Mark Muscat, Chelsi Cefai, Andrew Attard Montalto, and Leo Valletta should have been spending their days studying for their final-year medical course exams. Instead, they are now living away from their families and find themselves working at Mater Dei Hospital as the country, and indeed the world, faces its biggest health crisis in over a century.

They are four out of some 120 fifth-year medical students who have been drafted to the workforce at Mater Dei Hospital as Malta comes to grips with the spread of Covid-19.

“Surreal”, “nerve-racking and upsetting in some respects, slightly exciting in others”, and “a mixture of excitement and uncertainty” is how they describe their feelings towards the situation.

Attard Montalto says that “It feels nerve-racking and upsetting in some respects, but slightly exciting in others. I have moved out and am living alone for the first time in my life – that was always going to be an exciting step – but it’s a step I am taking in some very unfortunate circumstances. However, I am constantly reminded of the human and economic costs of this current crisis, and so this shift in lifestyle is tinged with a bit of sadness.”

Cefai meanwhile describes the situation as “surreal”. She recounts what was meant to be the last year of studies for her and her colleagues, explaining how after the final hurdle in June – the OSCE Clinical Exams – they would start work as junior doctors in July.

“I had this timeline taped to the back of my room door, and crossing each exam out was a huge relief. It seemed like finally there was light at the end of a long winding tunnel”, she says.

“It all came tumbling down on the eve of our international Prescribing Safety exam. This was to be carried out online, in real time with UK students. The Prime Minister was on TV announcing that as from the next day, the University will be shut down. All of us were watching whilst doing our-last minute cramming, until uncertainty crawled it. Soon after, our next-day exam was cancelled, whilst our clinical attachments were suspended. That same morning, I witnessed our Medical School Library being emptied of books, our teaching rooms cleared. It was heart-breaking to say the least. It’s as if we never properly bid our farewells. But of course, it was necessary”, she recounts.

She explains how the following three weeks were weeks of limbo. “We had no answers about our exams, our clinical attachments and teachings were postponed, so we felt compelled to ask to volunteer.”

She says that the University eventually told them that in order to sit for their final exams and eventually graduate, they must pursue clinical placements for eight weeks. “The vast majority of us chose to pursue with our clinical attachments – at the expense of moving out from our homes unexpectedly”, she says.

Valletta said: “I’d say the most accurate description is a mixture of excitement to finally be carrying out the duties of a doctor (however small they may be at this point) but at the same time it is undercut by an constant feeling of uncertainty (we’re not sure about what the current circumstances of our agreement with faculty holds for us in terms of our academic futures) and most importantly, I feel a sheer lack of confidence in the very administration that determines our passage into our future employment to look after our best interests (they have failed to do so throughout this entire transition and continue to keep us in the dark).”

“I feel like I’ve been taken out of my element and find working and studying more difficult than ever as a sense of duty is overshadowed by a sense of doubt and uncertainty”, he continues.

Medical students are not on the frontline, but are doing work that they would have done as junior doctors after graduating

Valletta stresses that he does not believe that they are at the frontline of the situation – as has been said in other quarters. He notes that they have been instructed to practice in non-Covid wards – meaning that while they are passing in and out of a building with Covid-19 cases, they have no part in directly dealing with the current crisis.

Indeed, as all of them explain, they are doing the work that they would do as junior doctors right after they graduate. 

“So far it has been more of shadowing and carrying out tasks within our competences. Such as taking bloods, inserting cannulas in veins, using the software to check results and investigations, writing-up discharge letters, reviewing treatment charts – all supervised”, Cefai explains.

She notes that, having feared being thrown in at the deep end, she is pleased to be learning the ropes now when the situation is still relatively calm in the hospital. It is, however, still overwhelming, she says – noting that the fact that her exams and the lack of details as to what will happen with them has left an “in limbo” feeling that is “devastating”. “But c’est la vie [such is life]”, she adds.

“The work is mostly clerical; be it writing in patient notes, filling in discharge letters and prescriptions, and so on. To me I feel like I should be bored of it but instead I welcome it. I wish this were a reflection of my eagerness to work but I feel it is more a reflection of how little we were trusted to do anything during our clinical exposure within the medical course”, Valletta explains.

“I understand that the work we must begin with is small stuff like this and I’m absolutely fine with it. I’m just sad that this is the first time anyone has trusted me to do anything resembling work”, he laments.

