“The government decided that it had spent a lot of money on doctors.” The situation in Russian hospitals is getting worse. We talked to doctors who could not stand it – and quit their jobs at government clinics.

Pavel Golovkin / AP / Scanpix / LETA

Almost every day in Russia, new records are recorded for the incidence of coronavirus or mortality from it. The total number of infected has already exceeded one and a half million – but it seems that the second wave is only gaining momentum. Against this background, the situation in Russian hospitals is getting worse: doctors complain about the shortage of places in hospitals and other problems. One of the main problems in the regions is the lack of staff; many doctors cannot withstand the burden of the pandemic and are quitting. Meduza spoke with doctors who left state clinics.The names of the medics interviewed have been changed for security reasons.

Artem

hospital doctor, St. Petersburg

I worked in the hospital from mid-April to early October, got a job in the rehabilitation department as a therapist and cardiologist. Then we were just getting ready for re-profiling. Coronavirus tests were just beginning, and almost no one was diagnosed with [COVID-19]. Many patients were even discharged, although by all indications they had the virus. A week later [after I went to work], doctors in the therapy department began to fall ill. Due to the lack of staff, I went there to close questions.

We worked in the coronavirus hospital mode for three months. The doctors got sick every week. On April 25, I also felt unwell and called my work. I was offered to come to my place [to the hospital] and have a CT scan. Many colleagues had already gathered there – my CT scan was clean, and everyone but me was hospitalized. I was conditionally congratulated and wished good luck – after all, I was the only therapist at the department. But I felt bad, and I went on a two-week sick leave. I returned, worked for two weeks – and fell ill again. The second time the disease was more severe and with pneumonia. For four days I lay in my department, and then I went home. Several times I passed tests for covid – the results did not come at all, sometimes negative. Only an antibody test confirmed that I had had a coronavirus infection. 

During the first wave, some of the doctors were very sick, relatives of our medical staff were dying. At the beginning of the second wave, my colleague died. Friends of friends, familiar colleagues in other hospitals were killed. But there could be no decadent spirit. We understood that there were risks, but we had to work. Although some tried to take less risks and set themselves fewer shifts.

The patients died every day. These were mainly diabetics and people with severe chronic diseases. But sometimes they were also young people – patients who did not cause fear at all. Unfortunately, nothing can be done about it. It remains to accept and go to treat others. If I covered my head with ashes, I would not be able to work. It saved me that after the shift there was no strength to think. 

I remember the strong irritation when in the summer we were supplied with low-quality Russian PPE made of cellophane. But there were also good points – cafes and restaurants supplied food. It was nice that they think of us. During the shift, the doctors had one opportunity to go to the toilet and eat. We did everything quickly and replaced each other, but sometimes we asked each other out of turn: we really wanted to go to the toilet and could not stand the strength.

Our bosses isolated themselves [and did not appear in the hospital]. Most of them received medals later, but they didn’t even have antibodies. These people took part in the fight against coronavirus only on paper. 

The saddest thing is that the managers did not take into account the spring experience. In April there was a paramilitary situation – they did not know how to resolve issues. Then experience appeared, but fatal mistakes were made. At the end of July we became a clean zone again, but in August a patient was admitted who infected the entire department. All planned patients who were recovering from strokes and severe operations were urgently transported to the infectious diseases department. Rospotrebnadzor issued a fine to the manager. He was accused of not transferring patients to the infectious diseases department on time. Although the authorities from above gave him a verbal order not to do this.

After this infection, they decided to make an observation of us, where they brought all suspicious patients. Doctors did not receive PPE – because we do not have a “red zone”, and in general “most of the employees were already sick, why do you need PPE?” The management asked to be patient. The number of patients not of our profile increased, intensive care units were brought in.

The nachmed began to actively scare that Rospotrebnadzor would fine for any mistakes. Then I wrote an application and left – now I’m going through interviews at a private clinic. In hospitals, a madhouse. I decided I didn’t want to participate in this. I am not a resuscitator, and it is risky to work in this mode. Some of the colleagues also want to quit, but cannot. They just have nowhere to go. Some have mortgages, small children. And what to do even without such work, they do not know.

