In the health system in Argentina, the intensive care units were reinforced by the Emergency Modular Hospitals, an initiative that met the needs of patients against Covid-19. How is the health system currently and what does it look like in the future?
By: Flavia Campeis and Jorge Lina Tomasin, Rosario, Argentina.
Unexpected deaths, loss of loved ones, physical consequences, in mental health and economically, are some of the main consequences of the COVID-19 pandemic that disrupted paradigms throughout the world and that even today has effects on society.
The pandemic has reconfigured both the way we connect with each other and the health system. Since its passing, new questions and uncertainties have begun to be raised.
What is the true magnitude of the impact of the pandemic on global health systems? And from Argentina, what is the current situation and what does the health future look like after the highest peaks of infections?
To approach these questions and understand the present, we delve into the work of the third level of complexity in health in Argentina, particularly in the intensive care sector, the area that required the most attention to try to save the lives of thousands of people. .
Places where death appeared without explanation, many times in young patients, victims of an unprecedented pandemic.
Intensive care, the key place of health in Argentina
The intensive care units were the decisive place, where life and death were on the edge, where 50 percent of the people admitted with Covid-19 died.
Nicolás Rocchetti is 36 years old, at the beginning of the pandemic he was 34 and had to face the most important moments of his professional career and his life, coordinating the team of the Intensive Care Unit of the Eva Perón Hospital in Granadero Baigorria, one of the effectors health centers in the province of Santa Fe, located in the great Rosario, Argentina.
The Modular Emergency Hospitals in the health of Argentina
To deal with the pandemic, the Argentine health system increased the availability of intensive care units by more than 40 percent, which implied adding beds, trained personnel, and equipment to provide care to critically ill patients, according to the Ministry of Health. Of Nation.
This implied that the Ministry of Public Works of the Nation built 12 Emergency Modular Hospitals (HME) in different jurisdictions, quickly building hospitals that were located in Buenos Aires in the Municipalities of Almirante Brown, Florencio Varela, and Gral. Rodríguez, Hurlingham, Lomas de Zamora, Moreno, Quilmes, Tres de Febrero, Mar del Plata and in Resistencia (Chaco), Córdoba capital and Granadero Baigorria (Santa Fe).
We came to this last city to interview Nicolás Rocchetti, a doctor specializing in medical clinics and intensive care who has been working there for more than 11 years and is currently the coordinator of the Intensive Care Unit.
A hospital with history
The population covered by the Eva Perón Hospital is 150 thousand people. It is a hospital under the Ministry of Health of the Province of Santa Fe, corresponding to the third level of complexity. Teaching practices are also carried out there, so it is a teaching hospital.
It belongs to the Gran Rosario area, located in the middle of the industrial cordon of the most important agro-export pole in Argentina.
It is a self-management hospital, which means that patients with social work coverage can be treated, but fundamentally emphasis is placed on caring for those people without prepaid coverage.
It is an emblematic hospital for the region, it was projected within the Second Five-Year Plan of the government of Juan Domingo Perón and built in the early 1950s.
With the arrival of COVID-19, the hospital was already a reference in the region and was consolidated as a fundamental health effector.
Nicolás Rocchetti remembers: «What happened to us here in the hospital is something that happened in the rest of the province, the rest of Argentina and we could say in the world, the health systems were not prepared for the stress they faced in The pandemic and the health catastrophe that this represented implied a set of adaptations from the human resource fundamentally as the protagonist and the adaptation of all electromedical resources, supplies, etc., to supply that demand.
For Nicolás, the health systems in Argentina have been «considerably stressed», but despite this, in the hospital where he worked during the pandemic, and where he currently works, they were able to respond to the need for care in the region and the province. , attending cases by Covid-19, but also other pathologies.
Eva Perón Modular Hospital
The Eva Perón Hospital was chosen as the COVID Center by the National Ministry of Health, next to the historic building an exclusive modular hospital for Covid patients was created, with 24 new intensive care beds and 60 beds for the Covid-19 clinic.
“They were moments of great uncertainty; we did not know what we were going to face. but we have been proud to be able to say that we have treated more than a thousand critical patients and almost 2,500 non-critical COVID patients,” recalls Rocchetti.
