GEORGE TOWN, Aug 30 —The recent spike in Covid-19 cases across the country and in Penang has resulted in a huge strain on hospitals as the healthcare system was nearly brought to its knees.

While doctors and nurses are often lauded for their dedication in managing Covid-19 patients in the wards, there is another group of frontliners in hospitals who have been toiling tirelessly, but with little recognition of their efforts so far.

These are the drivers, mortuary attendants and assistant medical officers who handle the last journey for the dead from the ward down to the mortuary, and finally back to their families for burials or cremation. 

Mortuary attendant Mohd Salleh Hussain, 55, has worked in the forensics department at the Penang General Hospital for 27 years and throughout his career, the pandemic is the most taxing as he has had to work long hours, pulling double shifts and clocking in on public holidays.

On top of that, the mortuary attendants and assistant medical officers were the ones to conduct the "last office” for Covid-19 patients who die. 

"Last office” is a term used for the final process of care for a patient after death, where the body is cleaned, then wrapped in a shroud, or covered in a body bag for infectious diseases.

"For non-Covid cases, it is the nurses who conduct the last office for the patient while we would only come to take the body down to the mortuary but in Covid-19 cases, we are the ones to conduct the last office,” he said.

The last office procedure of Covid-19 patients is also different as it must be conducted with utmost care to prevent the spread of the coronavirus. 

Forensics personnel don full personal protective gear as they prepare the body of a recently deceased Covid-19 patient for burial at the Penang General Hospital, August 24, 2021. — Picture by Sayuti Zainudin

First, Mohd Salleh has to don full personal protective gear in a ritual starting with the green operating theatre attire, cap, N95 mask, full head covering, jumpsuit, boot cover, long sleeve plastic apron, gloves and face shield. 

In between donning each item, he has to stop and sanitise. 

The whole process will take between 10 and 15 minutes before he is ready to head over to the ward to collect the body.

"At the ward, we will conduct the last office, spray sanitiser, wrap the body in a shroud, spray sanitiser again, then wrap in two layers of body bags and each layer we will spray with sanitiser and label with the name of the patient,” he said.

After fully wrapping the body, the cadaver trolley will be sprayed with sanitiser and then the body is moved onto the trolley; it will again be sanitised before the trolley is covered. 

The trolley is then pushed down to the ground floor where the mortuary van waits to bring it back to the mortuary, which is located on another side of the hospital grounds. 

Once he arrives at the mortuary, he has to go through the ritual of removing each item of the PPE and sanitising as he removes each item. 

Then he will don a new set of PPE, again going through the same steps of sanitising and putting on the item one by one, and only then move the cadaver trolley to the body fridges for storage. 

A forensics personnel conducts 'last office' procedure for a recently deceased Covid-19 patient at the Penang General Hospital, August 24, 2021. — Picture by Sayuti Zainudin

The bodies of Covid-19 patients are kept in an area separate from other patients. At the Penang General Hospital, 20 body fridges are set aside just for Covid-19 patients. 

The entire process of transporting the bodies from the hospital wards to the mortuary for processing and sometimes for post-mortems to finally releasing it to the families are handled by a team of about 23 people in the forensics department that include the administrative assistants, drivers, forensic science officers to the doctors and forensic pathologists.  

It is a morbid job for those in the department, one that Mohd Salleh said he is now used to, but the pandemic has thrown in more challenges to the daily jobs of each worker in the department.

One of the department drivers, T. Gopal, 51, said his job scope has increased and there were additional procedures when handling Covid-19 patients. 

He said his job include sending despatch items for the hospital, sending bodies back to their respective families, transporting bodies from the wards to the mortuary and now, when it comes to Covid-19 patients, he too has to don the full PPE.

"Each body that I transport, I have to change into two different sets of PPEs, this is for our protection,” he said.

He said there was also an increase in workload due to the pandemic in recent months.

Forensics personnel prepare the body of a recently deceased Covid-19 patient for identification before burial at the Penang General Hospital, August 24, 2021. — Picture by Sayuti Zainudin

"We are also short of drivers, not only to transport bodies, but we also have to continue with our usual duties such as handling despatch items for the hospital,” he said.

Similarly, assistant medical officers, Mohamad Nazri Mahmud, 42, and Mohd Adzahar Allaudeen, 32, said their workload has increased due to the pandemic.

Working long double shifts has become somewhat normal for them and if there were a high number of cases, they may not even get to go home for days. 

"I once worked a 12-hour shift and then due to more cases coming in and we are short-handed, I have to continue working for another 12-hour shift,” Nazri said. 

Other than managing and processing the arrival of Covid-19 patients, he said they also had to take turns assisting in post-mortems and the management of other cases.

"Sometimes, we even have to follow the police’s crime scene investigation team to the site,” he said.

On top of that, two staff will have to be on standby at the hospital’s forensic medicine department.

"So, we have our hands full most of the time,” Mohd Adzahar said. 

Forensic personnel conduct prayers for a recently deceased Covid-19 patient as they prepare the body for burial at the Penang General Hospital, August 24, 2021. — Picture by Sayuti Zainudin

They said the department handles on average about 600 post mortem cases and processes over 3,000 bodies a year. 

In August alone, as of the 19th, Mohd Adzahar said they handled 118 Covid-19 deaths, which has increased in recent weeks compared to the beginning of the pandemic last year. 

"We are all overworked, we sometimes take naps during short breaks wherever we can, before we go right back to work,” they said.

They said it is important that they handle each case with care and when it comes to Covid-19 cases, they too have a different procedure for the families to confirm the identity before the body is released to their respective undertaker. 

Head of Forensic Medicine Services of the Health Ministry Datuk Dr Zahari Noor said they are very strict with the identification protocol of all patients.

"We want to make sure there is no mistake in releasing the wrong body to the wrong family so we make sure that the patient is correctly identified by the family, and then correctly tagged with the right name,” he said.

He said the whole process of handling the bodies of Covid-19 patients involves not only the forensics department staff, with the other half of the process handled by respective undertakers from both Muslim and non-Muslim organisations. 

"They will have to don the PPE too and they will be allowed to come in to perform the final religious rites and then take the body for burial or cremation,” he said. 

The forensics team prepares to transport the body of a recently deceased Covid-19 patient to a burial site from the Penang General Hospital, August 24, 2021. — Picture by Sayuti Zainudin

Before the bodies are released, he said it is important that family members positively identify them and confirm the identities to make sure there are no mistakes.

Only one family member of each deceased Covid-19 patient is allowed to view the body through a tiny glass panel on the door to confirm the identity of the patient.

"We will only open the body bag at the face area to show the face for them to identify and we will confirm the name with them,” Mohd Adzahar said. 

At no point is the family member allowed to go past that door, and the rest of the family members must wait outside. 

Also, only family members or relatives, who are not under quarantine, are allowed to identify and claim the body. 

"They can hand us their phone, we will put it in a plastic bag, take a picture of the patient’s face and then bring it out back to return to them,” he added.