"We will cure if we survive": how regional hospitals deal with the second wave of COVID

Now we are clearly convinced how the chronic shortage of doctors, medical personnel and hospital capacity can leave no chance for patients.

Julia Suntsova

Doctors, nurses, paramedics and trade unionists told a press conference on "The Situation of the" second wave "of coronavirus infection and health workers, and the All-Russian action" Pay per COVID! "As they fight the covid every day.

After China, capitals and cities with international airports were the first in the world to face the new virus. So in big Russia for six months, the virus from Moscow and St. Petersburg reaches the regions. For years, "optimized" provincial medical facilities have been in a real ambush. Many hospitals cannot cope with the influx of patients. Ambulance calls hang for days, and sometimes patients simply do not wait for an ambulance to arrive, doctors say.

In Udmurtia, back in August, a man who looked like the Minister of Health of Udmurtia Georgy Shcherbak, at a meeting with officials in charge of medicine, signed his own helplessness, stating that due to improper organization of the work of medical institutions, patients with coronavirus died in queues, and did not having received medical aid [the video is at the disposal of the editorial board].

“I want to draw the attention of medical institutions that the situation with morbidity and mortality is not improving. We are in a serious situation today, when our medical institutions, where the process of treating coronavirus patients is taking place, are practically full. We try to use: a) different patient hospitalization schemes. First, we organized all this through the 2nd city hospital. But a process began to take place when she simply sewed up in this work, did not have time to examine all the patients, prescribe treatment, and something happened that should not have happened: patients, not receiving help, died. Their condition was aggravated. Then, only after death, we already received confirmation that they were positive for our coronavirus. Or another process was taking place. They were loaded there again, in this state we tried to transfer them to the infectious diseases or Zavyalovskaya hospital, and they practically died on the way. It is not right".

The strangest thing is that the speaker, having already actually provided a confession, proposes a "different scheme", in which he is also not very sure. “Hospitals take turns on duty. Also, maybe not an option. This option still needs to be studied many times, to see how effective it is, ” he concludes.

Ambulance workers speak in unison about the problems with patient routing due to the shortage of emergency services.

- The number of cases has increased significantly compared to the summer months, and there are problems with hospitalization of these patients. In the regional hospital, a redesigned hospital was closed, and now it will again provide planned surgical care. When we carry patients, we don't even have routing orders on hand, and for each patient we have to call the senior shift doctor. He sends, for example, to the 6th infectious diseases hospital, but we reach it - and there are no more places there. I can wait up to 40 minutes until it becomes clear where he can be taken. As a result, they are sent to the region in Petushki, for example, and so we ride for hours with the patient, '' says Yekaterina Ashaeva, an ambulance paramedic from Vladimir.

The order of the Ministry of Health and Social Development of Russia No. 180n is not being observed, according to which 36 general ambulance teams should be allocated to Vladimir, and we have only 9 of them, and this has long become the norm. That is why ambulances hospitalize even severe patients for hours, days, she sums up.

In Samara, on the contrary, they continue to transfer general-purpose hospitals under the covid hospital, including those within a radius of 50-70 km from the regional center. Planned patients with other diagnoses also began to be taken to the region due to a lack of places. But the existing capacities of the ambulance service and the medical institutions themselves can hardly withstand, says the driver of the Samara ambulance service Alexander Mitrofanov.

- Calls from patients have indeed increased significantly. It has become extremely difficult to get through to "03" - you can wait 40-45 minutes for an operator to answer, and up to three days for the car itself! Ambulance patients are heavier than they used to be. Why it happens? According to the standards of the Ministry of Health, even in "peacetime", not like in the covid era, one general ambulance brigade is relied on for 10 thousand of the population and one specialized (resuscitation) brigade for 100 thousand of the population. Thus, for 1 million 150 thousand of the population of Samara, at least 115 ordinary ambulances and at least 11 intensive care units should be allocated. In reality, no more than 60 ambulance teams are replaced, and sometimes it happens that only 1-3 resuscitation teams are on daily duty - and this is for the whole city!

