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Alexander Vitko: we will cope with coronavirus
Minister of Health of the Khabarovsk Territory spoke about the main problems in the treatment of patients with coronavirus in the region
The number of daily recorded cases of coronavirus in the Khabarovsk Territory remains one of the highest in the Far East - about 100 new cases appear per day. At the same time, doctors work on the brink of possibilities, working day and night at the beds of patients. Minister of Health of the Khabarovsk Territory Alexander Vitko spoke about the main problems in the treatment of patients with coronavirus in the region, as well as the prospects in this direction in an interview with EastRussia.
- Alexander Valentinovich, how would you rate the current coronavirus epidemiological situation in the Khabarovsk Territory, how difficult is it?
- I would like to clarify right away that healthcare is an industry that is the liquidator of certain phenomena. Today there is a coronavirus, with the consequences of which doctors are fighting. Fighting a particularly dangerous infection is a reinforced concrete discipline that must be in a certain area where there is a disease and its spread. Everything depends on discipline: on observance of the mask regime and social distancing, on the disinfection of streets and entrances. Coronavirus infection is a highly contagious disease in which one patient can infect four to six people.
All the measures taken are not something new, they have always been used to eliminate various especially dangerous infections. In the middle of the last century, there was an outbreak of cholera on the Volga, in Astrakhan. Then it was possible to quickly eliminate this infection and practically not lose anyone.
Medicine does not set limits, but helps patients who have already suffered. Therefore, our task is to create a bed fund according to a standard that depends on the size of the population - 0,5 beds per thousand population. We did this - we deployed 658 beds according to the standard. Of this fund, 70% are provided with oxygen, of which 50% are provided with artificial lung ventilation devices. In general, the situation is tense, the number of daily registered cases does not fall, and therefore today 1 beds have already been deployed in hospitals of the region, which is 626 times higher than the standard level.
- Many in social networks complain that patients are lying in the corridors, that there are not enough places in hospitals.
- Patients with this infection do not need special conditions, boxed wards. The experience of the whole world shows that beds are deployed in shopping centers and sports complexes. There is nothing wrong with that, the most important thing is that a person who needs inpatient care is not denied help, hospitalized, examined, examined, prescribed treatment, and that he eventually recovers.
The story of the coronavirus has been dragging on for a long time, so you can imagine how hard it is for medical institutions to work today. This is very hard work: people entering the "red zone" work for six hours in protective clothing, glasses and two masks, two sets of gloves. An hour off after a six hour shift, and back into battle.
The work is also complicated by the fact that the disease is new, there are no specific ways of treating it today. The work is being carried out according to the seventh version of the guidelines of the Ministry of Health of Russia. This suggests that the department is responding quickly, and many things change with the study of this infection. We in the Khabarovsk Territory have already gained our experience, because not a single patient is left without the attention of doctors, and every difficult case goes through a consultation, which was created by my order and is conducted under the leadership of the FESMU Rector, Corresponding Member of the Russian Academy of Sciences Konstantin Vyacheslavovich Zhmerenetsky, professor staff, chief specialists of the regional Ministry of Health and the Ministry of Health of Russia.
Also, we have created a commission to analyze each fatal case. And for each serious patient, we consult with Moscow. The special anesthesiology and reanimation center does not refuse us absolutely anything.
The first in the country to take a blow was Kommunarka with its leader Denis Protsenko, the chief anesthesiologist in Moscow. He is our friend and helper. We also consult with the head of the Department of Intensive Care Resuscitation at the Vladimirsky MONIKI, the country's chief pulmonologist, specialists from the Research Institute of Phthisiopulmonology and Infectious Diseases. These are the number one people in the country who are dealing with coronavirus issues, and I do not refuse to help us, day or night. We have developed strong connections and it is difficult to say that in this regard we are missing something.
- Does the Khabarovsk Territory need the help of Moscow doctors now? Will it be needed in the future?
- Indeed, today many Moscow specialists come to the Far East. We do not need the help of the Moscow brigades yet; we train doctors of other specialties for 36 hours. We train doctors of surgical specialties to be resuscitators-anesthesiologists, and doctors of therapeutic specialties - to be infectious disease specialists, pulmonologists. We manage on our own. On the territory of the region there is the Far Eastern Medical University, which this year had the largest graduation in the last 15 years. All the guys who graduated from the institute this year went to work in the infectious diseases hospital. Even my son, who graduated from the second year, works in a covid department in one of the medical institutions in Khabarovsk.
Our councils have acquired a name, so other regions - the Jewish Autonomous Region, Yakutia, Amur Region, Kamchatka, Magadan Region - turn to us for help. We have concluded agreements with many, and we do not refuse help. We took about 20 people from the Amur region to our hospital for treatment, many of these patients have already been discharged with recovery. Our teams and specialists travel to the Jewish Autonomous Region, Yakutia, and Sakhalin.