A mix of feelings: Duty, responsibility, pride, and some fear as well

How does it feel to be working at a hospital in these times? Is there a sense of pride? Responsibility? Fear?

For Muscat it’s a mixture of all three.

“Working at hospital has given me a feeling of duty and self-worth, as opposed to simply being stuck at home and wasting the days away doing nothing worthwhile. Such a role always instils a feeling of pride as we are finally, to a certain extent, doing the job we have been studying for these past five years to do”, he explains.

“There is always going to be a feeling of fear in what we do”, he adds, noting that they are still unsure of what exactly is expected of them, and that while they have spent three years in clinical where they start having attachments in hospital, the majority of their studies are theory-based – making this a huge jump from reading everything in a book to have to experience it first-hand.

Valletta meanwhile is happy to be back in hospital – speaking of his annoyance at how it had to take two weeks for what should have been a “no-brainer” to happen.

“I don’t feel proud because I don’t believe that is something I have chosen to do, it’s my duty. The sense of responsibility is to myself to take the final steps to becoming a doctor and to my community and my peers to do the best job I can”, he explains.

He said that it’s not the virus that he is afraid of, but it’s people that he is afraid of.

“People’s skewed perception of this disease and what protects them is what worries me because a lot of people have made my life and yours unnecessarily difficult because of their own fears and assumptions”, he says.

“If you give me the proper protective gear (or whatever is afforded to me), the proper training and tell me to go do the work then I’ll do it with no fear or prejudice. But when I enter the supermarket and see security guards pointing oven thermometers at people’s foreheads and I know full-well that it tells you absolutely nothing other than the temperature of their skin (not the core body temperature), that’s when I worry. I worry that people need to tell themselves these lies instead of accepting the truth”, he continues.

Cefai meanwhile speaks of the psychological challenge of juggling between “being at the hospital in an environment of a pandemic and resuming and tailoring our final year medical studies away from home, away from patients.”

“Even though we are attached to non-COVID wards and non-COVID A&E, with local transmission in the community, there’s always a risk. The thoughts of contracting the virus keep on looming whilst sitting at a desk and trying to focus on my studies – but I have been trying to overcome fear with knowledge, scientific and medical knowledge. Taking precautions is key”, she said.

On his part meanwhile, Attard Montalto explains that he does feel a sense of responsibility to help out and do whatever he can in hospital.

“There is always that fearful thought about the risk of catching the virus, but I don’t let it hamper me. Instead of allowing it to stop me from helping out, it pushes me to take as much precautions as possible – moving out to protect my family, only wearing my scrubs at hospital and washing them as soon as I get home, and washing my hands properly before and after every patient contact”, he says.

An appeal to the public: Educate yourselves about the virus and take care of yourselves

Cefai appealed for the public to educate themselves about the virus and about how it is transmitted, noting that individuals need to recognise that small acts of consideration can save lives. “It’s the public’s call to alter the fine line between a manageable crisis and a historical tragedy”, she points out.

Attard Montalto’s appeal is similar – he calls on people to simply pay attention to and follow the instructions issued by the authorities, and to get information from reputable sources – and not Facebook groups, some of which seem intent on pushing misinformation and peddling conspiracies.

“If you are young and fit and are likely to get through a COVID-19 infection unscathed, keep in mind those who are far less lucky than you. It is all our responsibility to limit the human cost of this crisis”, he concludes.

However, the students also have an appeal on a more human and emotional level for self-care.

“Every cloud has a silver lining: this situation has steered many away from a mundane routine. Enjoy the little moments in life. Take time to call an old friend, family member. Reconsider your unhealthy habits – this may be a good time to stop smoking, to cut on alcohol intake, to prepare healthier meals, to engage in physical activity, to plant a tree in your garden. Do keep up with your health follow-up appointments.”, Cefai says.

Muscat also adds his voice to this appeal.

“In life, people go through certain stresses and situations which they didn’t expect to be in and which are inevitable. In life, not everything is positive and not everything can go your way. However, it is a part of life and it is what defines us. If such a situation arises, you have to take the bull by the horns and prove to yourself that you can get through it as others have done before. We have to take such events as opportunities which build our characters for the better and will make us stronger people at the end of the day”, he says.

“No matter how long, how dark or how winding it is, there is always a light at the end of the tunnel.”