I did everything right: I don’t want to work in conditions where my rights are violated. If I am mobilized on the agenda, I will go to work without question and for free. But we live in a civilized state, the approaches must be civilized. Feelings that I betrayed someone, no. You can approach from an ideological point of view, but now the situation is not the same – not in wartime, an emergency situation has not been declared, formally ordinary life is going on. I remember how in the summer I left the hospital at four in the morning to get some air – and people go to bars, life goes on as usual. It was a little annoying.

People didn’t believe the coronavirus existed. As if the doctors had thought of everything. And now it’s a strange feeling that there was no summer in 2020. Was it there? Probably it was. I only remember that it all started in the spring, and now it’s autumn.  

WHAT’S HAPPENING IN HOSPITALS NOW

Valeria

local doctor, Arkhangelsk

Before the coronavirus, I [studied and] worked as a part-time district doctor in a polyclinic at Arkhangelsk City Clinical Hospital No. 6. When the pandemic began, the university sent us to distance learning and offered to switch to full-time in the polyclinic – there were already not enough doctors. The HR department approved the transfer, and then hell began. 

We were given only one pair of gloves and one respirator for calls – there was not even a disposable gown and hat. A month later I was asked where the respirator was. I had already thrown it out then, but I was told that it is not disposable and I will walk in it as long as it should. I was ready to walk in it – but not a month, let alone three. On one of the calls, an angry woman met me with the words: “I said 10 times at the reception that I had a positive smear. Why are you being sent naked to me? “

There was only one car in the clinic – it went to the lucky one. The rest made their rounds on foot. In peacetime, we went around several neighboring houses, and now – the whole area. I received 30 calls, but did not have time to bypass more than 20. If I did not have time to bypass all the calls, I wrote to the manager about it. He fined, and distributed calls between other doctors. And in the evening, you still need to draw up maps and directions for strokes. Sometimes you go after seven hours of calls to the polyclinic to fill out the documentation, you come up without feeling your legs, and a call comes from the registry: “We still need to serve a call, the temperature is very high.” And you again return on foot to the other end of the district, where they do not open the door for you, and the next day you receive a complaint that the doctor did not come.

The hardest part was with the strict rules that limited the taking of smears – they were done by nurses, not district doctors. And when I came to a young man, and he was gasping for breath, was in a panic and did not understand what to do, I called an ambulance. But you cannot be hospitalized until there is a smear, because the ambulance does not know where to take – to a clean or covid ward. This has happened many times. And you stand over a choking person and say that he has no evidence. They don’t take him away, he is afraid to sleep. But when you work a lot, you can’t really think about all this.

MANY DOCTORS COMPLAIN ABOUT THIS.

The main difficulties during the work in the pandemic were with the administration. The bosses ceased to be bosses, they became Cerberus – and there was no talk of support. At first, I was not paid any allowances [for working with covid]. My colleague called the ministry with this question – they were approved for us. But because of the allowances, the salary was reduced – [more] we did not receive bonuses and incentives. When I worked part-time, I was paid 30 thousand. At the full rate, she received the same 30 – all because of the allowances. If you don’t like something, the conversation is short: “If you don’t like it, leave. This is your job, you learned from it. ” 

In July, I was supposed to have a planned vacation. I reported this to the manager, but they did not let me go, saying that I would work to the limit until the coronavirus ended. I called the labor inspectorate. After that, the manager began to write SMS with threats that I would not get out of calls and would work for days. Then I decided to quit. Why do I need this? No amount of money is worth such nerves.

It was a great relief when I quit. I’m tired of fighting everyone. I didn’t think how the rest of the doctors would cope there. If there was support from the administration, I would stay. But she was not there.