- What other successes have our doctors achieved during the time when the first cases appeared in the region?
- We have gained some experience. When everything was just beginning, when I, as the head of the regional healthcare, realized that we could not cope on our own, we attracted our most powerful forces - the Far Eastern Medical University. The task was not only to deal with the treatment of patients, but also to accumulate and gain experience. Today we have come to the conclusion that we are creating guidelines for our doctors, taking into account the mechanism of development of this disease and the stages of treatment. We have completely worked out the mechanism of transferring the patient from the outpatient unit to the hospital, worked out all the indications. When they come to us to check our work, and this will happen without fail, we will prepare and do everything so that there are as few claims against us as possible.
- But the residents of the region complain that even at the initial stage of the disease they call an ambulance, and the doctors say that the patients have blown somewhere. They turn to the local therapist, he refuses to come and advises to drink antibiotics. As a result, the disease takes on a complex form. Will such facts be checked, the work of each link?
- Yes, of course, without fail. Once again I want to say that the scheme is the same: if a person is sick, he does not go anywhere - he calls an ambulance or an outpatient clinic. The doctor must determine the condition of the person, make a preliminary diagnosis, prescribe the necessary examination, look at the person in dynamics and continue to deal with it, so as not to waste time and do no harm.
Everyone works according to the scheme, I hold meetings with the chief doctors of the Khabarovsk Territory polyclinics, infectious diseases hospitals, and ambulances. Everyone understands everything perfectly. But the load is really very big, because the population is sick. This week the increase is more than 100 people per day, so you can understand what the burden is on doctors.
The edges of the beds deployed in hospitals are occupied by about 75,0%. There are quite a lot of serious patients today - 55, including those on artificial lung ventilation. Medical workers work around the clock.
- You said that your son works in the department where patients with coronavirus are treated. Has the infection affected your environment, your family? Nobody got infected?
- All healthcare workers are my family. A lot of people from my environment, with whom I directly work, fell ill. These are the main specialists who work daily at the beds of the most difficult patients in intensive care, those who are engaged in various technologies for the treatment of this category of patients. This is a highly contagious disease that affects our compatriots, our colleagues. Frankly, everything is very difficult, and we do not know a lot about this infection. Each of our colleagues counts today, we help to overcome all the difficulties of this disease.
- Have you managed to eliminate the foci of coronavirus in hospitals? Have there been new ones?
- A hospital is a place where infections can occur every day and several times a day. They brought a grandmother or grandfather with a stroke on an emergency basis, started treating or taken to intensive care, and after a day or two it turns out that this patient has COVID 19. Therefore, no hospital is insured against drifts. We understand this, so we try to examine the person upon admission. But, of course, there are cases of skidding. For each such patient, a notification is drawn up to Rospotrebnadzor, and he gives us instructions - what we must do.
- Has the time frame for the construction of medical institutions in the region shifted due to the coronavirus? Will this affect the delivery of objects?
- We are only the ideologists of the construction of medical institutions; the Ministry of Construction is engaged in the process itself. We without fail coordinate planning decisions with the Ministry of Construction, Rospotrebnadzor. Of course, the coronavirus has made its own adjustments, but, nevertheless, everything is moving in the regional targeted investment program. Of course, due to the pandemic, the dates are postponed, but the process is underway. We need a good fresh database of medical institutions and hope that in the near future - in 2021, in 2022 we will get it.
- Alexander Valentinovich, when will a modern infectious diseases hospital appear in the Khabarovsk Territory?
- We worked very hard with the Ministry of Health of Russia to ensure that we have a children's infectious diseases hospital - a project, and not as now, adapted in a former hostel. We need a specialized hospital. I am very grateful to the Ministry of Health of the Russian Federation, Deputy Prime Minister Golikova for the fact that federal funding went and the facility began to be built on the basis of the children's regional clinical hospital, on Progressive Street. The head physician monitors construction issues every day, while zero work is underway.
The hospital will have 130 beds. I think that such a powerful hospital will solve all the problems of infectious diseases among children in the region.
- And what about the adult infectious diseases hospital?
- Now there is an infectious disease department for adults on the basis of the city hospital No. 10 in Khabarovsk. But it was built in the 70s of the last century, so it does not correspond to sanitary standards and rules for a long time. We are studying the issue of building an infectious diseases hospital, preparing our ideology, it is already on its way out. We will try to coordinate it with the Ministry of Health of the Russian Federation, because not a single facility in the Khabarovsk Territory is being built today for a purely regional budget - the Federation needs money. If Moscow gives the go-ahead, then we will have a good infectious diseases hospital for adults.
We looked at the military hospital that the Ministry of Defense built in Anastasyevka, looked at the experience of other regions, in particular Crimea. We understand that we need a good vaccine storage. We also want to make a laboratory, because today there are few laboratories working with dangerous infections.
