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Ready for Duty

“A hero is born among a hundred,” a famous philosopher once said. But today, as we face one of the biggest challenges of the century, many of us have stepped up to become heroes in our own right–delivering essential services, ensuring people’s safety, saving lives.

On National Heroes Day, the Ayala Group of Companies gives a voice to these unsung heroes by chronicling their stories on chronicle2020.ayala.com. Here’s a story of a nurse, a doctor, and a lab administrator who went beyond eight-to-five to answer the call of duty. 

The first time Nurse Cristine Joy Cardenas donned a PPE, she almost quit. The discomfort underlined the danger she had signed up for. Together with Dr. Mark Pasayan, she was among the first to respond to the needs of COVID-19 patients at Qualimed Sta Rosa.

FOR ALL his medical studies and preparation, infectious disease specialist Dr. Mark Pasayan never imagined he would be on the frontlines of the biggest health battle the Philippines has ever seen. “In 2018, I gave a talk on the 1918 Spanish flu. Never did I think that I would experience a pandemic as big as the Spanish flu in a couple of years.”

Dr. Mark Pasayan

A graduate of the University of the Philippines College of Medicine who, most appropriately, had his fellowship training at the Research Institute for Tropical Medicine (RITM) admits he got into the field out of sheer curiosity. “It’s one specialty in internal medicine that is very investigative, very cerebral,” Pasayan says of his chosen field. “You need to determine the source of the infection, and you need to do it fast.”

Having stared the H1N1 swine flu, Middle East respiratory syndrome coronavirus (MERS-CoV), and ebola in the face during his work at RITM, Pasayan is no stranger to killer viruses. “When Covid-19 hit the news in early January, I thought it was just another infectious disease that might come into the Philippines—but I never thought everything would stop, and people’s fear would be so great.”

In 2018, Pasayan had joined the newly opened Qualimed Health Network, a partnership between Mercado General Hospital, Inc. (MGHI) and Ayala Land, Inc. (ALI), as an infectious disease specialist. Pasayan’s job has certainly become critical in the light of recent events. “I knew we would be having trouble for the next weeks or months when we had 20 patients admitted in a single day in several hospitals in the south, particularly Laguna and Batangas.”

In a timely response to the pandemic, Ayala Healthcare Holdings and Qualimed collaborated to convert the sleek Qualimed facility in Sta. Rosa City, Laguna into a full-scale coronavirus referral hospital, beginning last May 1.

 Meanwhile, Pasayan also had to deal with his own fears, aggravated by his concern for his parents and three maternal aunts, all seniors, with whom he shared a home. “There was always the chance that I would get infected. I just kept reminding myself that I know what I’m doing, and I should not be afraid. But Covid-19 was really a game-changer.”

May pledge tayo’

Nurse Cristine Joy Cardenas had originally wanted to become an accountant, but followed the footsteps of her aunt instead. She graduated from Lorma Colleges in San Fernando, La Union and passed the nursing board examinations in December 2019. She applied and was accepted at Qualimed, and started work just last January 13, 2020.

Nurse Kristine Joy Cardenas

Cardenas hesitated at first before accepting her very first assignment—in Area 19, which was dedicated to Covid-19 patients. “Nakikita kasi namin sa news at sobrang nakakatakot siya,” Cardenas says. “Tatlo kami noon na kakapasa pa lang sa board. Sabi ko, sige, punta na lang tayo, kasi may pledge tayo, nag-oath na tutulong tayo. Yung ibang nurses natatakot, kasi may pamilya sila at mga anak. So sabi namin, kung walang pupunta doon, walang mag-aalaga sa mga Covid-19 patients, so tayo na lang.” Cardenas spent three months in Area 19 without once seeing her family, doing 12-hour shifts, initially struggling to put on the bulky personal protective equipment (PPE), and enduring the suffocating heat. “Kasusuot mo pa lang, pinapawisan ka na,” she recalls. “Pero pagpasok mo sa room ng pasyente, nakikita mo talaga na there is sadness. So inisip ko na lang na bale wala yung init ng suot kong PPE compared doon sa nararamdaman noong pasyente.”

Looking forward

Thus, it is always a welcome occasion when Cardenas and Pasayan are able to release patients after COVID-19 treatment.  They even have pictures taken with recovered patients—a small reward for these everyday heroes.  As Cardenas says, “Yung pinaka-success para sa amin ay ang nakakapag-pagaling kami ng pasyente. Kahit mag-smile lang sa amin, ang sarap na ng feeling.” (Yael Ballesteros)

Finding the enemy

Anthony Geronimo and his team at the Tropical Disease Foundation convert a tuberculosis research lab into a COVID-19 testing facility for Ayala employees

“Nandoon yung pressure,” says Anthony Geronimo, laboratory administrator of the TropicalDisease Foundation (TDF) in Makati. “There was no room for error kasi umabot na sa taas, eh— sa taas ng company namin, sa taas ng Ayala, so pangalan namin yun nakataya, at parang pangalan ko na rin yun nakataya. Siempre, ayaw din namin mag-fail talaga, because this was anopportunity to get involved in COVID-19 and to help.”

