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November 5, 2021 Special Dispatch No. 9628

As Covid Surges, Russia's Healthcare Is At The Breaking Point

November 5, 2021
Russia | Special Dispatch No. 9628

In the fight against COVID, the Ministry of Defense has an important role. On Putin's orders, military doctors are being dispatched to the most Covid-afflicted areas. [1] This includes both areas in the periphery as well as the Moscow region. More than 220 specialists from St. Petersburg's S.M. Kirov Military Medical Academy are headed to the Moscow region to help fight COVID-19. [2] Involving the military in the fight against Covid is not unique to Russia, but it is definitely a response to the worsening statistics of Covid-related deaths and newly confirmed cases that hit record levels.[3]

Another possible reason for bringing in the military is the exhaustion of Russian medical workers. Natalia Kostarnova of Kommersant, in an article titled "Healthcare Calls for Help" that was picked up by many other news outlets, describes an overburdened health care system that has difficulty coping with the Delta variant outbreak. In the article, there is clearly a divergence of opinion between rank and file medical workers and officialdom. The former sound the alarm; the latter claim that the situation is under control and the doctors are getting all the help they need.

Kostarnova's article follows below:[4]


Doctors in a Russian Covid ward (Source: Vedomosti.ru)

"According to a survey conducted by the team of the 'Physician's Guide' mobile app, that is popular among doctors, Russian medics, working through the second year of the COVID-19 epidemic, face psychological burnout. Almost 30% of medical specialists, who work at first-hand with patients infected with the coronavirus are close to leave their jobs due to fatigue, while amongst 37% of the doctors, health problems have arisen due to emotional exhaustion.

"Doctors believe that public attitudes toward them have changed drastically in comparison with the start of the pandemic: people got used the doctors working in constant insanity, they are no longer considered to be heroes, and their work under the hardest conditions of the 'red zones' is taken for granted. The respondents themselves admitted that fatigue and emotional burnout have a negative impact on their attitude toward patients.

"Hospital managers and officials told Kommersant that doctors are 'provided with everything they need,' while the insufficient vaccination rate and the unwillingness of some Russians to get vaccinated, among other things, contribute to the relentless nature of the emergency situation in which the doctors labor.

"The team behind the 'Physician's Guide' app (a popular service for medical professionals, which optimizes the work of specialists and helps them make clinical decisions; the app unites more than 915,000 users) conducted a survey among medical professionals regarding their psychological wellbeing during the pandemic. A total of 2,822 respondents participated in the study, 90% of whom are physicians. 611 participants at the time of the survey worked directly in the 'red zone'.

"Among doctors and nurses, who work in COVID-19-designated hospitals and departments, only 12.6% are still 'full of energy' and 'go to work with interest.' 58.1% of respondents replied that they 'go to work with interest, but generally feel tired,' while 29.3% stated that they 'go  to work without interest. 'Doctors, who work in routine operations provided similar answers: 59.4% of them feel 'generally tired,' while 23.1% 'come to work without interest.'

"Nevertheless, over 90% of respondents in the first group and 84% of respondents in the second group admitted that in informal conversations colleagues often complain to each other about fatigue. 37% of physicians in both groups had experienced health problems during the pandemic as a result of emotional exhaustion. 27.7% of medics, who work in the 'red zones' and 31.9% of nurses assisting them 'often think about quitting,' or 'are on the verge of quitting' due to fatigue and overwork. Among the specialists working in 'green zones,' 25.2% of doctors and 17.2% of nurses are ready to quit.

"Meanwhile, 68.3% of health workers in the 'red zones' admitted that the [hospital] management frequently replies to their complaints 'If you don't like it, then quit.' Nearly 42% of the doctors in this group stated that their supervisors don't support them financially or emotionally.

"50.5% of their colleagues working in the 'green zones' don't feel support from their bosses, while 68.4% of respondents from this group also heard the suggestion to resign, if they did not like something.

"Virtually all of the physicians polled (over 90%) believe that their fatigue was affecting or had already affected the patients. For instance, 22.9% of those who work with coronavirus patients and 18.9% of their colleagues in other spheres of healthcare feel 'exhausted and have become more callous towards the patients.'

"8.4% and 7.4% of doctors [working in red and green zones] respectively, 'no longer empathize with patients.' According to the survey participants, improved work conditions could help cope with fatigue and burnout, for instance:  'doctors lounges for resident physicians,' 'an opportunity to eat comfortably and rest during breaks' (such answers were provided by 74.5% of physicians working in the 'red zones' and by 68% medics working in the 'green zones'); 'a decrease in the workload' (69.7% and 69.8% of doctors working in red and green zones respectively gave this answer); 'an increase in public respect for the [medical] profession' and 'thank-you posters, articles and stories' about physicians (54.8% and 51.2% of doctors working in red and green zones respectively gave this answer).

"Kommersant discussed the results of the survey with a nurse from a COVID-19-designated hospital in Moscow, who transferred to a work in the 'red zone' from a regional hospital after the start of the pandemic.

"According to the nurse, over the past 2 years physicians have become extremely tired due to the large volume of work, 'a bed in the hospital stays empty for a maximum of 2 hours while it's being processed following the patient's discharge,' and due to tough working conditions. For instance, there're shifts when you have to work without taking off the protective suit.