Now I am studying in residency. I used to think that I would continue to work in this clinic – it is close to home. Now definitely not. When I first got a job, I was inspired, the first six months I worked with joy. Then I was shaking with anger and fatigue. I do not regret leaving at all. When I left, there was a shortage of doctors. The attitude of the authorities is so bad that in the end, all the doctors with whom I spoke, left this clinic. Almost everyone who works there [now] is residents. Doctors cannot cope, patients complain about it. And the complaints are well-founded, since people wait for doctors for several days.

Stanislav Krasilnikov / TASS / Scanpix / LETA

Vyacheslav

nurse, Moscow

I study at Sechenov University. From mid-April to the end of June, he worked as a nurse in the infectious diseases department at the University Clinical Hospital No. 1. After retraining, the hospital consisted of intensive care units and departments where coronavirus was treated, although it was originally a multidisciplinary clinic with many different departments. My parents were radically opposed to me working. The coronavirus still scares them – it is not clear, not researched, there are no drugs, objectively speaking. 

The division into zones was more formal. “Red” – intensive care, “yellow” – a hospital with 70 beds. All doors were open, the wards were not isolated. Because of this, in the “yellow zone” the viral load was transmitted even in a higher titer than in intensive care. Patients with confirmed coronavirus infection and pneumonia lay mixed.

Everyone in the state has been ill. I think that in all hospitals, 90 percent of doctors have had or are sick right now. Our employees collapsed every day. The more it took, the more load was on the rest. Of course, it crushes: day after day you see people fading away. Medics in age are especially scared when they see themselves diagnosed with coronavirus infection. But then everyone returns to work: no one but you will do it.

If a [working] student fell ill, then he was not given a sick leave – he was immediately fired, because the students signed a fixed-term contract only for a couple of months. Therefore, I did not say when I fell ill: it was not too bad for me to leave. For five to seven days the temperature was 37-38 degrees. I showered with paracetamol and went to work. Although we measured the temperature at the entrance, I have never seen a non-contact thermometer show it correctly. Even if a person from the street has a temperature of 37-38 degrees, the thermometer will show 35-36. We compared this thermometer with mercury and electronic – in 90% of cases, the non-contact shows the temperature much lower. But they are used because they save time. 

It was painful to look at severe patients – how quickly they died away. They could hold on for a long time, lie with a temperature, their bodies fought – but then in one or two days they burned out. First, a person was transferred to intensive care, and there he usually died. During my work, five patients died. We talked, I tried to cheer them up, but the therapy did not bring the desired effect. Death always surrounds doctors, it is part of the job. If you react sharply, you can burn out and stop working normally. Some of my colleagues are mentally depressed now. But from time to time it happens to everyone. 

ABOUT THE TREATMENT OF CORONAVIRUS

In June, we got a stopcock on [new patients]. We completed the treatment of patients, the department was closed, and I quit. Since mid-September I have been working in an ambulance – and at the same time I am a fifth year student of the medical faculty. There is a lack of solidarity from teachers. In each group, 30% of people work with coronavirus, but there is no relief for us. The teachers are skeptical, say something from the series: “Everyone goes there for the money, and you need to study.” For them, working during covid is associated with commercialism. These people do not come into contact with the coronavirus infection – and condemn those who work. It’s pointless to argue with them.

In the ambulance, we [now] sew up. There can be up to 17 calls in a daily shift, more than half are covid. In addition to the coronavirus, there are other challenges: blood pressure, fractures, a lot of alcoholics and hypochondriacs. The beds are bad. According to colleagues, beds with people are placed in the corridors. Nowhere else.

WHAT’S HAPPENING IN MOSCOW HOSPITALS

After the first wave, the government decided that it had spent a lot of money on doctors. PPE, food, housing – all this was in the first wave. During the second wave, I did not hear from my colleagues that they were given benefits. There are only payments left, because of which all kinds of checks have now been launched. They are looking for ways to impose sanctions and not pay incentive payments to medical staff. And so the load from above is added to the large workload – someone has a finger on the pulse there. 

