“Nurses, doctors … Absolutely everything that can be hired has been hired.” The President of the Government of the Canary Islands, Ángel Víctor Torres, pronounced these words last Monday when questioned about the overflow situation that the health services are going through –mainly Primary Care, but also hospitals – as a consequence of the high incidence of COVID-19 cases in this sixth wave of the pandemic. It’s not just that healthcare pressure has increased. Human resources have also dwindled as a result of health workers’ sick leave. The Ministry of Health speaks of 2,200 infected workers. The professional associations of Medicine and Nursing estimate that between 10 and 15% of the staff of the Canary Islands Health Service (SCS) is in a situation of temporary disability. Not just because of the coronavirus. There are also casualties due to stress, job fatigue, anxiety or depression, their representatives emphasize.
As has happened in other waves, the job lists in Nursing have been exhausted. Nor are there doctors to cover the casualties that occur. The high contagiousness of the sixth wave has aggravated the chronic deficit of toilets in the Canary Islands, denounced for years by professionals. Faced with these shortcomings and the impossibility of finding more professionals on the job lists, the Ministry of Health is pulling voluntary: active workers to double shifts, retirees who have retired in the last two or three years or resident doctors in training to do overtime.
The College of Nursing of the province of Las Palmas issued a statement to its approximately 8,000 members on Monday at noon asking for volunteers to join the vaccination strategy. In just four hours, he had received nearly 200 notifications. A day later, that number had risen to 300. The list sent to the SCS is finally made up of 400 workers. According to Rita Mendoza, president of this organization, among those who have volunteered there are nurses who will help by doubling shifts, who will make this task compatible with their work in the private sector, who were either not available on the lists or who have just retired.
José Ángel Rodríguez, president of the Santa Cruz de Tenerife Nursing College, points out that last week he also sent a relationship with a hundred professionals who, despite having retired one, two or three years ago, have offered to collaborate in this sixth wave to alleviate the overload of active workers. In addition, on Monday he sent the administration a list with 60 volunteers to double shifts.
Nor can all the losses among physicians be covered and the work overload continues to increase. There have been calls for retired doctors to support tasks such as monitoring patients by telephone, although the deficiencies are basically being filled with an overstrain from the staff. According to Éric Álvarez, president of the Las Palmas Medical Union, in Primary Care an exclusive agenda has been created for the management of discharge and discharge of users infected by COVID-19. That is, once the professionals finish their shifts, in which they are seeing a much higher number of patients than usual (the average these days is around 50 or 60 per shift, although there have been cases that have exceeded the 80s, the workers point out), they stay a while longer in the health centers to carry out this bureaucratic work.
This Wednesday the management of Primary Care of Gran Canaria also made an appeal to residents (MIR) of the specialty of Family and Community Medicine to, also voluntarily, offer them to do extra hours paid as on-call hours, with the aim of reinforcing the work of monitoring patients with COVID-19, the management of temporary disabilities and other activities derived from this pathology, always under the supervision of the assistants and without jeopardizing their training itinerary.
In a thread published this Thursday night on Twitter, the director of the Canary Islands Health Service, Conrado Domínguez, points out that in just a month and a half there have been 2,211,350 consultations in Primary Care, a million more than on the same dates of the last year. The number two of the Ministry of Health points out that the administration has kept the backup professionals hired for the pandemic, which it has quantified at approximately 5,000, and has increased resources in this sixth wave with another 2,000 workers. Among the measures recently adopted to decongest services, he referred to changes in the processing of discharges and discharges to “largely free up” family doctors.
Lack of planning and vision in the medium term
The professionals agree. The current situation is the product of a lack of planning and organization of human resources in the Canary Islands public health. They speak of a “chronic deficit” of professionals that the pandemic, despite the reinforcements, has aggravated. But also from a lack of vision in the medium term. Rita Mendoza, president of the Las Palmas Nursing College sums it up: “Two years and six waves later, we are still not prepared.” The medical schools of the two Canarian provinces have also expressed this week their tiredness with the political management of the pandemic. The one from Las Palmas made an “agonizing” appeal in the face of the “unsustainable situation” of Primary Care. For the Santa Cruz de Tenerife, COVID-19 has been the definitive “diagnostic test” to reveal the “degradation” of a public system “whose seams have been seen.”