"According to Kommersant's informant, the medical staff are most upset by 'management's indifference.' The nurse stressed that in response to any personnel's complaints, the hospital management reminds them that the doctors themselves made the decision to 'come and earn money.' (The nurse refers to the premiums paid to the staff of COVID-19-designated hospitals - Kommersant).

"Public attitudes have also changed. 'At the beginning of the pandemic people thanked us, called us heroes, sent food from restaurants, we felt needed. Now we don't have that feeling anymore,' said the nurse.

"The founder of the 'Physician's Guide' mobile app, Konstantin Khomanov believes that society and officials need to acknowledge the fact that medical and nursing personnel are burned by pandemic conditions. Without this realization, it will simply be impossible to maintain the effectiveness of healthcare. Mr. Khomanov expects that the survey data will be used to develop 'measures to relieve stress in working conditions ' for medical personnel.

"Psychologist and medical communication expert, Anna Khasina noted that certain support measures have been instituted at the start of the pandemic. Back then many psychological assistance programs for medics appeared –public and private, paid or charitable.

"For instance, in May of 2020, the Ministry of Health set up a special hotline. At that time, according to Ms. Khasina, such assistance was not in demand. The psychologist argued that it was partially due to 'a culture of stoicism' and partly due to the stigmatization of psychological help in Russia.

"The expert believes that during the pandemic, those doctors, who even before felt unhappy, unwanted and unfulfilled in the professional field, were particularly affected. However, those who at first were able to deal with stress relatively successfully have lost at least part of their [mental] resilience in the last two years.

"The chairman of the interregional 'Deystvie' trade union ['Action'], Andrei Konoval agrees with the statement that the pandemic has aggravated problems that were already evident. For instance, even prior to the pandemic, some doctors felt that their profession isn't prestigious, that salaries are insufficient, while patients and the hospitals' management tended to demonstrate indifference.

"Mr. Konoval believes that a fear of criminal prosecution, problems with prescribing proper treatment due to an absence of some necessary medications, and constant overwork to be additional demoralizing factors. He provided data to the effect that on average, Russian doctors work overtime by a third. 'It's not uncommon for a nurse to attend 70 beds instead of the standard 20, or for a surgeon to attend to 1.5 times as many patients as the envisioned standard,' said Konoval.

"The chairman of the Russian Healthcare Workers Trade Union, Anatoly Domnikov acknowledged that the doctors work 'to the limit of their abilities,' however he noted that they feel supported by the state, receive social benefits, and have wider range of insurance guarantees. Domnikov drew attention to the help of medical college and university students, who assist doctors in hospitals, including in the 'red zones,' and volunteers who deliver drugs to those, who cannot leave their homes due to self-isolation.

"'Be that as it may, it's very important for doctors, nurses, paramedics, technical and support staff to return to a normal rhythm of life. We are all able to bring this time closer, if we all start making mature and sound decisions together. This includes responsibility for observing preventive measures and vaccinations,' said Mr. Domnikov.

"Maryana Lysenko, a chief physician of Moscow Municipal Clinical Hospital No. 52, which became one of the first hospitals designated for the treatment of patients with COVID-19, told 'Kommersant' that a year ago they conducted a similar survey among the hospital's employees. Back then the results demonstrated that the dramatic change in the work regime didn't cause serious emotional problems, 'Our staff was sympathetic to the unfolding events and were eager to work shoulder to shoulder in treating patients with the new disease.'

"According to the chief physician, since then doctors have gotten used to the situation [with coronavirus] and, at least, no longer perceive it as working in uncertain conditions. Maryana Lysenko argued that physicians are adequately paid and provided with everything they need, including psychological help. Psychologists work with doctors in Moscow hospitals and reserve hospitals. Special training and programs in both face to face and remote formats have been introduced in order to help medical workers deal with psychological stress difficulties.

"'Our medical staff is most depressed by only one fact, the poor rate of vaccination. Every person treated, every patient connected to the ECMO machine [the extracorporeal membrane oxygenation] or removed from a respirator, has the opportunity to protect himself and his loved ones from death via COVID-19, and foster collective immunity, to open hospitals for routine care and to promote a return to life without serious restrictions. But this is not happening, we are still witnessing a low vaccination rate. It is precisely that sorry state of affairs that exerts the greatest moral pressure on doctors today,' noted Maryana Lysenko.

"In response to Kommersant's inquiry, the Moscow Department of Health also recalled that vaccination is 'the most effective tool to protect the body from coronavirus infection and to reduce the risks of a severe course of the disease. The department stressed that Moscow's medical organizations pay 'special attention' to the vaccination of their employees. The rate of medical workers, who underwent vaccination is about 70%.

"Vladimir Chulanov, Chief Freelance Specialist on infectious diseases of the Ministry of Health of Russia, agrees that at the background of growing COVID-19 cases, doctors face 'extremely difficult' [working conditions]. Chulanov believes that this is due to a skyrocketing rate of new COVID-19 cases and a significant proportion of patients with a severe course of the disease.

"Chulanov emphasized that only the formation of collective immunity will significantly reduce the burden on the entire healthcare system, 'only in this case will medics working in the 'red zones' be able to return to their usual work.'"


Natalya Kostarnova (Source: Kommersant.ru)

 

[1] 1tv.ru, November 3, 2021.

[2] Forpost-sz.ru, November 3, 2021.

[3] Tass.com, November 4, 2021.

[4] Kommersant.ru, November 1, 2021.

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