Coronavirus in a provincial hospital in Ukraine’s COVID-19 epicentre
Sweat, Disinfectants, and Rubber Suits: Exclusive Report from Ukraine’s Most Coronavirus-Ridden Region
Published by Hromadske.ua
14 May 2020
Medical care workers work at the emergency room of the Chernivtsi regional hospital in Chernivtsi, western Ukraine on May 5. Zhanna Babayeva / Hromadske
Since the start of the coronavirus quarantine in Ukraine, the western region of Chernivtsi has been holding the first spot by number of total infected cases. Nearly 3,000 COVID-19 cases have been confirmed there. The main treatment center for these moderate and severely ill patients has been the infectious disease ward of the Chernivtsi regional hospital.
How to treat patients during a pandemic, whether doctors have enough personal protective equipment to be safe, and how they physically and psychologically cope with their work – we explain in this report from the region.
“It’s hard to inject a vein while wearing two pairs of gloves. The patients are exhausted.”
A man is carried out in a stretcher by doctors from the emergency room at the Chernivtsi regional hospital. He’s being taken for dialysis, a method of cleaning the blood when the kidneys fail to keep up. A person with a malfunctioning liver is in a high risk group when it comes to the coronavirus. Patients needing dialysis are taken from the COVID-19 treatment wing to one without coronavirus patients – the ER doesn’t have the necessary equipment for dialysis.
We’re standing at the entrance to the red zone, the corridors of the ER ward. But we can’t see deeper into the ward – a sheet of plastic hangs from the ceiling to the floor, and beyond it only the blurred silhouettes of people in rubber suits can be seen.
“Ladies, you need to put on some protection,” a senior nurse, Iryna Martynova, tells us.
“We have it with us,” I respond.
“Show me. No, that’s not enough, put on our suits. Your goggles will work, the robes – no. Shoe coverings, caps – yes, the respirators – yours as well,” she responds after checking what we’d brought.
Under the watchful eye of the senior nurse, the videographer and I put on the suits we received at the hospital. We pull on a second pair of gloves over our first. Then, the cap and hood.
“Close everything tightly,” says Iryna. “Now let me put on another robe on top.”
She gives us a blue surgical robe which ties together in the back, then asks us to put on our shoe coverings. On top of the shoe coverings, she pulls on the rubber boots from the first suit.
“Yes, we do this in order for your legs to be fully covered. Now give me your hands. We have to make a hole for the thumb in the sleeve. Put it there. We saw how they were doing this in China to prevent the sleeve from moving. There we go, now the goggles. Look, they have to be resting flat. Is it too tight?” she asks.
Now, fully prepared, we step past the sheet. We immediately feel the heavy air, and breathing in the respirator grows more difficult. Condensation quickly builds up in the goggles, so the surroundings are a bit blurred. The senior nurse leads us to another small corridor. Rooms containing coronavirus patients stretch out before us. The floor, wet from constant cleaning, shines. We hear the “beep beep beep” of the artificial ventilators. Nurses bustle around in their rubber suits, with only their eyes visible through face shields. There’s not a lot of light here, and one of the lamps on the ceiling keeps flickering, giving the place a particular atmosphere, and brings to mind only one association in my head, simultaneously with the flickering of the faulty lamp – frames from last year’s series of HBO’s Chernobyl.
The “red zone” corridor of the emergency room at the Chernivtsi regional hospital in Chernivtsi, western Ukraine on May 5. Photo: Zhanna Babaieva
“Natasha, that you?” shouts the senior nurse over to a woman in a rubber suit that is walking toward us. “These girls are from TV. They will shoot here.”
“ I learnt to recognize them by their silhouettes,” Iryna turns to us to explain. “In these suits, you can’t see anything but the eyes. It’s hard to recognize people.”
Iryna has been working at this hospital for 41 years, since 1979. She was a nurse for 20 years, 21 as a senior nurse. This pandemic, according to her, is much more difficult than the flu epidemic in 2009. “Six people died here over the weekend. Among them was a 30 year old woman, but she was a diabetic, and another two men, 42 and 44 years old. The 44 year old patient was begging for help, he wanted to be saved, saying ‘I have two children, I so want to live.’ But, unfortunately, he died,” Iryna recalled.
She’s positive that it’s too early to weaken the quarantine, because people are still not following the necessary requirements and are violating social distancing.
An extra room, previously containing a CAT scanner, was turned into more beds when there were more patients. At the moment, 14 people in critical conditions are held in the ER. There were 19 during the Easter holidays. Iryna says it was too many. She notes that they’re ready to turn a hallway into beds if necessary.