- Will the implementation of national health programs in the Khabarovsk Territory suffer from the coronavirus?
- Of course, it will suffer, because the project includes the children's infectious diseases hospital I mentioned. This is the only facility that is being built within the framework of the national project. For us, of course, it is very important not to stop the pace, to build and master the national project to zero. Today we, in fact, are a medical hub for the regions of the Far East, so the hospital will be able to receive children not only from our region, but also from other regions.
For our part, we supervise the construction site, as specialists who will accept this object. It should be handed over to us on a turnkey basis, so it is very important that everything is built on time and with high quality.
- When, in your opinion, will medical institutions in the region be able to return to their normal operating hours?
- To go to the mode of easing restrictive measures, three components are needed. The prevalence rate of the disease should be equal to one or less, we still have more, which of course affects the employment of the bed fund. More than 50% of beds should be free, we still have only 25%. Despite the fact that the first stage of lifting restrictions has been introduced in the region, there are many sick, the population does not listen to the recommendations that are given by the authorities and Rospotrebnadzor. Now the situation is tense all over the world, new outbreaks of coronavirus appear in countries where it seemed to be extinguished. It is not in vain that a vaccine is being developed, testing, and in our country they are underway. We hope that there will be a salvage recipe, but it is not yet known how long the vaccination will take, it is possible that, like the flu, when every year the World Health Organization identifies strains, orders the production of vaccines.
I think that our medical institutions will start working in full at the second stage of lifting restrictions. So far, at the first stage, we are trying to slowly launch planned care, but we do it very carefully, competently, so that neither patients nor the medical environment will suffer.
- Has the current situation revealed the shortage of medical personnel in the region, the problem of training specialists in narrow specialties? Will their training change after the pandemic?
- Of course, I opened it. Therefore, we are dealing with this issue very closely. We have always dealt with the issue of personnel and did it seriously. This year on the territory of the region the numbers of admission and graduation at the medical university are higher than ever. This year there are 167 target places for specialty, as well as 280 budget places - almost 70%. There are 183 places in residency, of which 119 are for the Khabarovsk Territory - 54 in 18 universities of seven subjects, ten in research institutes of the highest level in Moscow and St. Petersburg and one place in Krasnoyarsk. This is the Almazov Center, and the institutes of Vishnevsky, Kulakov, Dmitry Rogachov. We are already selecting candidates for whom the region will pay with an obligatory condition - to return to the region.
There is an opportunity to train specialists, and the main thing is that they will return to their jobs. I, being the chief physician of the cancer center, trained specialists, the region invested a lot of money in them, but time passed, the guys fulfilled their duties to the state, and then left for Moscow and other regions. It's a pity to lose such great specialists.
Now our other task is to attract research institutes to the region, to create their branches in the region. We are also thinking about creating a university clinic at our Far Eastern State Medical University. The heads of departments there will be professors, associate professors. You also need to create a federal-level cancer center, for example, under the roof of the Blokhin Research Institute. With his help, we created a branch of the Russian Cancer Center on the basis of the oncology center, which gave us a lot in terms of training specialists, and in terms of science, and most importantly, in terms of technology.
Today you can scold and blame our healthcare, but there is no such strong healthcare in the Far East anymore. Although we now do not have the capital of the Far Eastern Federal District, but the capital's health care should remain - there is a fundamental base, advanced technologies and personnel.
- Have the regional authorities come up with new plans to improve health care in the region?
- We are always committed to development and know what we need to change. Only in the regional targeted investment program there are about 35 healthcare facilities that need to be built. This is taking into account the feldsher-obstetric points and outpatient clinics. A children's hospital complex is under construction in Komsomolsk-on-Amur. This city was completely devoid of children's health care. There were many twists and turns with the designer of the facility, nevertheless, the project was finalized, passed an examination, I hope that the facility will be built in the coming years. The most difficult task is to build, equip, pick up personnel, keep them there.
Among the tasks is the development of oncological services. For me, this topic is very close, because I am an oncologist by profession. We need examination rooms, then oncology rooms in central regional hospitals. After that, treatment will be carried out at the oncological dispensary in Komsomolsk or at the oncological center in Khabarovsk. And in order for our oncological service to develop further on the basis of the oncological dispensary in Komsomolsk, it is necessary to build three facilities: an advisory clinic for 100 visits per shift, a pathological and morphological department and a radiological department, where patients can receive not only diagnostics, but also the necessary treatment.
In the regional clinical center of oncology in Khabarovsk, it is also necessary to build three facilities: a proton center, a chemotherapy center, and to increase the number of surgical beds and beds for intensive care and intensive care. We also need to tackle new technologies such as treatment with radioactive drugs.
We have much to develop, we know the ways of development. What are we missing? Resources. But, as you know, walking the road will master.