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Latvian hospitals are redesigning their wards to prepare for an increase in the flow of Covid-19 inpatients, which could theoretically come at any time. Doctors working on the Covid-19 “front line” admit to feeling overwhelmed, tired. Whether Latvian health care is able to withstand such a load, explains Latvijas Radio (LR) in the program “Open Files”.
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Edīte Kauseniece, a doctor of the Latvian Center for Infectious Diseases (LIC), shared her experience in the show. On a daily basis, she is an outpatient doctor, not a hospital doctor, and she still works with students on duty. At the beginning of October, Kauseniece had to replace her colleagues working on the hospital who had gone on vacation, and since then she has only worked at the Infectious Diseases Center.
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She points out that the whole LIC is one large Covid-19 hospital and no one asks if doctors want to work with Covid-19 patients.
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The doctor says that the number of free beds is decreasing more and more in the LIC and also in the Tuberculosis and Lung Disease Clinic, where the second Covid-19 hospital is located.
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“Nobody is going to put these patients in the corridors. At least for now, and we hope that we will not get there until then.
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Gender distribution and severity should also be taken into account. It must also be taken into account that these patients must be able to provide oxygen, which requires certain safety measures and also purely technical limitations, so the actual number of beds does not correspond to the actual number of beds, “explains the doctor.
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Currently, only those who are in a serious health condition are admitted to hospitals, because in comparison with the spring, not only the number of infected cases has increased, but also the number of days spent in hospitals.
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The doctor says if she had the opportunity to ask the government for something, it would be a larger medical staff.
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“If it were what was determined by the Riga East Clinical Hospital (RAKUS) as if officially, as if unofficially, but that there should be 12 patients per doctor – well, it is rare in which department it is,” says Edite.
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She admits that in the real situation the workload for doctors is two to three times higher.
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“Management has been forced to reorganize human resources, and in my case, too, if it was a planned replacement for a colleague’s leave, it would take a little longer. “The patients of a full – time outpatient doctor were either discharged or divided among other colleagues, and the workload of their doctors increased accordingly. It has not been ideal in the past, but now outpatient care is also suffering,” explains Kauseniece.
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The doctor reveals that it is only human, that doctors are also afraid and refuse to work: “Medical staff are just people too, they are just as scared. There are those who simply refuse to work with this type of patient. We live in a democratic country where forced no one can be forced to work. It can be understood, because medical staff also have chronic diseases. “
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“Well, of course, we also have some cases when the staff find out that the patient is in the ward, they are also afraid, they want to pick up the blue pages. Inga Ozolina, Medical Director of Vidzeme Hospital.
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In addition to Covid-19 patients, doctors also fight other patients with other ailments. Edite emphasizes that other diseases will be missed due to the pandemic.
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“Against this background, preventable diseases will not be prevented. It all turns into a vicious circle. Observation and detection of oncological diseases suffers, all these areas, which were not already at the height of the tasks, suffer even more against this Covid-19 background,” says Edite .
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The situation in Latvian regional hospitals is currently different. If in Rēzekne hospital Covid-19 does not affect work for the time being, then in Vidzeme hospital the situation is much more tense, because 90% to 100% of the hospital beds are already occupied. Vidzeme residents hope that if seriously ill people are brought to the hospital, those who need to be ventilated will be taken to Riga.
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“Unfortunately, we do not have the infrastructure in the hospital to treat these serious patients. Thank God, no one has been in such a serious condition yet, but if we have to treat them, it will be a very big challenge for us, because we do not have isolators in resuscitation. such patients should be placed.
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Then we will have to think about what we can change in the hospital plan. But it is very complicated due to these premises, which cannot be transformed and rebuilt at the moment, “says the director of Vidzeme Hospital.
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Ozolina explains that the hospital organizes the work in such a way that after a week they try to discharge Covid-19 patients and transfer them to the supervision of a family doctor or transfer them to a lower-level hospital, if possible. She very much hopes that the situation will not get worse Vidzeme Hospital is the only one in its region that treats Covid-19 patients.
