Sungai Buloh (HSB), Selangor.

Upper GI surgeons treat conditions affecting the oesophagus, stomach, gallbladder, bile ducts and pancreas, including cancer.

So there he was, seeing patients, operating on them, training junior surgeons, doing paperwork, etc.

All was going well until March 8, 2020, when his world turned upside-down.

“It was the wee hours of the night when we were informed we had to decongest our wards and transfer all our post- and pre-surgery patients to other hospitals in the Klang Valley to prepare HSB for Covid-19 cases.

“The news shocked us and no one knew what to do.

“Our patients were severely impacted and I instructed my team to call up different hospitals to check on bed availability,” recalls the 54-year-old, who was then the hospital’s head of surgery.

Thankfully, Hospital Shah Alam agreed to accept some of the upper GI cases, just before the first movement control order came into force on March 18, 2020.

Dr Mohammad Shukri says: “However, they couldn’t accommodate all our surgical patients due to the usual public hospital congestion.

“There were cases of cancer patients who had completed chemotherapy and required surgery, but we didn’t know where to send them.

“Sadly, some of them succumbed due to the delay in treatment.”

When the patients were relocated, only one surgeon from HSB was allowed to go to Hospital Shah Alam.

“There was a stigma surrounding doctors from HSB – as if we were going to transmit Covid-19 to everyone!

“So, from our team of three surgeons, we sent Dr Sou Jing Kim – who was our specialist trainee in upper GI surgery – to be stationed at Shah Alam to take care of HSB patients,” he says.

Improvising workarounds

Dr Mohammad Shukri and his other consultant, Dr Tee Sze Chee, continued to manage HSB’s outpatient surgical clinic, and if patients required urgent admission, they were sent to Hospital Shah Alam.

Since most of the facilities in HSB were being used as makeshift Covid-19 wards, the surgeons could not perform any endoscopies or take any tissue samples, which is crucial in upper GI cases.

“It was not easy to arrange endoscopies in Shah Alam as we were considered outsiders, plus it was also difficult to access their computer system,” shares Dr Mohammad Shukri.

“Worse still, their staff was not used to managing upper GI cases, so Dr Sou had a tough time in an emergency.

“The majority of our patients was high risk and required to be in the intensive care unit (ICU).”

A patient might start bleeding in the middle of the night and Dr Sou would have to stumble through police road blocks to get to the hospital.

Since he was on call daily, the subspeciality trainee often stayed in the hospital and only returned home every two or three days.

The trio resorted to virtual meetings to discuss cases.

After many rounds of discussion with Hospital Shah Alam, Dr Mohammad Shukri and his team were given one slot a week to perform surgery.

Alas, there were no instruments appropriate to conduct upper GI surgeries.

We survived: Dr Sou (right), who is now based in Penang General Hospital, had to literally operate out of another hospital during the pandemic. — Photos: DR MOHAMMAD SHUKRI JAHITWe survived: Dr Sou (right), who is now based in Penang General Hospital, had to literally operate out of another hospital during the pandemic. — Photos: DR MOHAMMAD SHUKRI JAHIT

“The problem was our instruments such as sutures, operating gadgets and other consumables, were not available there, so we had to transport these on a weekly basis, and after the surgery, bring them back to HSB,” he says.

All the postponed cases were always on his mind and the team made constant phone calls to keep track of these patients.

“We were one of the few upper GI centres (in Malaysia) and patients came from all over the country to seek treatment.

“But in 2020, some of them could not even come out of their village because they couldn’t get past police blocks.

“They didn’t have email either.

“This is where we had to think creatively and told them to write their clinic dates in their appointment cards.

“We also tried to arrange for ambulances to pick up critical patients,” he adds.

A sudden transfer

This went on until July 2020 when Dr Mohammad Shukri received notice that he would be transferred to the National Cancer Institute (also known by its Malay acronym IKN) in Putrajaya to set up the upper GI surgical unit there.

He was surprised, and his team, unhappy.

He shares: “I had to meet the then Health director-general Tan Sri Noor Hisham Abdullah to clear the issue on whether it was a single person or team transfer.

“I told him when I set up the unit in HSB in 2008, I was still young, but I didn’t have the energy any more.

“He then gave me the guarantee that the whole team would be transferred, but I had to go first to see what was needed.”

Thus, in August 2020, Dr Mohammad Shukri moved over to IKN, where more “shocks” awaited.

“So now I was seeing new cases in IKN, Dr Tee was redirecting patients to Shah Alam, and Dr Sou was trying to get them to IKN – imagine the chaos!

“The major stumbling block in IKN was the wards as we had to share them.

“Our patients require round-the-clock care, especially when it comes to feeding and nutrition, but the nurses and medical officers didn’t know how to care for them.

“Also, there was a bit of resistance because we were a new unit,” he recollects.

After an upper GI surgery, most patients cannot eat normally, and depend on parenteral nutrition, i.e. intravenous (IV) feeding, where the entire digestive system is bypassed.

Dr Mohammad Shukri says: “When you don’t know how to feed them, the infection rate goes up – it was complete havoc.

“My requests for funds were turned down as everything was being channelled to Covid-19, so I had to pinch from other departments.

“We also had complications because some of the medical devices had been used till exhaustion and couldn’t be used any more... every day was a new battle, but I never gave up.”

Day in and day out, he was retraining the IKN healthcare professionals, writing proposals, calling the ministry for emergency funds for endoscopy services, and asking when his team would be transferred over.

He was questioned, yelled at – and felt dejected.

He had to give himself and his team daily pep talks.

Thankfully, Dr Mohammad Shukri didn’t need to think about family matters as being single has enabled him to totally dedicate himself to work.

But he still had sleepless nights, not knowing what was going to happen the next day and whether his patients would survive.

Slowly, the funds trickled in, and by December 2020, his team had transferred over to IKN.

“Looking back, I don’t know how I overcame all this, but now, we are even stronger and bigger.

“Upper GI services have completely transferred to IKN, while HSB only manages general surgery,” says the surgeon who leads the national upper GI training programme.

Two years on, Dr Mohammad Shukri’s department now comprises three consultants and four subspeciality trainees who are on rotation.

They also manage bariatric surgery and advise patients on making lifestyle changes and doing exercises.

He says: “Our bariatric cases are expanding, and because we don’t have enough physiotherapists, all our specialists, including the consultants, have to coach patients.”

In his leisure time, the affable doctor spends time working out with his patients to keep them motivated.

“What else is there in life but to serve humanity?

“I just enjoy it.”

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Merdeka , Surgeon , Covid-19

   

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