What to do – the incidence among health workers is increasing rapidly. Rotation? Attract students and retirees? New organizational strategies?
Health Minister Maxim Stepanov cited alarming statistics: as of April 14, of 3,372 laboratory-confirmed cases of COVID-19 in Ukraine, 594 had been recorded among medical workers. In other words, among patients infected with COVID-19, one in six is a doctor. Particularly noteworthy is the situation in the Kalinovsky district of the Vinnitsa region, where as of April 12, out of 30 people infected, 26 were doctors. Although, at the same time, according to the regional administration of Kalinovka State, among the medical staff it’s contagious The branch has not confirmed any cases. Globally, there is still no question of a shortage of medical personnel, but if the situation in Ukraine worsens, such a problem could arise, as explained Oleg Kalashnikov, director general of the network of clinics Dobrobut in an interview. And it’s better to start preparing for it now.
Rotation, special selection of doctors to work with COVID-19 patients – the world is looking for a way out
All countries with rapidly spreading coronavirus infection have high morbidity among medical workers. As of April 9, it was known that in Italy, 12,000,681 medical workers were infected with the coronavirus, including doctors, nurses, laboratory assistants, paramedics, and support staff. More than half of the infected doctors are nurses. If we take into account that on April 9, there were 143,126 people infected in Italy, it turns out that every eleventh of them is a doctor. This became the biggest problem, as they solved it – wrote on Facebook Gleb Bityukov, one of the doctors of the Ukrainian team in Italy.
“The biggest challenge the health system has faced is the understaffing. These are mainly nurses and entry-level nurses, who perform many functions here. Much more than in our conditions. As a result, they have also been transferred from other hospitals in the area to temporary jobs here. Thus, by redistributing resources, these isolated hospitals, which have completely reoriented themselves to help infected patients, have gained more opportunities. The transport connection is limited, but this has not resulted in a collapse of medical staff like ours, because here everyone has their own car. “
Another example comes from the United States. Irina Kot, a nurse from Ukraine, who works in one of New York’s largest hospitals, told Voice of America that her hospital had transferred doctors at risk to other departments. “In the infectious area, the young and the healthy stayed at work. If they fall ill, they will most likely have mild symptoms and be able to care for patients in the future, ”says Irina.
Ministry of Health: medical institutions will attract additional contract workers
Although there is no shortage of medical personnel in Ukraine, the incidence among doctors has increased considerably over the past week. If, on April 7, a coronavirus infection was registered with 172 doctors, then April 10 – in 334, April 13 – in 530.
Health Minister Maxim Stepanov responded to Ukrinform’s question about the strategic measures the Ministry of Health is considering to avoid a shortage of workers.
“Yesterday, the Verkhovna Rada of Ukraine amended the Ukrainian law on the protection of the population against infectious diseases” relating to COVID-19, which granted the right to local authorities, including under a contract, d ” attract doctors to fight COVID-19. We are constantly analyzing what is going on with our health workers so that all our hospitals receive as many doctors and health workers as possible, “said the Minister of Health.
Earlier, the ministry announced it would attract medical students to help hospitals fight COVID-19. Those who express such a desire can fill out a special form. As Maxim Stepanov said, the number of questionnaires completed by students in the ministry is now around 1,100. But he noted that students will not be involved in providing medical care, but in organizational measures and techniques for controlling COVID-19.
“We are standing firm because we have several lines of defense for our workers and our patients”
The Mukachevo Central District Hospital is an example of how to play before a possible staff shortage. The head of the hospital, Yevgeny Meshko, told Ukrinform that no case of health worker infection in the facility has yet been recorded. This is facilitated by the thoughtful organization of work during the epidemic in the establishment.
“The important role is played by good personnel management, that is to say the way the work is organized, the logistics inside the institution. We have a reliable patient movement system inside the hospital, which is why we have protected most departments from contact with COVID-19. Since we have a PCR laboratory, we can carry out the tests ourselves. Patients are admitted to hospital after the test. For this, there is a separate department where primary patients meet before the test and where they receive medical care. In other words, we hold on because we have several lines of defense for our workers and our patients, ”says Yevgeny Meshko.