- In Kostroma, out of 18 assigned line brigades, only 3-6 work in the field. Two or three teams per shift specifically for covid with 300 calls from patients with suspected coronavirus, hospitals are overcrowded. We don't even have time to eat in a day. The tension and intensity of work is growing. Paramedics are not appreciated at all - there are no irreplaceable people, they say. And we, ambulance drivers, are generally not considered medical workers - according to the documents, we are just some sort of 6-grade drivers from an incomprehensible motor depot, - says the driver of the city ambulance Yevgeny Zubtsov.

The situation with an acute shortage of the capacity of the ambulance service developed even before the coronavirus. The pandemic has exacerbated this problem. Almost throughout Russia, the number of brigades is 1.5-2 times lower than the norm. In addition to this, those teams that go out on calls are often understaffed: one medic instead of two, or instead of three, if we are talking about resuscitation teams. In fact, we have - a pair of hands instead of six during resuscitation - and this already clearly proves how exactly the chances of patients for survival are reduced, how the thoughtless reduction in the staff of medical institutions directly affects people's lives, comments Andrey Konoval, organizing secretary of the Action Interregional Trade Union of Medical Workers.

It is not enough to take a patient with coronavirus to the hospital, you still need to provide him with primary care quickly and efficiently, and here the ambulance service may again be extreme due to miscalculations of the administration with the provision of special equipment and medical equipment.

Yekaterina Ashaeva, a paramedic from Vladimir, talks about systematic problems with computed tomography and oxygen deliveries for patients with covid:

- We understand that at the very beginning it was difficult to put everything on the rails, but in six months with the equipment at least the issue could be resolved. We were silent from the very beginning of the epidemic, and only now the head physician informs us about the opening of the CT Center in Vladimir. Before that there was no free CT examination for patients with pneumonia, all CT scans were in private hands. Severe shortness of breath, decreased oxygen saturation, but the patient is given an x-ray. On X-ray, pneumonia is not found and is sent home. And in a few days we return to him on call and everything is already deplorable - resuscitation measures, '' says the medical worker. - Oxygen is also in constant shortage. Many patients have severe oxygen deficiency, we come to the call - oxygenation is needed, but there is no oxygen in my car. How many times did the administration write - supply oxygen, there is no oxygen. An official answer comes from the authorities: "There is oxygen" ...

Another big problem is the chronic shortage of medical personnel themselves - those who treat, receive, nurture, wear and carry. Doctors, nurses, nurses, paramedics, administrators, ambulance drivers are sorely lacking, and the doctors who remain in the public health sector are the first to fall under the blows of infection. According to the latest official data only (July 2020), more than 14 thousand Russian doctors contracted the coronavirus while on duty. The incidence among Russian health workers, according to statistics, is 2-3 times higher than among residents. There is simply no one to replace sick colleagues, and a triple load falls on the shoulders of those who remain.

- In Russia, 1.5-2 times less money is spent on healthcare than even in Eastern Europe. In understaffed teams, in outpatient clinics, in hospitals, doctors work at 1.5-2 rates - twice as much as provided for by the labor standard. When one doctor falls ill with us, the medical care system loses, one might say, two at once - because he worked for himself and for that guy. People have been dragging themselves with extreme psychological and physical stress for years. And they are constantly fined for shortcomings in the preparation of documentation, prosecuted by criminal cases - the recently known "Doctors' cases". Our junior staff were voluntarily transferred to the category of room cleaners - hundreds of thousands of hospital employees continue to perform the functions of junior medical personnel, but do not have preferential work experience, incentive and insurance premiums, additional payments for harm, the same promised payments for work in conditions of coronavirus infection, '' says Konoval.

In Vladimir, junior medical personnel were denied payments for work with patients with covid, citing orders from the Department of the Vladimir Region. After bringing local regulations in line with federal guarantees, physicians have diminished.

- By local order, payments are not due to doctors who worked with patients at risk of contracting coronavirus infection. What does this mean? They paid only to those health workers who worked with patients whose COVID-19 was confirmed through Rospotrebnadzor. But since August, for example, they stopped taking tests from bedridden patients, they said that there was no indication for that. Bedridden patients, they say, and without covid are prone to the development of nosocomial pneumonia. And there are no tests, no confirmed diagnoses, no payments. Only a picket was able to turn the tide, - ”says Larisa Malysheva, a nurse at the City Hospital No. 4 in Vladimir .

