Fabiola Cárdenas, the spokesperson for the staff of the San Miguel Arcángel Hospital (Hisma), exposes the heartbreaking situation they experience in the absence of payments, protective equipment and supplies. Exhaustion, stress, terror and helplessness.
How dramatic is the lack of protective equipment for Hisma staff?
Very dramatic. Every day we have to see how we get through the day. And every day the challenge is greater. We no longer have surgical gowns, gloves, hats, or shoes. They only got a few for the operating room. Not even for emergencies.
Who should order these kits?
The coordinators of each service make a weekly request to the Warehouse, but there are too many obstacles in our way. Orders take up to two months. And every day we need more supplies, because all the patients are suspected to carry the virus.
Have those processes been streamlined by the pandemic, taking into account that this is a state of emergency?
No. In fact, they added another procedure, which is the approval of the Directorate for the Provision of Health Services. Without that, purchases are not made. And that step alone takes up to a month. The order goes from Warehouse, through Administration, Medical Management and Purchases, to the Minsa
; then back to the Hospital Budget, up to Panama Compra. It is expected that there will be several bidders who have a technical file, health record, and so on ... The cheapest one wins. They wait 3 days to see, if anybody complains. Then the process is for the hospital to request for an endorsement from the Comptroller's Office, where they also ask for remedies. After 10 days, they deliver to us.
The cheapest? Don't they look at quality?
In theory. I have had to return supplies for poor quality.
You say that the countersignature of the Comptroller is mandatory. How does it feel that the modular hospital has been opened without endorsement?
No comment. We were hoping that that hospital would give us a break, and it didn't happen.
Do they use protective equipment per patient, as it should be, or when there is a shortage do they have to re-use them?
We are wearing the mask and gown all day. While it is true that there is no proof that the virus doesn't stick to clothing, we could be touching contaminated patients and contaminate ourselves and other patients.
Has that already happened to you?
We do not know how exactly the virus has spread, but we always have the doubt.
In this regard, Minister Luis Francisco Sucre shoots the ball at the medical director of each hospital. It is right?
He says we have all the supplies. But the medical director knows that the shortage is increasing.
And then why doesn't he come out and say it?
Where does Sucre get that Hisma has inputs?
Supposedly, they allocated a budget to defray the expenses of each hospital. Supposedly. The two million that they allocated to purchase supplies in the Hisma were used to pay for purchases at the central level of the Minsa
, regardless of our needs.
What do you buy?
I don't know, but they spent millions.
So, Sucre knows that you have no supplies ...?
Yes. He says there is, but little, and it's true that we cannot say that we don't have any. There are personnel who can not fully protect themselves, because they we are short [with supplies]...
How do they manage it?
Since day 1 we have received donations. Without that we could not operate. In addition, we have bought our own equipment.
As for supplies, do you have everything to treat patients with?
We do not have trays or spinal needles. We have borrowed them from Santo Tomás and Oncológico, because the purchase process takes more than a month and a half. We also lack laboratory reagents, among them, rapid tests to detect virus antigens in order to separate the positive from the negative patients.
What do they tell you about it?
They are coming. When I do not know.
At this time, how are the doctors' shifts?
We are doing uninterrupted 12 or 24 hour shifts; We work weekends and holidays, and we cover for the elderly staff, who are in the risk group and cannot work.
What is the danger of that?
We are exhausted and under a lot of stress.
How many people die per day from Covid-19 in Hisma?
Some days, nobody. Other days, up to six.
How many Covid-19 patients do you see at the hospital?
We receive 30 to 50 patients per day. Of those, 75% are hospitalized.
Is Hisma saturated?
Yes, already for three weeks. Sometimes a bed or two is vacated, because the patient dies or is discharged.
How do you deal with new patients?
The patients have to wait long hours on stretchers or chairs, to see if a bed is vacated or we transfer them to other hospitals, already saturated too.