We peek into one of the sick rooms, though nurses ask us to keep our distance and not to touch anything. Green-blue walls, as is typical for hospitals, completely closed plastic windows, wheeled beds, and IV stands and oxygen masks decorate the spaces.
A COVID-19 patient hooked up to a ventilator lies in the emergency room of the Chernivtsi regional hospital in Chernivtsi, western Ukraine on May 5. Photo: Zhanna Babaieva
Shelves next to the beds are overloaded with medicines, jars of food, tissues. Only the doctors speak. There’s not a peep from the patients. We see an old woman among the patients, sitting motionlessly on her bed, paying us no mind. It’s emotionally taxing to stay in these rooms – we don’t want to bother any of the patients with the squeak of my shoe coverings, nor even with my glances.
Around 36 nurses work in the ER, with 12 of them being junior nurses. Two have already quit, because dealing with the stress is very difficult.
“It’s psychologically difficult for us because we work in these suits, and they are very uncomfortable. Plus, it’s hard to inject a vein while wearing two pairs of gloves. The patients are exhausted. Healthy people have good veins, but when they’re here for a week already, and they’ve already had several shots, then it’s hard to land in a vein,” the nurses working with COVID-19 patients tell us.
The only thing that the patients can see daily are people in rubber suits fighting for their, the patients’, lives. During a pandemic, a change in the junior and mid-level hospital staff lasts up to 24 hours.
“How does your family deal with the fact that you’re working so hard, do they support you?” we ask the nurses.
“They’re not very positive, because they know who we’re working with…they don’t want us to go to this work because we have very low salaries. No one wants to work in a hospital for $118.50 [per month]. But this is our duty, and we do it. We chose this profession to help people. And definitely not for the money,” they reply.
A COVID-19 patient hooked up to a ventilator lies in the emergency room of the Chernivtsi regional hospital in Chernivtsi, western Ukraine on May 5. Photo: Zhanna Babaieva
Disinfecting equipment in the emergency room of the Chernivtsi regional hospital in Chernivtsi, western Ukraine on May 5. Photo: Zhanna Babaieva
“Most of those who had dialysis are now here”
There’s an infectious disease ward at this hospital, aside from the people with coronavirus complications in the ER. Moderately ill people are hospitalized there. The hospital converted the pulmonology, otorhinolaryngology (ear, throat, and neck or ENT – ed.) and urology departments to make more room for coronavirus patients. An ambulance ferries new patients through a separate entrance made especially for people suspected of having the coronavirus.
People wait in the courtyard, holding their distance, until they’re taken for a check-up by the doctor on shift. He checks the oxygen levels in their blood, collects their analyses, and decides whether or not to hospitalize.
We meet a person in the infectious disease ward who is also there for dialysis. He’s sitting on a bench by himself, shouting at us. His medical mask is hanging off a single ear. We keep our distance and don’t approach, meaning that our conversation is loud, almost a shout.
“Ladies, you should have gone to shoot in the neurological department, the beds there are awful,” he says.
“Are you being treated here?” we ask, pointing at the infectious disease ward.
“Yeah, I had pneumonia. The…what do you call it?”
“COVID?”
“Yeah. But actually I’m here for dialysis. And most of the dialysis [patients], the ones that were there – now most of them are here.”
“Do you have any suspicions of where you were infected?”
“At dialysis.”
The man’s name is Pavlo. He tells us that the day after his dialysis, his temperature shot up and breathing became difficult. He decided to have a fluorography test, and the hospital immediately took a swab for testing. He recovered at home for a week, but then he was confirmed to have coronavirus.
“Then I got weak and was taken to the hospital. On the 12th day, I felt better, and now I can walk and run.”
A COVID-19 patient lies in the emergency room of the Chernivtsi regional hospital in Chernivtsi, western Ukraine on May 5. Photo: Zhanna Babaieva
Protective and disinfecting equipment for medical care workers in the emergency room of the Chernivtsi regional hospital in Chernivtsi, western Ukraine on May 5. Photo: Zhanna Babaieva
“We have always been left to our own devices: the patient and the doctor”
At the regional hospital in Chernivtsi, there’s an anaesthesiologist named Mykola Rykhlitskyi. He’s one of the doctors that traveled to Italy to help out. We met him not far from the hospital building containing the ER ward for COVID-19 patients.