Less controversial situations among those working in the "red zone" and in the ambulance. But there are initially non-coronavirus patients who are in hospitals and are treated, for example, according to the vascular profile or oncology, and on days 4-5 they are diagnosed with COVID-19. General practitioners and nurses need to be turned inside out to get paid to work with these patients. At best, they are paid extra for one shift or for the actual time worked with this patient or for the rest of the month after contact with the coronavirus, although he may have had ten times more contact with coronavirus patients than a doctor.

Regional ministries of health are also trying to exclude administrators, nurses and junior staff from the "risk categories" by hook or by crook.

- Treating the outpatient link as a second class. CT centers are not something that has fallen from the sky; they are not temporarily erected hospitals, but redesigned outpatient clinics, and we work in them. We work in PPE around the clock, but it is believed that we do not particularly risk getting infected with coronavirus, as if. We, employees of outpatient clinics, are not subject to any federal regulation. The flow of patients with suspected coronavirus in our country is even greater than that of doctors and nurses in hospitals. The volume of work has increased significantly. If earlier we only had an appointment to see doctors and on admission from an ambulance, now the functions have expanded. In addition to everything, we route the patient, issue personal protective equipment, send for a doctor's examination, for tests - for CT, coronavirus tests, blood sampling of all varieties, smears, - says Olga Shymko, an x-ray laboratory assistant at the Diagnostic Center No. 5 DZM.

According to her, according to a special decree of the Mayor of Moscow Sergei Sobyanin, only doctors and nurses (and not all of them), nurses and junior medical personnel received incentive payments in their institutions - only if they had contact with coronavirus patients. The administrators were completely forgotten, although there is not a day that administrators do not encounter infected covid, says the interlocutor. The promised doubling of payments did not come either. The heads of the outpatient clinics write complaints to the capital's Department of Health, and from there come refusals with reference to some methodological recommendations they themselves have developed, which says that payments are due only to employees who directly conducted chest studies.

- We are approached by many employees who have problems with insurance payments. According to Presidential Decree N 313 "On the provision of additional insurance guarantees to certain categories of medical workers", many disputes arise in cases where the infection becomes nosocomial and it is already impossible to understand who infected whom, and in order to receive payment, it is necessary to prove contact with a specific coronavirus patient. If a doctor, for example, became infected from a colleague who worked with a patient with COVID-19, then he no longer receives a payment, says medical lawyer Anastasia Manzya.

"There are also many refusals under Federal Law No. 125-FZ "On Compulsory Social Insurance Against Industrial Accidents and Occupational Diseases", - she says. Refusals in insurance payments are motivated by the fact that the alleged coronavirus infection is not included in the list of occupational diseases.

In Izhevsk, for example, relatives cannot obtain payments for the deceased son of Oleg Nabokov, a dentist at Izhevsk City Clinical Hospital No. 4. The doctor is left with a family - a spouse with a serious diagnosis, two minor children, two elderly parents. The reason for the refusal to pay is that the hospital cannot find who their doctor could have contracted at the workplace. In the questionnaires pre-filled before the dentist's appointment, no patient considered himself to be infected with covid.

- All health care workers should have the presumption that they were infected in a professional environment, and they should not run and prove it. They do not have such capabilities. In addition, there is a conflict of interest with the administration of medical institutions: the employer is always interested in not admitting the infection of employees in the performance of their professional duties, otherwise this automatically means a fine for the employer for improper organization of working conditions during the epidemic, - medical workers comment.

More than 290 thousand medical workers received presidential payments for the performance of particularly important work during the coronavirus pandemic, and over 400 thousand people received payments for working with risk groups, Prime Minister Mikhail said, speaking in the State Duma with a report on the results of the government's activities for 2019 Mishustin.

But, as we can see, they are not produced on a regular basis, but rather sporadically. The heads of the regional ministries of health interpret federal norms often at their own discretion and cling to all the gaps in the regulatory framework in order to minimize the announced payments for COVID-19, issue a one-time payment and not to everyone, remove from the category of "medical workers" the army of people who, like and doctors, every day in the most difficult conditions and on behalf of the state, fight for the lives of people. And the epidemic continues ...