Novye Izvestia chronicles the struggle between patients and doctors in Russian regions, and the help that is still awaited from Moscow.
Lyudmila Butuzova
Covid statistics in the country have been taking off since mid-September. Doctors are getting sick more and more. There is nowhere to treat patients with covid, nothing and no one. Regional health departments are already luring specialists from other areas, doctors and nurses are sought through employment centers. They pay well for working with covid, although they promise even better, and for many this fact is decisive in choosing whether to go to the hospital or not.
People in white coats
Professor Sergei Borisov, vice-president of the Federation of Intensive Care Physicians of Russia, told Novye Izvestia that the staffing situation is complicated by the fact that the infectious diseases service is one of the most economically costly items of health care. Because of this, a problem for rural doctors when faced with any infectious disease is the lack of access to expensive equipment and problems with the provision of consumables, as well as labor-intensive laboratory diagnostic techniques, on which the success of treatment depends. As a result, in many localities, there are simply no doctors who can provide quality care for coronavirus. In short, once in the hospital, you have to gain experience on the go, or move to another place where "not such a madhouse."
- We are faced with the task of creating a personnel reserve in the healthcare system. We feel their outflow in the region, in this regard, we have to attract medical students, the functions of junior medical staff are often performed by students as well, ”said Boris Alexandrov , acting Minister of Health of Komi , who took office six months ago. His predecessor held the position for about three months. Before arriving in the region, both worked in one of the structures of the Federal Medical and Biological Agency, and according to rumors, they are waiting - they will not wait to get back as soon as possible.
In Ivanovo, more than 100 doctors have resigned since the beginning of the pandemic. The personnel issue in regional health care continues to be acute. The primary health care sector alone lacks about 300 specialists. The head of the regional health department Artur Fokin told about this at a press briefing. According to the employment service, more than a thousand vacancies for health workers are open in the region. Another 500 employees are needed to work in the new infectious diseases hospital.
In the Oryol Department of Health, personnel hunger is satisfied at the expense of college students and students of the medical institute, mainly the neighboring one - Kursk. Regional council deputy Larisa Udalova drew the attention of the head of the health department to the fact that students cannot fulfill the duties of a doctor: “They have the right to work as nurses and orderlies. And the region does not have enough doctors! I know doctors who leave to work in the nearest regions, where the salary is several times higher. Of course, if in our country people receive 20-30 thousand rubles for working with covid patients, and in other regions - 100-200 thousand, then they will go to healthcare institutions in another region".
“A serious load on the outpatient link is growing now. But in fact, many specialists experience professional and moral burnout. Many people find it easier to quit and not work. The issue is not about salaries, ”retorted the head of the regional health department Zalogin. This statement contradicts the words of the official himself, who recently stated that at the beginning of the pandemic, many Oryol doctors left to work in Kommunarka, bleeding their own region. By the summer, specialists began to return, but another misfortune struck - today in the Oryol region 96 doctors are sick with coronavirus, there are re-illnesses. Over the entire period of the pandemic, 1,420 employees of medical organizations were infected, 604 people received insurance payments, the official said.
The mobilization of doctors and medical personnel to work in the capital's hospitals during the pandemic increased the outflow of personnel from the regions close to Moscow. The medical institutions of the subjects of the Central Federal District have lost 3500 employees - doctors and nurses in six months. The most tangible losses are in the Voronezh (450 specialists) and Yaroslavl regions (455 employees). In Kostroma, 432 doctors were missing, in the Belgorod region - 358, in the Tver region - 504, Smolensk (318), Vladimirskaya 282, Ryazan - 274.
The trend is sad, but according to the law of physics, if it has disappeared somewhere, then it has arrived in another place. The number of medical workers in Moscow and the Moscow region increased in the first half of 2020 by 3.3 thousand people, most of them are doctors.
In early April, Moscow was actively recruiting medical personnel from the regions to the new infectious disease center in Kommunarka. In the vacancy advertisements posted on the Superjob.ru portal, the salary bar initially reached 450 thousand, but then it was reduced by 75-100 thousand.
Today, on the popular Internet job search sites - hh.ru and superjob.ru - large Moscow hospitals, for example, the GKB im. S.S. Yudin, they invite an anesthesiologist-resuscitator to work in a "covid" hospital for vacancies with a salary of 250 thousand rubles. In the Lyubertsy regional hospital there is a similar proposal - with a salary of 170-200 thousand rubles. Similar proposals were found in vacancy announcements in hospitals in Domodedovo, Mytishchi, Khimki.