Lack of staff and lack of job stability. “If we compare ourselves with France, the Canary Islands have half the number of nurses per number of inhabitants. If we do it with Germany, a third. Our ratio was already low. The system was not prepared to receive an epidemic”, explains Rita Mendoza . To this is joined precariousness, the proliferation of temporary contracts, sometimes days. “It is inconceivable that the same nurse who is giving vaccines today and who needs to know a lot about vaccines is going to be tomorrow wearing two respirators in an ICU (Intensive Care Unit). There is no profession capable of supporting this. What is needed is stability labor in services so that talent is developed and retained, “explains the collegiate spokeswoman, who emphasizes that the Islands generate” very good professional profiles “that, however, choose to leave because” they are offered better contracts outside. ” “We cannot lose that talent,” he says.
A few weeks ago the Canarian Health Service made an appeal to find Nursing personnel specialized in the treatment of critical patients in order to be able to join the ICUs of the hospitals of the Islands in the face of the increase in demand for care and the lack of these profiles. “Decisions must be made regarding the training of nurses specialized in respiratory diseases. If two years ago we had trained 50 professionals, today we would not have the problem we have. Nothing can be solved without thinking about the medium term. It has been thought about. There is a lack of specialists in the ICUs because they have not sat down to train, “laments José Ángel Rodríguez. Mendoza specifies that in some managements, such as that of Doctor Negrín de Gran Canaria, there has been any training activity to reinforce this profile, but that it is not a generalized practice in the Canarian public health administration.
“We have been proposing since the beginning of the pandemic, that coordination be improved. We must rethink hiring policies, staff training. They only dedicate themselves to solving the patch when it occurs and they send confusing messages to the population. It is not understood that a soccer field be filled with a variant as contagious as the omicron. The emergencies, the ICUs, the Primary Care are saturated. In the health centers they do not pick up the phones, that is a sign of collapse. There is an impact at the level of care and attention to people’s health. They are doing a disservice to contain the pandemic “, adds, visibly annoyed, the president of the Tenerife nurses.
Incentives and training places
Rodrigo Martín, president of the College of Physicians of the western province, agrees on the diagnosis. “You act late and badly when there is an emergency. There has never been a plan for the future” to adapt health resources to the demand for care. “We must reinforce the workforce with the few doctors who can come,” says the representative of the organization, who states that, for this, to attract professionals to the Canary Islands, it is necessary to give them incentives. And the main one is job stability. Two out of every three specialist physicians practicing on the Islands have a temporary contract.
“One way to get doctors is to give them things they do not have. One is stability. Then, de-bureaucratize care, especially in Primary Care, take away from the doctor powers that are purely bureaucratic and have another type of professional do it for a doctor dedicate himself to doing medicine “, remarks Martín. Economic conditions, technical means, work-life balance and the possibility of developing a research career in optimal conditions are other aspects that health professionals “value very much” and can make them choose a job.
“The problem is that there are no doctors. And that is the responsibility of the administration. It is a chronic, structural deficit, at all levels, which has worsened with the pandemic. Health is totally overwhelmed and does not happen only in the Canary Islands,” he says Eric Alvarez. A report by the Federation of Associations for the Defense of Public Health revealed that before the pandemic, more than half of the family doctors in the Archipelago had more than 1,500 patients in their quota, the limit that the authorities recommend not to exceed in order to guarantee the quality of care in the service.
For the president of the Union of Doctors of Las Palmas, there has been no forecast. “The number of doctors that have been trained in recent years has not been enough, taking into account the aging of a population that increasingly needs more medical attention.” The difficulty, he adds, is that a doctor is trained in at least a decade (six in career and four in specialty), so that the decisions that are taken now in terms of increasing positions will not be seen for a few years.
The paradigm is Primary Care. “There are many positions that must be filled. A significant percentage of doctors will retire in a few years and there are no personnel to fill it. The shortage will be even greater, there is a critical risk,” says Álvarez, who agrees with Martín that working conditions and job stability are key to preventing a flight of professionals to other countries. “In the Canary Islands, before the pandemic, there were no unemployed doctors. And many had two jobs. If they had only one job, many of the places would be deserted,” he says.
The representatives of these health groups warn that the staff is exhausted, “exhausted by the pandemic” and enduring, in some cases, the verbal attacks of users unhappy due to the saturation of the services, and they demand that the administration be listened to, that they count with workers in search of solutions. “We always reach out to the SCS, there are still many actions to be implemented,” concludes the president of the Las Palmas Nursing College.