Dubai: If one were to consider the current pandemic a war, the field hospitals set up by the Government of Abu Dhabi in the second quarter of 2020, to tackle COVID-19, were literally the frontiers where the battle was fought during the first wave of the pandemic.
With a mind-boggling array of logistics that were put in place in a record nine days for Al Razeen Field Hospital, on the outskirts of Abu Dhabi, the field hospitals created the finest example of running a massive emergency operation at minimal cost. The organisation that pulled off this feat in setting up the field hospitals was UAE-based MediQ Healthcare group. Bidhan Chowdhury, the founder and Group CEO of the organisation, tells Gulf News what it took to pull off the challenge last year.
GULF NEWS: Can you throw some light on the logistics of setting up such massive field hospitals?
BIDHAN CHOWDHURY: The field hospitals were established at a time when Abu Dhabi Government decided to go for field hospitals in order to meet the requirement to isolate patients in a cost-effective manner. We are glad we had good partners to set up these tents, meeting all the vital parameters — weatherproof material was used, considering heat, sand storms, winds and rain. Internally, temperature-controlled A/C, one-way ventilation, air pressure and fresh air control, HEPA-approved filters were deployed, cosy patient rooms with all the usual amenities like regular hospital were set up. The deadline to set up such a hospital with all these amenities was met in record time. Uninterrupted supply of Personal Protective Equipment (PPE) was maintained throughout those difficult times.
We carefully absorbed a large workforce in the clinical domain and our key men groomed them specifically for COVID-19 care. We worked according to the advice of the Department of Health, Abu Dhabi, which provided us the guidelines as per the updated protocol of World Health Organisation and the Centre for Disease Control. Indeed, there were challenges as newer units were opened and operated periodically. We also recruited a workforce from outside UAE, overcoming their communication gaps — say for instance, Cubans with Spanish as their primary language. We apprised them about the cultural sensitivities and local awareness.
Why are they called field hospitals?
These hospitals are termed as field hospitals primarily because of the following reasons:
• They remind us of the urgency to cater to patients as in war zones.
• They are constructed with utmost speed.
• They are managed by multitasking personnel and optimisation of resources.
• They handle large volumes of patients.
If these hospitals are designed to last for years, then what is the need to decommission them?
Indeed these were set up in record time as in nine days and are capable of withstanding extreme weather conditions. They are capable to serve for a long time. That is why none of the field hospitals have been dismantled completely. There have only been some partial conversions for complying with screening and vaccination needs.
What is the criteria for a patient to be shifted to a field hospital from a regular hospital? Do they take direct admissions or only referrals?
Admission criteria depends on the local planning of the facility, via the COVID Command Centre. Private health care also may be empowered to refer patients diagnosed in their facility to the field hospitals. Direct admissions are discouraged unless guided through the command centre.
How was MediQ Healthcare chosen?
MediQ has been involved with many national and international COVID-19 management programmes as an expert. We are sharing our experience with various governments to combat the situation. In our previous experience, we had shown our strength. Our management team successfully counselled and motivated the medical staff to overcome initial fears and reluctance to work in a COVID-19 facility. Within the first month, we were successful with less than 0.05 per cent death rate and 99 per cent level of patient satisfaction among the 8,000 patients we handled. Therefore, we were given the additional responsibilities to operate three more isolation centres and the first field hospital and subsequently the other four field hospitals.
Our learning grew while working on-site. The government started recognising our efforts. We also successfully brought down the costs that added a new dimension to our efficient work-style.
What kind of COVID patients are treated at the field hospitals?
Catering to volume of patients depends on the number of beds planned and the size of the hospital, which varies from 150 to 1,200 beds in different set-ups done so far. Such hospitals typically have 20 to 30 per cent of total bed capacity as ICU beds. The criticality level of patients accepted in the ICU thus depends on overall resources and the scope planned.
What is the cost of setting up such a hospital?
That depends on the level of the set-up, clinical equipment and other structures. It ranges from Dh18 million to Dh25 million for a mid-sized 150 to 250-bed facility.
Why have a few permanent field hospitals in various emirates not been set up to deal with any unprecedented crisis or a pandemic in the future?
It’s a million dollar question. Our learning from this COVID crisis is not to live under any assumptions any longer. Newer pandemics may come, always be prepared. As part of future preparedness, every country should have the option of field hospitals. After the successful operation of field hospitals in Abu Dhabi, the UAE government has already announced setting up of field hospitals in every emirate.
Why can’t these field hospitals work during normal times and be transformed into field hospitals in times of crisis?
Field hospitals are excellent for crisis management, but they cannot replace the normal health-care structure. The material and structure of field hospitals have their own limitations. However, for isolation and infection control purposes, as in the present situation, field hospitals provide the best solution to curb a pandemic like this.
Does the country need additional trained health-care professionals to fill these field hospitals?
Yes, the specially trained professionals can always manage this pandemic in a better manner. In a field hospital, the staff have the zeal of a warrior to combat the difficult situation with limited resources. More than the academic part, we need skills of sound psychology and total dedication in the field hospital staff.
List of field hospitals set up by MediQ Healthcare Group:
• Rezeen Field Hospital
• Mafraq Field Hospital
• Musaffah Field Hospital
• Al Ain Field Hospital
• Emirates Field Hospital
A field hospital — at a glance
Overall, there are many similarities between a field hospital and a regular hospital on clinical and maintenance protocol such as nursing care, resident and specialist doctors’ interactions, bedside diagnostics and therapies are all similar.
However, in a field hospital, these all are carried out differently.
The patient are under barrier in zones, the staff enters these zones after duly sanitising and donning requisite PPE gear. The patients gain familiarity with the staff by their names and designations emblazoned on the staff outfits. COVID-positive patients are different from normal patients in any hospital in terms of fear and uncertainty with longer stay than usual.
Food is served in the patient’s room and all meals are served in disposable containers with disposable cutlery. For convenience of the staff, pantry stations have been set up within different units so that the staff in that section can have a small snack or coffee break without having to completely discard their PPE.
No visitors permitted
One of the major factors in COVID-19 treatment is immunity improvement. Since visitors are not permitted in these campuses, patients experience isolation. Their morale boosting is important so that their immunity is boosted as well. We treat patients with the principle of healthy body, mind and soul. Regular schedule of prescribed exercises, yoga and meditation are undertaken for the patients by drawing them in designated sunlit areas within the facility.
Outside, for other staff who are not in PPE, along with those who are on their break, are also provided with amenities. Staff avail the shower facility before exiting the campus at the end of their duty hours.
Several principal and ancillary services are required to run the facility efficiently. These include water supplies, sewerage vehicles, and general and medical waste collection services. All these services are scheduled with independent access gates in the field hospital campus.
The access gates are designated to keep the other staff and service operators away from any exposure. Apart from the dedicated patient admission and discharge gates, clinical staff access points, the relative communication areas are also designated and separately planned on site.
Management activities such as clinical meetings, update dissemination, interaction with various other stakeholders, staff and patient feedback are undertaken as routine affairs in the field hospitals.