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“It just came to our attention then. Everyone feels the same, both doctors and patients,” says Karolis Kilčauskas, resident physician at the Emergency Medicine Clinic of the Kaunas Clinics of the Health Sciences Hospital of the University of Lithuania and president from the council of the Association of Young Doctors.
– With the rapid increase in the number of people with COVID-19 every day, doctors are facing a number of problems. Is it true that one problem is that there is a decrease in the number of doctors who are not sick and can work, and the other problem is that sometimes there is no place to place patients who go to the doctor?
– The operating principle of the emergency medical clinic has not changed since the quarantine period: we have two separate clinics where patients are “classified”. The “fever side” includes people who are more likely to have COVID-19 and the “clean side” includes people who are less likely to have a coronavirus infection. Now we see that every day on the ‘clean side’, where people do not have the symptoms or risk factors for the disease, there are people who test positive for COVID-19. Negotiations with epidemiologists then begin on whether to isolate and isolate.
The same is happening in the hospitalization departments, for example, in the Gastroenterology, Nephrology and Chirugia Clinics of Kaunas, there were problems with the spread of COVID-19, so much of the staff had to isolate themselves, there is very little left staff, and since workers do not fall out of the blue, they have to work overtime, fill positions, treat other patients and wait for colleagues to return, without waiting for more sick or “crowded” workers.
Regarding the level III hospital, which are the Kaunas clinics, it is important to remember that there is a certain distribution of patient flows, because it is also a cluster center, patients from all over the region come together (for example, there is a procedure that strokes are diagnosed only in Kaunas clinics). ). If it happens (it happened recently) that outbreaks appear in other departments, such as the Kaunas LSMU Neurology Hospital, the hospitals begin to clog. Then patients remain in the Emergency Department without a response to the COVID-19 test.
– What do you miss the most about handling the situation?
– We lack inertia and adaptation to a changing situation. Everything changed quickly during the first spring wave, but now he lacks the speed to adjust. The order of the isolation rooms hasn’t changed either: People are waiting for COVID-19 responses for a long time, half a day and so on, and there is nothing that can help. In each section, the number of such isolation rooms is also very limited and now we see that difficult situations sometimes occur. Suppose there are empty wards in the wards, but the isolation wards are occupied and the order is such that they cannot remove new patients from the Emergency Department. Lack of flexibility.
Sometimes when employees get into a fight, it is a great start to trust medical residents. There is even a level where people work overtime, but are even told that they will not be paid for it. This problem has been occurring for many years, especially in Surgery Departments. This is not normal. The pandemic highlighted long-standing problems, and this is one of them.
– How many of your colleagues have become ill or have to spend days in solitary confinement?
– I can’t say the exact numbers, but in our subjective opinion, there are quite a few such cases. The staff is very responsible in meeting all safety requirements, but we are already beginning to feel that the situation is becoming more and more dangerous. Every day, on the “clean side,” where people do not have the symptoms or risks of COVID-19, they receive positive responses to the COVID-19 test.
– Am I aware that the situation is not under control and that patients without COVID-19 are infected in a hospital?
– Recently, there have been outbreaks in the departments of Gastroenterology, Nephrology and Surgery of the Kaunas Clinics, this is coming to light. It is very difficult to handle that situation.
The biggest problem is internal collaboration with other clinics, where patients sometimes remain in emergency medical care instead of receiving specialized care.
– How long does each person have to spend in an inpatient clinic in an isolation ward?
– It may take 6 to 8 hours to receive a COVID-19 response. It depends on when the study takes place. Sometimes we also improvise: based on our experience and knowledge, we test a person before knowing if the patient will really need to go to the hospital. We know that the result will have to wait a long time.
– You also shared your ideas on the social network. You ended the record with the words: “Ladies and gentlemen, October 23, the ship is sinking.” Really drowning?
– Yes, the situation is really worse than in spring. Everyone feels the same, both doctors and patients.
– Do you see more often? Maybe you have to do it every other day?
– Fortunately, our staff has still held out and no further action is needed. In the spring, when the situation was expected to be really more complicated, preparations were made: even the residents were removed from “cycles”, from other clinics, we all returned to the ER. But it was not necessary.
So far, we have not withstood any additional surveillance. Staff shrugged, we support each other. But the biggest problem is internal collaboration with other clinics, where patients sometimes remain in emergency medical care instead of receiving specialized care.
But I really know that the worst situation in the Kaunas clinics is in the Surgery Clinic: people work overtime there.
– In the near future, is it possible that medical institutions will no longer be able to provide many services?
– This option is very possible. Certain outpatient services are in a rush to perform, those numbers appear to be increasing, and hospitals are not made of rubber. There will only be one ambulance left and some people will have to wait.
– Doctors are getting closer and closer to the public and asking people to be aware. What message are you sending to people?
– These messages may already be a bit boring, but the only weapon against a pandemic and a health care system that is no longer charging and starting to fall is to protect yourself, your surroundings, wear masks, disinfect your hands, and maintain social distance. And don’t really go to see the Žalgiris game live.
– And what would you like to say to colleagues and management?
– Resident physicians must do everything legally and if they work overtime, they must be paid for it. It is important not to give up.
I want to wish my teammates strength because we are really all in the same sleigh. If we can withstand this pandemic, we will only do it together.
More leadership, mobilization and communication between the different departments and hospitals would be desirable on the part of the administrators. I want inertia to adapt because every day that situation changes and until now the Emergency Department can still deal with that stress, but once they can no longer deal with it, I no longer know who will. Systematic decisions must be made and there is certainly no need for delay.
A. Veryga: The government will also consider granting additional payments to residents
At a press conference on Friday, Health Minister Aurelijus Veryga promised that the government will discuss the issue of overtime pay for residents working with coronavirus patients.
“Because the government has been talking about extra pay for doctors, those who work specifically with covidiniais patients, we will definitely raise the issue of resident payments as well, “he said at a news conference on Friday.
On Monday, Facebook Prime Minister Saulius Skvernelis announced on the social network that additional supplements will be paid to doctors at the country’s top five hospitals.
“Doctors and epidemiologists continue to be key people in our fight against COVID-19. We must protect them, create the best conditions for them and respect their work. That is why today we decided to pay supplements to doctors in five hospitals who work directly with the virus. “, wrote.
S. Skvernelis mentions five hospitals: the Santara Clinic of the Vilnius University Hospital, the Kaunas Hospital of the Lithuanian University of Health Sciences, the Klaipėda University Hospital, the Šiauliai Republican Hospital and the Panevėžys Republican Hospital.
According to A. Veryga, it is not yet known how much extra money will be needed for this.
“Until now, we do not know the specific amounts, because the situation is changing very dynamically: not only infectologists are used, but also therapists are used in medical institutions.” (…) They (medical institutions – BNS) have been asked to provide figures, ”he said.
It is true that the Minister was unable to comment on the situation due to the lack of beds in the isolation wards in the Kaunas clinics. “I can’t comment on whether the beds are enough. I don’t want to speculate, because I can’t say how many full beds there are in various medical institutions,” said A. Veryga.
The kauno.diena.lt portal sent a comment to the representatives of the Kaunas clinics. Once we have the answers to the questions, we will supplement the post.
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