If you ask almost any doctor – only if he is not a hypocrite or he is not a doctor in the tenth generation – then every doctor [now] thinks about giving up his business. You look at our healthcare system, at how doctors live abroad – everything becomes clear. But a person has a higher need to get moral satisfaction from work. And when you see the result of work and gratitude, your soul becomes warm.

Rasul

hospital doctor, Zelenograd

In January, disturbances began in our hospital. I have 12 years of medical work [ENT], but they started to pay my salary as a student. I endured for three months, and then [began] covid.

We only worked for emergency hospitalization, which is why the hospital decided that our workload was reduced. They wanted to send the ENT service additionally to the polyclinic – to walk on covid patients. No additional payment was promised. I learned about the conditions from another doctor: in the clinic they give one suit, the doctor sculpts it with duct tape and walks like that all day. There are 30-40 calls per day. I refused, saying that it would be better to work in Kommunarka, to receive PPE and allowances and control over my work. The deputy chief physician got up and left at these words.

We contacted patients, worked in intensive care, performed operations on patients with bilateral pneumonia. Or, for example, a patient presented with abdominal pain. They called a surgeon, did an ultrasound, the patient walked around the entire emergency department. Then he was transferred to a hospital, where a smear was taken. Three days later, a positive response came – and the patient was urgently transported to observation. So our whole department got sick. 

It was scary. Every day the department had one or two fewer doctors and nurses. Some of the [sick] colleagues were at home, some were in intensive care. A young colleague who switched to 0.25 stakes in order not to leave completely died – and died.

You look at all this and imagine that tomorrow you will be lying with pneumonia yourself. I understood that if you get sick, then it will be like luck: in a mild form, in a severe one, or you will die. Nobody knows.

It was scary, but from a medical point of view, it was impossible to isolate oneself. There is a sense of duty, it leads: you need to come, help, you need to save, work out, make it easier for patients to progress the disease. I thought about leaving medicine after [another] difficult emotional day and stress. But I like helping and healing people. Simply healing is the most wonderful job. 

If only there were no inspectors and administration. [At some point] the administration told us that we are not officially working with coronavirus infection, so there will be no payments. I say: “If there is no covid in the hospital, then why is everyone sick? Do I have to die to get paid? ” They refused anyway.

I wrote a complaint to Gosuslug. The next day I was called to the head physician. They repeated once again that payments were not due. I asked for an official answer, after which I wrote to the prosecutor’s office, the president and the Ministry of Health. After that, the administration called with threats: “If you do not take the memorandums, we will open a criminal case against you.”

The next day, the head of the intensive care unit was forced to write a denunciation against me – that I had not come for a consultation. They decided to conduct an official check on the failure to provide medical care, they wanted to hang a criminal case, they called me to the carpet, and started asking questions. When I said that they would communicate with my lawyers, it became quiet. They could not hang the case because it was not there. By that time, I had already written a letter of resignation. The administration wanted to dismiss me under the article, but I brought in a lawyer – and the hospital signed everything of their own free will. 

The most unpleasant thing is that the betrayal is on the part of the administration, they put pressure on us. We, colleagues, understand each other. Therefore, when someone leaves, everyone knows that, most likely, better conditions were found and one must wish them success. In hospitals and clinics, poor working conditions, low wages, constant pressure from the administration. Doctors are fired because of this, and the workload is distributed among the remaining staff. Someone does not cope psychologically. A familiar young therapist went to work in Kommunarka, and then decided to leave medicine. I wanted to help in finding a job – but I see there is emptiness in his eyes. Says: “That’s it, I can’t, I’m dry.”

After my dismissal, I immediately got a job in a private clinic – they pay more, the schedule was adjusted for me. In November my wife and I will move to Dagestan. My mother lives there – she is alone, she has already had a coronavirus. There is a republican hospital in Makhachkala, a huge department, 90 beds. The department takes care of most of the critically ill patients from the district hospitals. I’m going there for an interview. I want to work in my profession in a hospital. I think it will be better to work at home than here. Despite the fact that the number of patients there exceeds the number of patients in the metropolis.

(c)MEDUZA 2020

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