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Representatives of regional hospitals emphasize that the problems are also caused by the long time they are available for the results of the Covid-19 tests. This is due to the fact that any patient is initially taken to a transit ward in a hospital, where a Covid-19 test is mandatory regardless of the circumstances.
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“This department is also quite full for us, because on-site tests are not performed anywhere in the region. Including not in Vidzeme hospital, we have to take each patient’s test to Riga and wait for an answer. We now perform tests three times a day. “The situation in the transit department is, of course, not normal. It should be that we get a response quickly and move on to the department,” explains Ozoliņa.
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Kauseniece, a doctor at the Infectious Diseases Center, doubts that people with Covid-19 symptoms, but who are not yet in the hospital, will also have to wait a long time for tests. Sometimes analyzes have to wait up to a week. According to the doctor, this is the reason why the number of patients with severe disease is growing. The doctor also mentioned that the reason for the increase in the number of patients was that people went to the doctor late. As a result, the symptoms of the disease become more severe and patients spend more time in hospitals.
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It has also been observed in Rēzekne and Vidzeme hospitals that the treatment has become longer – on average it is three weeks.
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Meanwhile, there is sometimes talk in society about the possible sorting of hospital patients. For example, Kalvis is confused about the actions of doctors when his seriously ill nurse was not transferred from Ventspils to Riga Hospital. His sister later died at the age of 34 years. Shortly afterwards, Kalvis’ father died at Ventspils Hospital.
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“The answer was that it turns out that Dad is 70 years old, has a chronic illness, he has already been written off. He will fight for the new ones, there is no place in hospitals. Dad is already written off so he spends the last days, hours or minutes there,” says Kalvis.
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When asked by Kalvis why his nurse could not be taken to Riga, the doctors answered that they had fought for lunch to see Kalvis’ s nurse in Riga hospitals. “My father had also complained that he had a catheter dropped and the medicine was flowing into bed, but no one cared,” Kalvis continues.
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Viola Grīnvalde, a representative of the North Kurzeme Regional Hospital, explains that in accordance with the Law on Patients’ Rights, the specific case may not be commented on.
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The program reports on the case when the adequate assistance of doctors has been questioned. The incident occurred at Daugavpils Hospital, where a pensioner with Covid-19 symptoms was admitted. The doctors of Daugavpils Hospital released the man at home because they had not seen any symptoms, but the man died at home on the same day.
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Physicians’ concerns about healthcare congestion are growing by the day. LIC doctor Kauseniece explains:
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“The treatment of Covid-19 patients requires a large amount of oxygen, but the infrastructure of Latvian hospitals is not suitable for such a large consumption.”
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In the middle of October, a message appeared in the media – if at X o’clock there is a moment that the artificial lung fan is not enough for everyone, patients will be sorted.
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Some of the recommendations made by the Latvian Medical Association are considered logical, others are considered inhuman. Patients will be divided into four groups.
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The first group is predicted to have a high probability of mortality, artificial ventilation will not be started, but palliative care will be provided.
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The second group will include patients with single organ failure. They will be provided with the maximum treatment available, as their recovery is expected to be high.
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The third group will be patients whose condition is not considered severe. They will be provided with intensive care and connection to the artificial lung if there are no candidates from the second group.
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The fourth group of patients will be those whose course is less severe and does not require specific treatment.
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Currently, Latvia is far from X hours, as there are more than 500 artificial lung ventilators, which are currently used in small quantities.
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Representatives of the hospitals in the program say that they have not been introduced to the X-hour plan.
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Sanita Janka, Head of the Medical Quality Department of the Ministry of Health, reassures everyone that the situation is under control:
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“I would say that our health care system is now ready enough for us to provide services. In the current situation, if it does not get worse, we hope to deal with university and regional hospitals, but if necessary, we will involve other hospitals as well. ”
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“This human resource issue – we can’t buy it with any money – the way he has it, we have to take it into account. Therefore, the second aspect of these restrictions is that it must be understood that medical personnel move on public transport, go to the store and if they become infected, it is a great loss for us, “says Janka, emphasizing the very important role of doctors in society.
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“It is not the masks, but the pandemic that affects our freedom,” Kauseniece concluded.
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