How Ukrainian doctors work at epicenter of coronavirus epidemic?

Author : Kateryna Chernyavska

Source : 112 Ukraine

The Ukrainian healthcare system was not ready for a pandemic. According to the latest data, about 1000 doctors became infected with the coronavirus, and this figure is increasing daily
21:29, 27 April 2020

Associated Press

For more than a month, Ukraine has been suffering from coronavirus epidemic, the peak of which is expected in a couple of weeks. The Ukrainian healthcare system was not ready for a pandemic. According to the latest data, about 1000 doctors became infected with the coronavirus, and this figure is increasing daily. Due to the lack of personal protective equipment, medical workers massively quit, despite the fact that they are promised a bonus of 200%. There is no stalemate in hospitals today, but doctors are expecting a peak epidemic.

We were able to communicate with an intern who works in the intensive care unit of the infectious diseases hospital, and find out what really happens.

Oksana (name changed at the request of the heroine) is already completing an internship, she is anesthetist-resuscitator and she was not at all ready to work with covid-19 patients. According to the Ministry of Health order, students and interns can be involved in the fight against coronavirus only at their request. Oksana and her friend were simply said that from now on they will work in an infectious diseases hospital.

About transition to work

We are just slaves in this situation. By law, we were not allowed to change the base of the internship without our consent. And even more so to be thrown in the epicenter of the virus.

I don’t give a damn about the virus itself; on the contrary, it’s interesting to work in an epidemic. But it really hurts to feel the attitude of the hospital towards us. My rights were brazenly violated. Neither the hospital nor the department had any right to send me to the site of infection.

Everyone who works in this intensive care unit for today is there voluntarily. They themselves did it, but we didn’t.

Moreover, I learned about the transfer late in the evening, they informed me that there was already an order. But, as it turned out later, the order was dated the next day after I was informed that I was going to work in the infectious disease unit. To my refusal they said only that I can write a vacation application at my own expense. But, firstly, it’s three weeks to stay without money, and secondly, then I may not complete the internship.

And, frankly, I do not fully understand why they called us here. Today, doctors manage to work there without us. Moreover, we are not doctors yet, we cannot work without supervision. The intern is sometimes help, but sometimes is a burden.

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At first I was even a little scared, because I use public transport on the way to and from work, I live in a campus. And, accordingly, I can bear the potential danger to others. However, I do not have close contact with patients; I try not to contact the medical staff either.

Now I am calmer about this, on the contrary, it will be good practice. Because I’ll finish the internship soon, I’ll go to work, and the Covid-19 will not go anywhere.

About the patients

We were lucky that we got an adequate head of the department. He immediately said that he had neither the legal nor the moral right to force us to work directly in the boxes with Covid-19 patients. At will, we can do this. In addition, he divided us into shifts so that we would not go to the hospital every day. But when the peak of the epidemic comes, of course, you have to work every day.

So far I don’t work directly in the boxes. Firstly, I see no reason to waste protective suits. Secondly, for the doctor there is almost nothing to do there, the main work falls on the shoulders of nurses.

Today, we have three patients in the intensive care unit with confirmed coronavirus and one more with suspicion. All the elderly. When I look at a 70-year-old woman who has had a stroke, and heart failure, and diabetes, I understand that Covid-19 can finish her off, and there's nothing to be done about it.

A little thing in this whole situation that annoys me is misinformation. There was a case when information appeared in one of the local media that in our hospital, in our intensive care unit, a 78-year-old lady died from Covid-19. I look into her unit – she is more than alive!

On the readiness of the hospital for the peak

Now we are working in normal mode, but everyone understands that there would be the influx. In a nearby building, an entire floor was allocated for resuscitation of patients with Covid-19. From all over the city 13 mechanical ventilation devices were brought there, oxygen was brought there. Therefore, the equipment may withstand the influx of people, but there are sorely lacking personnel.

For example, 13 patients in intensive care are already many. 13 ordinary, for example, resuscitation patients require two resuscitation doctors and at least four nurses, or maybe more. And we cannot live there permanently 24/7. We have a general resuscitation routine designed for 15 beds, but a shift requires four sisters and two doctors. This is a huge problem.

Also we have not enough drugs. All relatives of patients buy them at their own expense - both drugs and oxygen. For example, Plaquenil (an antimalarial drug that used to treat Covid-19). I don’t even know where it is being taken. There is nothing in the hospital. We don’t have even normal catheters. That is, Polish or German ones, which are expensive. I have to use cheap Ukrainian, but they are very bad.

There are still enough remedies. There are respirators, and suits, and shields. But everything was bought by volunteers. All. There is nothing from the state.

About doctors

Three doctors are currently working in our intensive care unit. And they literally live there. They were given a floor, and they really live there. And the nurse lives there alone.

At first there were only two doctors. Another doctor recently came to us from another hospital. She has a vacation there, but what a vacation during the pandemic - neither to go anywhere, nor to leave the house, so she came to work for us at this time.

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Everyone, as I said, came voluntarily. This woman, who is on vacation decided simply to earn some money. The head could not just leave his unit. And one more doctor from those for whom it is important to be at the epicenter of events.

In general, the doctors have a normal mood, they are quite calm about this. But these are resuscitators, they are used to the fact that they are constantly in trouble and patients are constantly trying to die (laughs). But it’s still difficult to talk about the general mood, because there is no influx.

Now the medical staff is massively quitting because there are no remedies. Regarding moods, I can only talk about resuscitators. Some are frightened - they constantly disinfect everything, reprimand people who walk without a mask or violate the distance. Doctors worry about themselves because they know that they are old.

One anesthetist in our city got Covid-19, survived a clinical death and is now in intensive care. And no one knows if he will get out.

But there are those who do not care. There are doctors who generally go around without a mask.

About salary

The state, of course, promises the medical staff, which is involved in the fight against Covid, a premium of 200%, but so far no one has seen it.

But it is unlikely that they will take the doctor’s salary and multiply it by two or three. No. They say that they will calculate the hours spent directly in the box with the patient, and give an increase. For example, if you stayed in the hospital for 24 hours, and in the patient’s box for only 4, then you will receive an increase in only 4 hours. And I’m more than sure that they will think so in a cunning way.

We, the interns, more than likely will not be paid more. When we were transferred to an infectious disease unit, we tried to find out but no success.

About a high incidence among doctors

Yes, indeed, in Ukraine there is a very high incidence among doctors, but most of these are family doctors. They were simply thrown into the embrasure. Because they are the first to meet the patient, and they have almost no protection. They are not given anything at all, the maximum that they have is an ordinary facial mask.

One doctor said that she was on a call and sent the patient with pneumonia to hospital. The patient died, she was tested and found Covid-19. And then Covid-19 turned out to be in the doctor.

Therefore, now a lot of doctors are infected. And a very big problem is the lack of protection. Because they have no respirators. The only thing that protects the doctor is a facial mask.

Volunteers at least brought us shields. Therefore, a resuscitator, for example, when he does a tracheal intubation procedure (insertion of a tube into the trachea to connect the patient to the ventilator, - ed.), almost ‘kisses’ the patient. And the mask will not save at all.

Although, the possibility of doctors in the infectious diseases hospital becoming infected is paradoxically less. Just because they know what they are dealing with and have the means of protection. Of course, each patient in this period needs to be kept as conditionally infected, but there is still no protection.

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