“The situation with personnel in many regions is very difficult. I can't say about the "red zones", but the district service is simply "sewn up" given the fact that now there is a shift of mild and moderate forms of coronavirus infection for treatment at home. A huge shortage of personnel is also observed in the ambulance. It turns out that the only region that is now able to solve its personnel problems is Moscow”, - commented the co-chairman of the Action Interregional Trade Union of Health Workers Andrey Konoval for Novye Izvestia.
Who comes to work in the regions, and what keeps them there? Barnaul information resource "Talk" talked with a paramedic of one of the regional hospitals of the Altai Territory Vladimir (name has been changed), who spent his legal leave in October to work in a covid hospital on the basis of city hospital No. 4. According to him, it is harder to work for 10 years was not necessary. The hospital is overcrowded: out of 300 beds, more than 400 are occupied - people lie in the corridors, the canteen, sit in the emergency department for days for 30-50 people - waiting for beds. As soon as someone is discharged or someone dies, a new patient is brought up. “They are treated mainly with antibiotics and anticoagulants, sometimes with immunosuppressants. There were no antivirals left at all, only drops in the nose. They treat it like this: pour one antibiotic, if there is no dynamics for two days, change to another. Many lie for a month, but in the end they recover "- says the paramedic. But they also die in the hospital every day, often several people." The toughest thing is when a person suffocates, his saturation is 70%, he needs to be put on a ventilator, but everything is busy... …We had a case with a woman in her 40s. For her sake, a dying old man was removed from the ventilator. But she still didn't survive. You sign your own powerlessness. I'm used to this, but it hurts young inexperienced students to the depths of my soul. "Youngsters suffer no less from injustice - all the bumps are on them, people don't understand who is to blame, put on a white coat - treat!
“I’m not boasting, but we, the villagers, are respected in the hospital. Because we can do everything. Due to the lack of staff at the Central Regional Hospital, we had to learn a lot. -But there were some colleagues and nurses who had never installed the system before. They had to learn on the go. In the hospital, many single mothers from nurses work on mortgages, 3-5 year students earn money for their studies. Most doctors are residents, and work this is literally a practice for them. Some have less experience than mine".
For 336 hours of "watch" in the hospital, Vladimir earned about 130 thousand rubles. According to him, “I would have to hump for six months for this amount in the Central Regional Hospital. The amount includes a "covid payment" - 57 thousand rubles, payment for contact with coronavirus patients - twice 13 thousand rubles each, an advance payment of 14 thousand rubles and the actual salary.
By order of the Ministry of Health, any physician can be transferred to a permanent covidarium. But Vladimir refused this idea: “Firstly, we also have a shortage of specialists in the regional hospital. Therapists went to the covid hospital, there is no resuscitation due to the absence of an anesthesiologist, surgery, respectively. We are taking everyone to the neighboring regional center".
The most offensive thing during my work in the covidarium was to observe how negligently the common residents of Barnaul treat the pandemic, says the nurse. Until the governor tightened the mask regime, people seemed to care. "In our hospital, hell is going on, and you go out into the street - and it’s as if there’s nothing. It’s like we have an exclusion zone, some kind of Bermuda triangle, and outside the gates the world lives an ordinary life. I was shocked"
Meanwhile, there are no hospital beds at all. “They called three hospitals - NO! I have lost so much time because of these unfortunate doctors who just do not care, who do not want to go to the call, they don’t need anything ... ”- Departments of health throughout Russia are inundated with similar complaints.
Penalty company
“The perpetrators will be punished, you can be sure”, - Vitaly Yakushev, an expert at the Health Independent Monitoring Foundation, told Novye Izvestia. - But it will be the same punishment as in its time at the front, - a penal company: the paramedic of the ambulance who did not reach the patient will be temporarily transferred to the orderlies, the head physician, who has no free beds, will be sent to the “red zone”, the chief The health department, which has not contained the growth of the epidemic in its region, will be persuaded for some time at all meetings until a new scapegoat appears. You can't even fire people, because the front line will be exposed.
We're at war, aren't we? So? Why did it happen? We shift the focus from specific "penalties" to the health care system in the country and get an answer to the main question: all the fronts in the country were long open, the enemy was waiting, and don’t hang us noodles that the coronavirus caught someone by surprise.
Statistics confirm this version.