READ MORE: “Coronavirus is a Test of Solidarity”: Why Ukraine Is Helping Italy Fight COVID-19
“I’ll immediately ask that you not lionize us. We’re just doing our jobs,” he says to us.
Mykola told us about his experiences in Italy, saying that he was most struck by how people there were consciously adhering to the quarantine. And of course, the organizational details of the hospital itself: “Everything was strictly delineated, information was posted everywhere – where you have the right, where you don’t, where there were COVID-19 patients, where the confirmed cases were, where the unconfirmed were, where the ‘clean’ patients were. In Ukraine, however, there are no protocols for how to communicate with each other, with the patient, and in the room where we work with these patients,” he tells us.
“Here, for example, the dialysis department is on the opposite end of this long building. It goes through other departments, through the admitting department, and unfortunately, we don’t have bedside dialysis machines which would let us conduct this artificial kidney procedure in the ER department without transporting the patient. These are the conditions we live in. The government hasn’t given us this equipment, which is why, in order for the patient to survive, we’re forced to expose them to other risks to save their life,” Mykola adds.
Anaesthesiologist Mykola Rykhlitskyi was among the 20 doctors who went to Italy to help treat COVID-19 patients. Now he’s using his experience at the Chernivtsi regional hospital in Chernivtsi, western Ukraine. May 5. Photo: Zhanna Babaieva
According to the doctor, medical staff can catch the virus at work – but not in the red zone when they’re working in full PPE. But this changes when they move to the relatively “clean” zone, which, in reality, doesn’t exist.
“We’ve always been left to our own devices: patients and doctors. We’re reliant on the patient, and the patients on us, and that’s how we’ve been all this time. Now the government needs to take a bigger role, the local authorities, because nothing can be done without them – in order to obtain at least some level of quality care,” the doctor says.
The head doctor of the Chernivtsi regional hospital, Serhiy Tsyntar, tells us that the hospital played host to the regional governor, Andriy Prokopenko, along with a commission. They noted that the hospital’s wards need repair: “We were told that when this is all over, there will definitely be solutions to the question of repairs to the infectious disease ward, the wiring, plumbing…We didn’t even have oxygen machines in the infectious disease ward when the coronavirus started. But in a week we managed to get them and made this so-called ‘intensive therapy’ ward…” Tsyntar explains.
A doctor watches over a COVID-19 patient at the emergency room of the Chernivtsi regional hospital in Chernivtsi, western Ukraine on May 5. Photo: Zhanna Babaieva
“And so we entered into the coronavirus: with public rooms without oxygen and a single bathroom for all the patients.”
Olha Kobevko is an infectious disease specialist with 13 years of experience. We met at 8 in the morning near her home in order to chat on the way to the hospital.
“How’s Chernivtsi, did you manage to see anything?”
“We had a little walk in the center [of the city].”
“I actually hold tours for my acquaintances who come here, but now there’s no time.”
We’re rushing with Olha to catch the morning shuttle bus – public transport in Chernivtsi has been shut down because of the quarantine, so the regional authorities provided doctors with a minibus so that they could come to work and go back home.
“The working day lasts for about 12 hours, and you’re on your feet the whole time. After a 12-hour work day, one should be allowed 24 hours of rest, but you find yourself at work again the next day. There’s no time to rest,” Olha tells us.
Despite this new working schedule and the new risks behind the pandemic, doctors salaries remain low. Olha says that a high-level infectious disease specialist with 13 years of experience like herself earns only $176.70 per month. “These one-off bonuses – they’re good, but if they’re one-offs, then that’s just a humiliation. A doctor’s labor isn’t counted like the labor of a person who is constantly saving lives. This pandemic proved that medicine needs to be raised off its knees, and [the government] should turn toward doctors. We end up alone in this pandemic and with these patients, forgetting about our own families,” says Olha.
The doctor believes that in the future many medical workers who have taken COVID-19 tests will have negative results, in order to reduce agitation over infected doctors. We stop near the next stop. Another doctor gets into the bus.
“Natasha, listen and mark my words, that from today there will be ‘fewer’ sick people,” Olha says to her . “And there will be fewer medical workers [who are officially confirmed to have COVID-19], all their results will be negative.”
“We’ll see, I took [the test] yesterday,” replies the other doctor.
Over the past two months, Olha has had only two days off – as an infectious disease specialist, she works in two hospitals in Chernivtsi: the regional and city hospitals. After shift change at the regional hospital, she hurries to her second shift at the other hospital. She’s been working there since March 23, which is when they opened a COVID-19 base there.
