“We are used to contact with the suffering of patients and the families ”, affirmed the doctor Jorgelina Guyon, head of the Intensive Therapy Unit of the Leben Salud Image Clinic and representative of SATI Comahue Filial. She, like many other professionals, is at the forefront of this battle against coronavirus. With urgency, commitment, monitoring and follow-up, they attend to patients with Covid within this health effector.
“We have learned not to underestimate this pandemic”, affirmed to LMNeuquén this 40-year-old woman who was trained in a public hospital in the province of Mendoza and arrived in Neuquén ten years ago.
The therapy at this health center has the capacity for the hospitalization of eleven patients who require a respirator. “Today we have four Covid patients who require a respirator and others are being monitored without a respirator, but at any time they may need it,” he explained.
He stressed that both the respirator and the human resource in the intensive care “They are the main turning point” in patient care.
The intensive care training lasts four years where the professional acquires the experience and knowledge to use highly sophisticated equipment that allows stabilizing and monitoring a critically ill patient until his illness is resolved. “The lungs affected by Covid are among the most difficult to ventilate, it is not like in other pathologies that ventilatory support is needed in a standardized way. The misuse or improper use of a respirator can cause more harm than the patient with the disease already has“, Held.
For the specialist, at the beginning of the pandemic the intensivists, as well as all the health workers, the first feeling they had was of fear and anger. “You wonder why I chose this, why am I in this situation. Also, all activities of daily life are limited by totally different action protocols, both for eating, for changing, for bathing, and that generated a lot of stress. The fear that one will get sick and be a serious case, even though we are young people, ”said Guyon.
The Covid put all health professionals to the test, which is why they prepared to have no margins of error. “We have put a lot of energy into learning about this disease, be it from how to dress, how to use the protocols and adjust to the change of treatments, initially we had to use antivirals and hydroxychloroquine, and now we don’t. The learning and training has given us more confidence to assist these patients. Before we would take half an hour to get dressed and in that time a patient can die ”, he described. Despite the confidence, he confessed that he feels physical and mental fatigue and exhaustion: “We know that the worst has not yet come.”
Fear appears when thinking that the contagion can be transferred to family members and, on the other hand, the fear of infecting the patient who is hospitalized for another non-Covid pathology and the co-worker with whom they are in close contact because they cannot maintain the distances. “With the advance of the pandemic, this fear has been transformed into awareness and changes in work habits and in our lives. We are committed to the task”, He assured.
He assured that the institution where he works made a significant investment in personal protective equipment because “It is essential that among the staff we do not get infected because we have no replacement; nurses, kinesiologists, therapists have no replacement in intensive care, and a drop in staff means that the other is overloaded with work and when that happens serious mistakes can be made ”. That is why he stressed that one of the lessons that this pandemic has left them is “to value ourselves as essential personnel and to take care of each other; no one would think of getting together with other people outside the workplace because that would mean a risk with oneself and with their coworkers ”.
The uncertainty hovers around the health teams because it is not known when this will end, if the peak of infections will arrive or not. This creates additional anxiety that professionals are not used to. “We have seen health personnel with Covid, young people without risk factors, but who are serious cases. One empathizes with that situation because we start to think that it could be any of us ”, he commented.
Guyon noted that Covid patients take a long time to recover. “At present, in intensive care there are two patients hospitalized for 45 days. They were very serious, they came out of the disease and are recovering. For 45 days we had two respirators occupied. Yes, for example I have 11 respirators occupied and one enters More patient who requires it, I cannot give him what he needs and that patient can be any of us, ”he stressed.
Perhaps the most difficult thing for therapists to face when they leave their workplace, is that other reality that they can see on the streets: people without masks, without complying with social distancing or finding out about the infections that have been caused by meetings or gatherings that are not allowed. “I can understand that my friends say that they are fed up with the quarantine or my mother that she wants to visit her grandchildren. What happens is that The experiences of other countries that have not quarantined have had a great impact on both their economy and the health of their population. And that is reflected in the large number of deaths in the United States and Brazil.”Explained the head of the ICU of the Leben Salud Image Clinic.
A patient entering intensive care has a reversible disease or condition, and staff training goes hand in hand with the results, Guyon described. “Mortality decreases dramatically when there are specialists in the sector,” he added. “The only satisfaction that staff working in intensive care have is to see that a patient who was about to die returns home with his family as if nothing had happened,” he concluded.
Planning and social awareness
Given the increase in infections that have occurred in recent weeks in the city of Neuquén as well as in other towns in the province, Jorgelina Guyon, head of the Intensive Therapy Unit of the Leben Salud Image Clinic, considered that it is necessary analyze another proposal to face this situation.
He pointed out that in the metropolitan area of Neuquén “we have 110 beds, of which 45 are occupied by COVID patients, representing 43 percent, which is why hospitalization in mechanical ventilation due to Covid prevails.” He exemplified that the level of contagion in two days was almost 100 people, “of that number of infected, 5 percent will be requiring mechanical respiratory assistance, so they will use respirators for at least fourteen days (in Neuquén there are on average 23 days on respirator). Obviously, if this contagion curve continues, respirators will be missing and the system will collapse ”.
He considered that the health authorities of the province of Neuquén “have carried out a very good management taking advantage of the resource, but there is no planning that works without the collaboration and awareness of the community.”
Training, a pending account
When this ends, commented Jorgelina Guyon, it will be time to analyze the situation of the lack of medical therapists. According to data from the Patagonian Regional of the Argentine Society of Intensive Care, the 43 intensive care units have very heterogeneous realities. “Most are fortunate to have at least one specialist doctor coordinating patient care, 30 percent of therapies do not have all their specialized staff, 60 percent are privately managed and 70 percent do not have residents (that is, to say that they will not train new specialists). This last one is a tendency since 50 percent of the positions of residences for training intensivists remain vacant throughout the country. It is a specialty in extinction, “he explained.