According to him, the staff shortage has not yet been discussed. “But we are not waiting for the labor shortage, but we are now creating a reserve of personnel. We communicate with colleagues and ask some of them to take vacations – annual or at their expense, as is convenient for anyone, for two reasons: to reduce the number of people inside the house. hospital and build up a staff reserve. In fact, additional people in the department risk spreading the infection. The hospital now operates in emergency mode, that is, only for emergencies. Only a fifth of our capabilities are involved, so most departments are empty. We have reduced treatment services to one, and there are now 10 patients in 100 beds. A large number of people who were not involved and who went to work are now at home and do not pose a threat to the medical environment. And at the same time, it’s a reserve of staff in case the virus arrives at the hospital – we will have someone to replace the staff if necessary, “said the head of the central district hospital. Mukachevo. He adds that if there is a critical need for hospital work, they will attract everyone who might need it – both interns and retired doctors, but hopes this scenario can always be avoided.
Another strategy: “sorting” of patients, deliberate involvement of medical specialists
Commented Ukrinform and director of the Revival Institute for Future, the specialist in infectious diseases Vadim Aristov: the number of doctors per 1000 inhabitants in Ukraine is not too different from other European countries. If in Ukraine there are 3 doctors per 1000 inhabitants, then in Italy – 4, and in Belarus – 4.1. And it is more than that of South Korea, which has managed to avoid the Italian scenario for the development of COVID-19 – there are 2.33 doctors per thousand people.
“But with a small number of doctors in South Korea – a large bed fund (12.27 per thousand inhabitants compared to 8.8 in Ukraine or 3 in the USA). This indicates the great efficiency of doctors in the Asian model. At the top, they managed to serve patients on the beds of ordinary hospitals, in urgently constructed temporary clinics and in hostels of large companies. The number of staff has increased thanks to volunteers. A rigorous classification of patients according to their severity has been revealed: only one in 10 patients needs a bed in a hospital with complete equipment. Patients of moderate severity were isolated in “medical homes” where, for 200 patients, there were only 10 “units” of medical personnel. The effectiveness of such a model in the event of a pandemic must be studied – it is possible to prepare “preserved” buildings with a certain medical infrastructure so that they can be deployed in an emergency due to an epidemic ” says Aristov.
Speaking on how to influence the situation urgently, the expert said that in certain regions of Ukraine, there is already a mobilization of doctors from other institutions to those who are identified as supporting during the epidemic of coronavirus. “Doctors are redirected to COVID-19 treatment centers for a week, where they work and live. And then they are placed in a sanatorium or an inn for observation for two weeks. But we have to take into account that generally doctors, in addition to working in public institutions, have a private practice in order to survive in one way or another under conditions of underfunding of the industry. Therefore, being under observation, they lose their basic earnings. Therefore, the mobilization of staff should take into account the peculiarities of the work of doctors in Ukraine – they should receive decent monetary compensation, which will be calculated not from state supplies, but from real income. Without this, doctors will not be able to provide for their families. The game will simply go on vacation and we will not get the desired staff gain, ”says Aristov.
They should feel it: a doctor is a hero, a doctor is at war
At the height of the epidemic, it is worthwhile to mobilize interns and medical students: for a significant part of the work in an epidemic, you do not need a high specialization. “There are also doctors who have left medical practice to work in the private sector and often – not in their specialty,” adds Vadim Aristov. – It is also a reserve of personnel who can be called as a military doctor.
But to mobilize doctors in a realistic way and not “on paper”, it is not necessary to force, but to create a system of thoughtful cooperation. Give them the appropriate prestige in society, communicate in partnership: this, they say, was done by the State, and we cannot do it without your participation. If we want people to enter the crucible of an epidemic, we need it to resemble the campaign of a hero in wartime, not slavery.
And of course, it is necessary that the state and society assume part of the efforts of the mobilized – training, provision of protective equipment, but also financial protection – for example, interest-free loans or food rations for children and the parents. “
Looking to the future, Mr. Aristov predicts that after a global pandemic, the preparation of task forces will begin to respond instantly to the challenges of new threats. “Doctors will receive additional specialization in order to be ready to be thrown as an assault at the scene of the epidemic. They will have additional skills as an anesthesiologist or an infectious disease specialist. Additional specialization, of course, should be rewarded by the state, but it is certain that its citizens will receive medical care in the event of a new pandemic, ”notes the expert.
Julia Gorban, Kiev
According to the materials: ukrinform.ru