Doctor-turned-survivor talks about how stigma hampers COVID-19 efforts

Kristine Sabillo, ABS-CBN News

Posted at Jun 04 2020 01:15 AM

MANILA — As a fellow at the Department of Health’s Field Epidemiology Training Program (FETP), Dr. Ludina Insigne was at the forefront of the COVID-19 battle just as it was starting.
 
FETP fellows are trained to be “field epidemiologists,” responsible for investigating and responding to health threats in the country. 

Because of this, Insigne and her batchmates became the first contact tracers in the country, tasked to follow the trail of the two Chinese citizens considered the first COVID-19 cases in the Philippines.

Soon, Insigne found herself in Dumaguete, one of the tourist destinations that the couple visited.

“I expected it to be the usual outbreak investigation,” said Insigne, who was an internal medicine doctor in Leyte before she pursued a career in public health.

Despite being trained in field epidemiology, she acknowledged being scared, too.

“That time s’yempre bago pa lang ako. Matatakot ka din talaga,” she said, explaining there is a lot they do not know about the virus.

(That time of course I was still new. You’ll get scared also.)

But the challenge for contact tracers, she said, is to allay the fears of the people they talk to.

“Iyon ang challenge, kasi kung matatakot ka how can you deliver?” she said. “Alam ng pasyente ’pag nandidiri ka o takot ka. Those are non-verbal cues.”

(That’s the challenge because if you get scared how can you deliver? The patient would know if you are afraid to approach them. Those are non-verbal cues.)

While Insigne overcame her fear by making sure she followed health protocols to protect herself, she faced other challenges.

Dr. Ludina Insigne was an internal medicine resident before she pursued public health. Contributed Photo

STIGMA

Insigne and her teammates, which included local health personnel, visited establishments the Chinese couple went to in Dumaguete.

“The problem at that time was the stigma,” Insigne said, explaining how some people might tend to withhold information because of this. 

At the time, not a lot of COVID-19 patients acknowledged they had the disease. People feared discrimination.

Insigne recalled how one establishment cooperated but presented them with only 3 employees who came into contact with the two confirmed cases.

“Nakiusap kami if we can view the CCTV (closed-circuit television). Kasi di rin malalaman talaga sino ang nakasalamuha,” she said. 

(We requested if we can view the CCTV, because you can’t really know all those who interacted.) 

“That time nakita namin na hindi lang 3 tao, madami pala ang nakasalamuha nya,” she narrated.

(That time, we saw not only 3 people, but there were a lot of other people who interacted with the patient.)

On the other hand, the manager of another establishment not only gave them a list of employees who might have come into contact with the patients but also showed them the CCTV footage.

She said the full cooperation of contacts allowed them succeed in contact tracing.

“Napakaimportante na masabi ng confirmed case ’yung mga lugar na napuntahan n’ya at mga tao na nakasalamuha nya,” Insigne said, explaining that catching suspect cases on time could greatly reduce the impact of the outbreak.

(It’s important for confirmed cases to enumerate the places they went to and the people they interacted with.)



According to the DOH, close contacts are people staying in the same close environment with a confirmed COVID-19 patient. They were within a meter of a probable or confirmed case for more than 15 minutes, had physical contact with the case or provided direct care for the patient without using proper personal protective equipment.

All of the contacts of the two Chinese nationals tested negative for COVID-19.

Dr. Ludina Insigne wearing full body PPE while working as a contact tracer. Contributed Photo

TESTING POSITIVE

It was already in March when the first local transmission of COVID-19 in the Philippines was recorded.

Insigne and her group continued to work as contact tracers, checking on people by calling or visiting them. She helped contact trace for PH4, the first Filipino who tested positive for COVID-19. She was also sent to New Clark City to do profiling and disease surveillance of Filipino repatriates who were undergoing quarantine after disembarking from a cruise ship in Japan.

Besides contact tracing, it was also their job to get swab samples from suspect cases.

“When we have to get the specimen, we wear full body PPEs,” she said in Filipino.

But despite such precautions, Insigne showed symptoms during the fourth week of March.

She had colds, body pains and occasional coughing. Because she had hypertension, she was advised to stay at a hospital. On March 28, four days after she gave her samples, she learned that she was positive for COVID-19.

She became PH1077.

Asked how she could have gotten the virus, Insigne said it was already impossible to trace since she had interviewed a lot of people at that point. 