On this, the medical director of the Hospital, Dr. Tomás Diez, is also proud and adds:
“One of our greatest prides is that there was not a patient who was left without care. Every patient who arrived was treated with or without Covid. All were treated accordingly, with multidisciplinary teams, with specialists, respiratory kinesiologists, and with all the support that is needed”.
Reinforcements
In Argentina, social, preventive and mandatory isolation was decreed on March 20, 2020. From that date and during the months in which the population was kept with strict care and distancing measures, the Government implemented a battery of measures throughout the entire country.
According to a report from the Ministry of Health, 2,907 million pesos were invested for the construction and complete equipment of health units equipped with a total of 840 therapy and hospitalization beds, 276 respirators and 24 transport fans with multiparameter monitors, portable ultrasound machines, electrocardiographs and X-ray equipment, among others.
These 12 new hospitals were built with the objective that they remain to be used in each community, even after the pandemic within the health system in Argentina.
One of these units is the Modular Hospital No.3 of Baigorria
Connection with the modular hospital. Photo: Jorgelina Tomasin.
“When you talk about modular hospitals, you think of very camp-style structures and this was not the case. This was a well-formed construction, with light structures and with a flow of air pressure that meant that we had all the security guarantees so as not to get infected”, says Director Tomás Diez.
The Modular Hospital during the pandemic was a safe place for health personnel, Tomás affirms that the vast majority of infections in the health personnel and general services of the facility were outside the Hospital.
The consequences on health workers in Argentina
When asked about how day-to-day life was lived in the intensive care unit, Nicolás Rocchetti recalls: “The occupancy of the beds was almost permanently at 100%, that is, we had every day at all hours, all the beds occupied. This means greater stress to the system and therefore to the entire health team, because we work at maximum capacity.
He also narrates that since at that time most of the patients were cases of Covid-19, «the demand for work that these patients require when they are in a pharmacological coma, with a respirator and others, added to all the personal protective equipment, to the own fears of getting infected, of taking the virus home, infecting the family and in a pathology that unfortunately has a high mortality in critically ill patients, I think they were a cocktail of things that had a terrible impact on physical and mental health of the entire health team.
«They were very distressing moments»
For his part, Dr. Diez adds: “They were very distressing moments. I remember cases in which a grandson, his father and grandfather, three generations of the family, were hospitalized in the same room at the same time. The capacity of the morgue was also exceeded; we had to hire a container with the right characteristics with refrigeration to be able to leave the patients who died there, that was very impressive”.
Tomás Diez, medical director of the Eva Perón Hospital in Granadero Baigorria, in the industrial belt of Santa Fe, Argentina. Photo: Jorgelina Tomasin.
While the statistical data worldwide were followed minute by minute, the fatalities caused by the COVID-19 pandemic in intensive care units increased.
In that line of fire, thousands of workers did everything possible to save those lives of others. Nicolás recalls it first-hand: “The days were really stressful and personally it caused me multiple problems and it was very common for all of us to start having problems sleeping, family problems, to relate to each other, a lot of negative effects that it had. This sector of health care.
Tomás Diez, medical director of the Eva Perón Hospital and doctor Nicolás Rocchetti, coordinator of the intensive care unit. Photo: Jorgelina Tomasin.
Undoubtedly, the focus on the mental health of these workers was decisive, “constant contact with death is a point that has a terrible psychic impact. The Hospital’s Mental Health team was very important because although we always try to work as a team and in an interdisciplinary way, the ties in this context were considerably strengthened with the entire mental health team”, says Rocchetti.
“There have been several collateral damages that the pandemic has caused us, obviously beyond the damage it has generated in patients who have had COVID, its sequelae, and obviously those who have died from this, their relatives, in the patients who are left with sequelae. Post COVID, the entire health team, I think the damage on a psychological level was probably irreparable and it will mark us for the rest of our lives and our careers as health professionals”, reflects the medical coordinator.
Other side effects
After the pandemic, the Director of the Eva Perón Hospital assures that other pathologies were affected by not being treated during all that time.
“The occupancy of maternity beds increased a lot; we did not understand why, and it was that during the pandemic there were no maternal-fetal controls, that is why all those pregnant mothers who did not have control, had a lot of premature babies, we wondered why there were so much occupation in neonatology and that was one of the issues”, he comments.