“If there’s no work on the weekends here, then in that hospital [there is], or the other way around. We just don’t have any other options, we have to just be patient,” says Olha.
Medical care workers pose outside the infectious disease war of the Chernivtsi regional hospital in Chernivtsi, western Ukraine on May 5. Infectious disease specialist Olha Kobevko is on the right. Photo: Zhanna Babaieva
Working on such a schedule doesn’t leave a lot, if any, time for a personal life – but Olha jokes that everything is stable. “I haven’t seen my parents in over a month, probably. They have accompanying illnesses. When this strict quarantine began, I forbade them from leaving [the house],” she says to us. Her 14-year-old son studies at a sport-focused school in Kyiv, now he lives separately from his mother. “I haven’t seen him since the New Year. He left for school, and returned [here] when the quarantine started. But he has to live separately from me.” She adds that she would have had to give up one of her hospital jobs in order to have time for her son. But she’s had to make this decision during the pandemic, saying that her son supports her.
The current situation, working to the bone, isn’t new for Olha. She served as a volunteer since the Euromaidan and the Donbas conflict, then visited the conflict zone as a doctor. She spent all her holidays and free time on these trips. And now she has to work extra hard during the pandemic. She says that even if she’d chosen a different speciality, she would still have been with these patients, even as a volunteer. “We’ve been faced with the sort of disaster that we have to fight together,” the doctor says.
She began reading about the coronavirus back in January. “Every day, during our five-minute [meetings], I would talk about what we would need to bring and how we would need to change the structure of the department, but there was constant aggression against me [from several doctors and management]. When the virus came, it was too late to do anything, because we already had patients. And that’s how we entered the coronavirus: in public rooms without oxygen and shared public toilets for all the patients,” explains Olha.
More people had entered the minibus while we were talking. There were more than eight of us now. We approach the hospital.
“Gloves,” jokes one doctor while leaving the bus. “Yeah, we’ve definitely not gone to work like this yet.”
Someone offers to take a selfie as a memento. The faces on the picture are half-covered by masks, and only our eyes can be seen on the photo.
Nurses at the emergency room of the Chernivtsi regional hospital in Chernivtsi, western Ukraine on May 5. Photo: Zhanna Babaieva
“I was rushing to help and even forgot to wear my shield”
A new shift hurries to the hospital. After a few minutes, everyone will be wearing rubber suits, masks, and gloves, which all hinder movement. And for a few hours, they’ll be required to forget about their personal needs, even the most basic physiological ones. Skin can’t breathe and loses a lot of liquids in the hazmat suits.
“You can’t drink water, can’t go to the bathroom for four hours, and this is very exhausting. There are times when the patients feel worse, and the doctors have to quickly check up on them and help them. The doctor gets ready in a rush, and can put something on wrong or forget a piece of PPE. There were times when our doctors were tripping over themselves in a rush to help, saying: ‘I even forgot to put on my face shield. But, thank god, everything turned out okay,’ says senior nurse Iryna.
She explains that one of the biggest risks in terms of doctors getting infection is to touch their own clothes when they’re taking off PPE. “You have to do it very carefully, not shaking anything, and to turn it inside out when you’re taking it out. After taking off each layer of PPE, for example, caps, shoe coverings, suits, you have to disinfect your hands. We have two pairs of gloves, so we take off the first pair, and with the bottom pair we take off other parts of PPE and after each removal we spread antiseptics over our lower pairs of gloves,” says Iryna.
Nurses at the emergency room of the Chernivtsi regional hospital in Chernivtsi, western Ukraine on May 5. Photo: Zhanna Babaieva
The hallways of the ER are filled with lively conversations amongst the nurses. They admit that working in these suits is the hardest part of their job, because they’re so uncomfortable. They say that they spend up to six hours in a single set of PPE, and then change.
“Sweat just pours down our bodies. We sweat, the goggles fog up.”
“All of our women are fighters,” adds the senior nurse. “They’re all brave, they’re all working. Of course, it’s sad that the government doesn’t respect our work.”
“We want for all of this to end and for us to be able to wear our usual work clothes. Without these gloves. And just do our jobs.”
Someone shouts at the healthcare workers that blood tests need to be taken. We ask them to give some advice to our readers.
“Just be patient for a little longer, adhere to the quarantine, take care of yourselves,” the nurses smile and return to work. Ahead of them is a new shift in the ER, surrounded by the sick.
/By Oksana Savoskina and Zhanna Babaieva
/Translated by Romeo Kokriatski