“I was also overworked and had been trying to lose weight,” she said, explaining that she had been exercising a lot since January. 

She had also not been getting a lot of sleep.

Despite taking high doses of Vitamin C, her immune system went down. 

Insigne said she would cry not because she was scared of what would happen to her but because she was worried that she infected her teammates. 

She thought of how lonely it would be if she died in isolation.

When she was brought to the hospital, she was made to ride an ambulance filled with plastic to keep her isolated.

“Walang gustong lumapit sa iyo,” she recalled.

(No one wants to go near you.)

“Hindi ka mamamatay sa sakit; mamamatay ka sa stress and sitgma.”

(You won’t die of sickness. You’ll die from stress and stigma.)

At the hospital, she met a doctor who told her that while they do not know a lot about the enemy that is COVID-19, they still had the power of prayer.

“At that time I have been praying a lot,” she said, recalling the mix of emotions and confusion she felt during the first few days in the hospital.

“I felt the love and the compassion of the doctors and nurses working at the hospital and risking their lives,” Insigne said, adding that being in the medical profession is not just a job but a passion for service.

Fearing the worst, she decided not to tell her father that she was positive for COVID-19.

“That time hindi ako nagsabi sa tatay ko. Ang sinabihan ko lang mga kapatid ko. Siyempre natakot sila pero every night nagtatawagan kami,” she said.

(I didn’t tell my father that time. But I informed my siblings. Of course they were worried but every night they would call me.)

Support from her siblings helped her get through the isolation.

“It really helps when ang family mo andiyan, and mga kaibigan mo. Napakaimportante yung simpleng ‘Kamusta? Ano’ng nararamdaman mo?’ ” she said.

(It really helps when your family and friends are there. It’s important for people to ask you how you are, what you feel.)

Dr. Ludina Insigne during her stay at the San Lazaro Hospital. Contributed Photo

CONTACT TRACING THE TRACER

Tables were turned while she was in the hospital. This time, tracers were helping her find her contacts.

She said it was only then that she was able to reflect on how she interacted with COVID-19 patients when she was doing her job.

“Before I call, I always text them.”

When she became the patient, she realized that she was more comfortable texting since calls made her nervous. 

She realized that what she was doing, introducing herself properly before calling, was also a good way to establish trust.

Fortunately, her condition soon improved. After being discharged from hospital on April 3 and undergoing another 14 days of quarantine, she tested negative for COVID-19.

It was only after she was discharged that she told her father that she had the virus.

Once she was well, Insigne returned to work for the DOH.

“Bumalik na ako sa work kasi kailangan na ng manpower. Kailangan na ng tulong. Hindi siya kakayanin kung hindi ka tutulong,” she said.

(I returned to work because they needed manpower. They needed help. They couldn’t do it, if we didn’t help out.)

Now, she helps validate cases coming from laboratories that run COVID-19 tests, making sure that patient profiles are complete and accurate.

Looking back at her experience, Insigne said she learned a lot about the importance of her work.

“If you feel compassion to these cases in a way parang doon pa lang naghi-heal na sila (you help heal them),” she said.

She also befriended patients for whom she contact traced.

“Kahit hindi na ako magfa-follow up iba na, nagte-text pa rin sila, ‘Dok, negative na ako’,” she said.

(Even if someone else is following up, they still text me. They tell me that they are now negative from COVID-19.)

Nowadays, contact tracers are sourced from local government units. Many have tapped their city health office while others still seek to hire more.


The World Health Organization suggests one contact tracer for every 800 people in a population. According to the DOH, the country needs P11.7 billion to hire additional 95,000 contact tracers.

Because of this, the DOH has been calling on people from allied medical professions to apply at their local government units.

Contact tracers are expected to do data gathering, interviews, and health assessment of contacts and health education.

Because they are expected to advise people about watching out for symptoms and caring for themselves, Insigne said it’s helpful to have contact tracers who have a medical background.

Insigne said she went into medicine wanting to earn money but she found satisfaction in public health.

“I feel happy and satisfied with my work now,” she said.

“At the end of the day hindi naman ito pansariling kapakanan lang natin but kapakanan ng buong mamamayang Pilipino,” she said. “Hindi ka nabubuhay pansarili mo lang. Nabubuhay ka para sa kapwa.”

(At the end of the day, this is not just for our own sake but for the sake of all Filipino people. We do not live just for ourselves. We live for others.)