Corridors of the Eva Perón Hospital. Photo: Jorgelina Tomasin.
Nicolás Rocchetti reinforced this idea: “the side effects of the pandemic were the postponement of chronic diseases both related to mental health and chronic non-communicable diseases such as hypertension, diabetes, pregnancies, cancer patients, the immunocompromised, patients who You need elective surgery, they are all postponements and I think they were collateral results of the pandemic, that we are seeing them now and that future studies will probably demonstrate with evidence the impact on public health of all these pathologies”.
Diez deepened: «the health personnel were worn out, in fact many professional therapists stopped practicing intensive care and have gone on to other subspecialties or have tried to do a medical practice without the stress that therapy is.»
Third level versus the first level
Although the third level of complexity, such as the Eva Perón Hospital, felt the effects of the pandemic in the wear and tear of its workers and in ceasing to attend to other cases, at the building level, beds and equipment increased within the health system in Argentina. . Compared to this situation, a few kilometers away, another was the reality at the first level of care, in the Health Centers of the Rosario neighborhoods.
María Inés Stapaj, a general practitioner at the Débora Ferrandini Health Center, located in the Ludueña neighborhood of Rosario, expressed: «We had, at some times during the pandemic, to suspend all kinds of activities and only dedicate ourselves to caring for patients with COVID-19 and all which had to do with vaccination, leaving aside most of the other health problems”.
For María Inés, this situation generated inequality in access to health, since those who had social security, prepaid insurance or money could access controls, but those who did not have these possibilities could not get care, since health centers in Argentina were Dedicated to tackling Covid-19.
The reinforcement of the biomedical model to the detriment of what?
María Inés Stapaj, with her experience of more than a decade in the first level of health, highlighted that there was more investment in some sectors and that others were affected: «With the pandemic, everything that has to do with the biomedical model, that is, intensive therapies, which has to do with what is hegemonic and above all what is “hospital centric”, that is, putting more reinforcement in hospitals, to the detriment of the first level that is thought of as a strategy of social justice, of equity in health».
According to María Inés, the care model that prevailed within health in Argentina was to «think about the disease only from the place of the virus and with a response in only biological interventions, such as diagnostics, PCR, rapid tests».
Which for her represented a mistake, since the disease was not only the virus, that patients did not die only from Covid. but that living conditions and underlying diseases influenced factors that were left aside and «became the disease understood only as the war against COVID-19”, he comments.
This brought as a consequence that «although it was not to the point that people died in their homes, that happened in the smallest situations, it did come at the cost of not attending to a lot of other situations, where we are now seeing the consequences of that , as children who have developmental problems with how important it would have been to diagnose early, “says Stapaj.
Many children were neglected during the pandemic, reducing the opportunity for early diagnosis of chronic pathologies. Photo: Jorgelina Tomasin.
For her part, the social worker from the same Health Center, María Eugenia Di Pato, explains that they are trying to return to a logic in which they worked before the pandemic, in which the care offered was primary level, where patients had to take turns «because people come with the demand that they want to be attended to at the moment,» he says.
Read the report on the first level of healthcare in Argentina here: Covid-19 in Argentina: doctors on the first line of care and the vaccine as hope.
The pandemic, an opportunity for the health system in Argentina?
As a balance after the passage of the most intense work, the Intensive Care Coordinator of the Eva Perón Hospital, Nicolás Rocchetti, analyzes that he sees something common in healthcare centers, because in his opinion:
“The pandemic stressed a health system that had to adapt very quickly to a catastrophic event, such as the great demand for a single pathology such as COVID-19, without relegating other pathologies. The pandemic exposed the shortcomings of health systems around the world.
The case of this hospital works as an example of how health providers have had to adapt to the enormous demand for medical assistance.
Although in recent weeks there have been no hospitalizations of patients due to Covid-19 within the health system in Argentina, the health facility of the modular hospital continues to be used for the care of patients with other types of pathologies, it is heritage and an example of the public health of the region of the Cordón Industrial santafesino.
Dr. Nicolás Rocchetti, coordinator of the intensive care unit. Photo: Jorgelina Tomasin.
In conclusion, Rocchetti remarks that «the negative events of the pandemic should function as opportunities to improve health systems towards universal coverage, which I believe is where health systems should go, to provide much fairer and more equitable care.» And effective”.