According to the calculations of the Center for Economic and Political Reforms, carried out in 2017 based on Rosstat data, from 2000 to 2015 the number of hospitals in Russia decreased by half - from 10.7 thousand to 5.4 thousand. Polyclinics decreased by 12%. Following hospitals, the number of hospital beds also decreased in 15 years - by an average of 27.5%, to 1.2 million. Optimization had the strongest effect on the state of medicine in rural areas - the number of hospital beds there decreased by 40%.
The smallest district hospitals are almost gone, the reduction was about 2500 units. Health reform ideologists explained the reduction by the fact that instead of unnecessary hospitalization, patients will have quality outpatient treatment. But simultaneously with hospitals, the number of polyclinics also decreased - every tenth one was closed, and the load on one polyclinic on average increased from 166 to 208 people per day.
- "Ambulances" did not fit into the new scheme at all, - recalls Yakushev. - Let's say they closed 5 district hospitals in the village, and opened one large hospital with full equipment. As if yes, not bad. But these numbers prove little. We also need figures on the number of ambulances that will transport patients from these 5 villages to this wonderful large hospital. Now it turned out that there are not just enough of them - catastrophically few. Patients have no opportunity to get to the hospital. Logistics is like that. Well, that's me, by the way. Otherwise, we will agree that ambulances are useless if there are still not enough places in wonderful hospitals.
And yet, what did the reformers think, leaving hundreds of settlements on a vast territory without an ambulance? According to the ONF, only in the Sverdlovsk region there are about 90 villages located more than ten kilometers from the nearest first-aid post. In the Altai Territory, 70 villages and villages are 20 km away from medicine, at the same distance there are 50 settlements in the Ryazan and Novgorod regions, in the Krasnoyarsk Territory. In the Republic of Mari El and Chuvashia, there are more than 100 villages, in the Primorsky Territory - 120, located 80 km or more from hospitals.
Told to hold on
In 2019, Deputy Prime Minister Tatyana Golikova officially recognized the optimization of healthcare in many regions as a failure. A year earlier, Vladimir Putin had been particularly critical of rural optimization. “In a number of cases… they were obviously carried away by administrative reforms: they began to close medical institutions in small settlements and in the countryside. <…> They left people practically without medical assistance, offering nothing in return. This is absolutely unacceptable. Forgot about the main thing - about people. About their interests and needs. Finally, about equal opportunities and justice”, - said the President.
After the outbreak of the pandemic, Leonid Roshal, President of the National Medical Chamber, told Kommersant that the issue of the readiness of the healthcare system in the event of a massive admission of victims in emergency situations was discussed back in June 2019 at a closed meeting on the basis of the ONF. Then its participants came to the conclusion that "we are not ready to provide massive assistance to the population of the country", including because of the optimization of health care and staff cuts.
It was as if they were talking about the village of Vysokogorny in the Khabarovsk Territory. There is almost lost a stock-washing hospital. Women have nowhere to give birth, there is nowhere to isolate the sick. Communication with civilization is only by train, which arrives once a day at night, and it is not easy to buy tickets. There is no road. Over the past two years, nothing has changed, despite the requests of State Duma deputy Sergei Shargunov and his TV reports from the Khabarovsk Territory. Taking advantage of his official position, Shargunov asked the new Minister for the Development of the Far East and the Arctic, Alexei Chekunkov, to help the village of Vysokogorny: “What should the residents, who have now been deprived of ambulance services, do? How to preserve the right to life?"
From a sore head to a healthy one
How long can this go on? Ahead, according to all forecasts, at least 7-8 months of a pandemic. I would like, of course, for a miracle to happen, like in New York in the spring, when in a few days the pandemic suddenly took and evaporated by itself. But with our problems in medicine and health care, it is better to prepare for the worst, says respected economist Yakov Mirkin.
To prevent this “worst” from becoming a disaster for more than 100 million people outside the capitals, the regions must have resources, primarily money. “And not a couple of tens of billions, but at least hundreds to fight the pandemic. We have not touched the National Welfare Fund, which has about 10 trillion rubles (in hard currency) in real money. What to spend on? Urgent purchases of drugs and equipment - anywhere, to break the wave of rush demand and drug shortages. Maximum payments to medical personnel - many quit, medical care may collapse. A multiple increase in the network of recovered volunteers". This is the economist's advice to the Russian government.
What to do in the hinterland? Wait until they sway up there and fork out, or adapt? Watch out, be isolated by ditches, worship holy springs, wear those damned masks? It is necessary. First, it will help. Secondly, the top at least will not have a reason to accuse the population of epidemiological carelessness and blame problems from a sore head to a healthy one.