Anthony Geronimo

Anthony is remembering the Zoom meeting last April 16 where the partnership was first established between Ayala Corporation and TDF—the 36-year-old private, non-stock, non-profit organization providing research, training, and laboratory services to fight infectious diseases— to conduct COVID testing of Ayala employees.

Virtually present were Ayala Corporation chairman and chief executive officer (CEO) Jaime Zobel de Ayala and his team, including AC Health chairman and CEO Paolo Borromeo and Ayala Corporation chief human resource officer JP Orbeta. TDF was represented by president Dr. Roberta Romero, vice president for programs Lani Naval, and chairman of the board Dr. Ruben Encarnacion.

Anthony learned more about the two entities’ shared history, which started when Ayala donated the land that TDF stands on in Pio del Pilar, Makati. “It was like a meet-and -greet, but I felt that the top management of Ayala Corporation really wanted to get this done,” he says.

Groundwork

The groundwork had actually been laid weeks earlier, when, anticipating a return to work after the lockdown and quarantine in the National Capital Region, Ayala Corporation decided that its employees needed to be tested, at their own testing center. A rapid test would be administered, and a positive result would lead to a reverse transcription polymerase chain reaction (RT-PCR) test, considered the definitive indicator of infection. Earlier this year, no institutions other than the Research Institute for Tropical Medicine (RITM) were conducting such tests.

Instead of setting up laboratories from scratch, AC Health opted to tap TDF, originally a tuberculosis (TB) research lab that had been built with funding from international donors. Less than a month after that meeting, Ayala had provided for additional machines and people, as TDF could not use their TB equipment. In short, a dedicated COVID laboratory of sorts was established within the building, with Anthony and other senior staff undergoing special training at RITM to handle the new virus.

Five people in the laboratory handle the samples. “You need a minimum of three people working inside to complete the process,” Anthony says. “So now, we receive approximately 10 to 15 samples per day.” TDF also works with Healthway, the network of mall-based clinics also owned by AC Health, which takes care of swabbing patients and sending over the samples.

Anthony and his staff prepared for the responsibility by building competence and capacity in the first few weeks. “Ayaw naman namin na sumugod agad, tapos papadalhan kami ng 100, tapos magkaka-delay,” says Anthony. “Ang takot namin yung maba-backlog o ma-contaminate yung process, so ayaw namin yung mabilisan.” For now, some 32 tests are processed a day [as of this writing, June 12, 2020], but TDF is working on speeding up the process.

Anthony walks laymen through the procedure, which begins with receiving the samples. “Once we receive it, of course we need to verify the data and the labels. Ayaw natin magkaroon ng maling report, di ba? Baka yung pasyente mong negative, ma-report mo as positive kung napagpalit mo yung samples. So doon pa lang, dalawang tao na ang gumagawa.”

The samples are received from the courier and brought into the laboratory, Anthony continues, where a staff member awaits. The samples are carefully opened inside a sterile cabinet, in case of leak and contamination. Labels, documents, seals, even name spellings are checked and double-checked. Late arrivals are stored in the refrigerator, to be processed the following morning.

Genetic makeup

Inside the coronavirus molecule, Geronimo explains, is the ribonucleic acid (RNA) that determines its genetic make-up; this is what the laboratory team extracts and purifies. It will take up to five hours to perform RNA extraction on some 30 samples.

The next step, master remix preparation, entails adding a “primer” of chemicals to make the RNA multiply, so the presence of the virus can be better detected. This is also done under sterile, cold conditions to prevent contamination. “Para kang naliligo sa alcohol palagi,” observes Anthony.

After mixing for around 20 minutes, the material is taken to the PCR machine, which resembles a microwave oven with test tube holders inside. At the end of the process, there will be millions of copies of the RNA, and fluorescence is an indicator or the presence of the virus.

Anthony refers to “certain parameters” that must be satisfied. Laboratory staff look for patterns in the resulting graphs that determine a minimum threshold, and even then the cycles are examined repeatedly before concluding that a sample is positive.

Anthony volunteered to be the first patient tested at TDF after the staff training at RITM. Although he was anxious about the result, “Honestly, I was also very excited,” he admits, “because for a lab person, it was new, and you realize you can already help in detecting COVID, you can help the government, you can help other people. We said, ‘This is it. There’s no turning back.’”

After working hours, Anthony, who has a wife and a toddler at home, shifts to driver mode, dropping off co-workers as far from his Cubao home as Novaliches and Makati. What keeps him going, he says, is seeing how hard his staff works. “Naglalatag sila sa floor para lang makatulog. So wala rin akong karapatan magreklamo na pagod ako.”

“Pero ang pinaka-nagpu-push sa akin para magtuloy-tuloy is, gusto na natin talaga matapos itong COVID,” Anthony says. “We need to do our part if we want to end this pandemic. At kahit gaano ka-init yun sinusuot namin, kahit gaanong nakakangalay yung process namin, at the endof the day, meron kang isang mapapangiti pag negative yung resulta niya.” (Yael Ballesteros)

 – Read more stories of quiet heroism on chronicle2020.ayala.com


Source: Manila Bulletin (https://mb.com.ph/2020/09/04/ready-for-duty/?utm_source=rss&utm_medium=rss&utm_campaign=ready-for-duty)

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