How does a doctor cope with this, whose job it is to save lives?
We are very frustrated. We do not see the end: there are more and more patients. We are afraid of having to decide who lives and who does not. Who deserves a ventilator and who doesn't. We did not think that there would be so many cases. And we thought there would be a better system preparation.
Among the staff, how many positives have there been?
110 and one dead.
What percentage is that of the total staff?
Hisma serves patients with and without Covid. Are the staff who serve them the same?
Yes. More people were hired, but the same staff attend to everything.
Isn't there a risk that the entire hospital will end up getting infected?
Of course. We wash ourselves and change clothes after seeing each patient, but it's still a risk.
What staff are you missing?
We need stretcher bearers, because there are times that there is only one on duty in the entire hospital. The hospital stops. It becomes a mess. We also need nursing technicians, nurses, radiology technologists, laboratory workers, and laboratory assistants. And general practitioners for the emergency room. There are shifts that have to come to cover doctors from other hospitals. We are exhausted.
Why does Hisma have no Occupational Health and why is that vital?
They did not contemplate it when they created the hospital. We do not have a doctor who takes control of our health.
How do they do it?
We must go to the ER, like the rest of the patients, or to a private clinic.
What are the two most dramatic things doctors experience while attending Covid patients?
Patients die in our hands, even if we try to save them. And the fear of infecting others and ourselves. I have not seen my family since February. Nine of my colleagues have died.
Are patients dying of Covid or lack of timely care?
Due to complications. We are still giving them the attention they deserve.
What important things have you noticed in the patients?
The most difficult, is to get an obese person into the tube. There is no predominant age: we have seen patients in their twenties die. And every time we perform a surgery of a patient who has tested positive; they have a 30% chance of dying.
What would you say are the three most critical areas?
Deliveries, Emergencies and Operations.
Sucre said he appointed them as staff, but that they quit out of nowhere. Why did they resign?
Perhaps because the salary is lower than in other hospitals. Or because of overtime.
What have the authorities done about what you report?
Absolutely nothing. We have made 10 peaceful protests and have not received a single call.
Not even from the medical director?
This is not in the hands of the medical director. The is all about Minsa
You report lack of payments. First, how much staff do they owe?
85% of us are owed something.
What do they owe you?
Approvals, bonuses, etc ... and we have not been paid the last four months of extra shifts.
What do they say?
They say that rectifications and calculation of income tax ... MEF staff telework: there is no justification for this wait. Also, this should be automatic, and every month we have to be calling and pressing. We work and we have to beg to get paid.
How do you feel that, on the other hand, officials continue to get their salaries, even without working, from their homes?
It's frustrating. We are exposing our lives and they don't pay us.
Is this situation same in other hospitals, or is it only in Hisma?
It is the same in many hospitals.
Hisma has one of the two Sicarelle laundries, which does not pay for water and electricity, but does charge for service to the State. What do you think about that?
I prefer not to comment.
Do you feel at ease with Sucre or Rosario Turner?
It doesn't matter who it is, we only ask for answers.
Do you trust the new advisory team?
Three weeks have passed and we have no response. I don't know what they are advising on.
And, in the previous committee?
They also gave no answers.
What has been, according to you, the greatest failure in handling the Covid-19 in Panama?
Having not done an absolute and more vigorous initial quarantine. The positives were not followed up in a timely manner, and the blocks were opened too quickly. This has already gotten out of control.
Can you give three tips to the president?
Do not let yourself be carried away by economic pressures, stop giving speeches full of empty verbiage and focus on the health sector and on social aid, because we are in debt for who knows how many generations, and there are no answers. Get rid of the current health policy.
Fabiola Cárdenas' Profile
Medical specialist in anesthesiology and resuscitation. Coordinates the Anesthesiology Service of the San Miguel Arcángel Hospital; She is a spokesperson for the health personnel of San Miguel Arcángel Hospital (Hisma) and an Operation Smile volunteer.