“Doctors Are Forced to Choose Who to Help and Whom They Are Unable to Help”

Dr. Martau from Vitsebsk spoke about the cost of the authorities' lies about COVID-19.

Reanimatologist Uladzimir Martau, former head of the department of anesthesiology and reanimation of the Vitsebsk emergency hospital spoke about the burnout of doctors during the fourth wave of the pandemic, the high cost of lies and those responsible for it, and the heroism of doctors in the "plague barracks."

Uladzimir Martau is a representative of the famous Vitsebsk dynasty of doctors. He was one of the first in Belarus to start talking openly about the real situation with the coronavirus. In the spring of this year, the doctor's contract was not renewed, as he spoke openly about the problems in medicine and in the country, the Radio Svaboda website writes.

The conversation took place before the cancellation of the mask regime in Belarus.

"It is as if there has not been a year and a half of work with the coronavirus, and we are facing the fourth wave like the first one."

- My doctor friend, whose department was redesigned for the treatment of coronavirus patients, said that "we are waiting for a second Italy." What is your assessment of the real situation with the coronavirus in Belarus during the fourth wave?

- I have not worked in intensive care for several months, but I get information about what is happening in my hospital, in Vitsebsk, in the country. I have an unpleasant feeling as if there has not been a year and a half of work with the coronavirus, and we are facing the fourth wave like the first one. Again, the re-profiling of hospital beds begins, planned care is suspended again, and, again, it will be problematic to operate on trivial appendicitis to do it safely. And I do not understand why we are as organizationally prepared as we were in the first and second waves.

- Doctors gained experience in the treatment of coronavirus infection. Or is it just a matter of organization?

- I also do not understand it. If you listen carefully to the Belarusian news about the coronavirus, then hospitalization in the hospital, places in intensive care units are discussed, oxygen points, the number of cylinders, ventilators are discussed. Things are discussed that are remotely related to defeating the pandemic since the plague is not defeated in the plague barracks. People with severe illness get into a plague barrack. Resuscitation is the tip of the iceberg. Victory takes place outside the intensive care unit. There are no victories in intensive care, there is a struggle for each person. I just do not understand why there are no so-called organizational and anti-epidemic measures that should defeat the coronavirus. I understand why this was not the case in the first wave: politics, not politics, illusions, an idea that it will go away by itself. But now I don’t know who has the illusion that this will go away by itself.

- You said that modern and prepared medicine is not only the availability of modern equipment and trained doctors and nurses, but also organization, coordination, and cooperation. How do you assess this particular organizational component?

- I am not the greatest specialist in organizational and anti-epidemic measures. Now in the news, in conversations with colleagues, we are faced with the situation that doctors are forced to choose who to help and whom they are unable to help. Now again the staff is looking for oxygen points, problems arise again. But this is a matter of organization at the lowest level. Why an ordinary practitioner should deal with triage issues, why they piled it on him, why aren't the organizers who understand what the workload is, how many oxygen points are left for a shift, how many people will be admitted on average doing it? It's all predictable. It's a separate profession, and there's nothing of that. Everyone in their workplaces is again engaged in heroism, vanity, searching for oxygen points and vacant places. In this way, we will not save even those whom we can save. It's not really organization.

"Vaccination is one of the surest ways to avoid a severe course of the disease"

- Have you been vaccinated against the coronavirus?

- Yes, I was vaccinated with the Chinese vaccine. It was a deliberate decision, as it seems to me, the best in our conditions. I was not immediately vaccinated, as I had been ill a year ago, albeit in a mild form. While I was working in the "plague barracks," I had the feeling that constant contact, taking small doses is a kind of vaccination, as people around are sick. Now I do not work and do not communicate much with people, and one of my friends who work can bring me the virus. It was clear that you need to protect yourself, and vaccination is one of the surest ways to avoid a severe course of the disease.

- The rates of vaccination in Belarus are quite low in comparison with the countries of the European Union. It is said that many people are now finally deciding to get vaccinated and sit in long queues for several hours to get vaccinated. What do you see as the reasons for Belarusians' distrust of vaccinations against covid? What the state and the medical system could and should have done in more than a year and a half from the start of the pandemic and in 9-10 months about t start vaccination, so that there was a different situation?

- The vaccine appeared quite late. In the first wave, it was not there, and it began to slowly appear in the second. I do not remember that the idea that this method will overcome a pandemic was persistently promoted on the part of the organizers of the health system and the highest officials. This topic was not particularly sounded in our country. A personal example and a huge machine, not a propaganda machine, but an agitation machine, must work. If we do not have normal statistics and are unable to assess the effectiveness of the organization of the health care system by publicized figures, we can see how it works by the rate of vaccination.

And this is not only the health care system but also the Council of Ministers and all departments. This is a serious topic. Our people are not very different from people in Germany or Israel. There, the country's intellectual circles acted correctly, and there are completely different rates of vaccination. In addition, there are problems with vaccines, with their quality, with evidence of this quality, with access to other vaccines. They try not to discuss this topic in Belarus, but, in my opinion, it is very important.

- There is a lot of evidence that people in some enterprises are forced to vaccinate under the threat of dismissal. How do you feel about such measures if, on the one hand, there is coercion, and, on the other, there is no widespread popularization of vaccination?

- This is a bit like the fight against alcoholism in the days of Gorbachev when sensible ideas were incorrectly implemented. The constructed vertical is not capable of doing all this humanly. Compulsory vaccination is a profanation, by and large. There will be inflated numbers, there will be negativity, and, from the point of view of the prospect of defeating the pandemic, there is more harm than good here. Soft power, examples, benefits for the vaccinated - that's how it is. My colleagues, who had been ill with coronavirus two or three weeks ago, are forced to be vaccinated. It is thoughtlessly done. It's better to lose with a wise man than to win with a fool. It's about this.

"There is no public agreement that masks are important and vaccinations and social distance are necessary"

- How do you assess the current measures of the Ministry of Health?

- As far as I see the statistics and hear the news from my colleagues from different hospitals in the country, a wave has risen, which flooded hospitals and intensive care units. Loud statements have been made. But to put it mildly, this is not what will save people. I wear a mask, although I saw a scandal in the store that the guy made when he was forced to wear a mask at the checkout. There is no public agreement that masks are important and vaccinations and social distance are necessary. This is strange because, after all, a year and a half have passed.

- How do you see it, is the current wave the strongest since the beginning of the pandemic?

- It's hard to argue without statistics. Now more children are sick. There are a few seriously ill patients among them, but children are carriers of the disease and pass it on to their parents, teachers, and collectives. There are no orders to stop this, and so the virus spreads. And the virus is a little sweeter now. Therefore, it seems to me that it is stronger.

- And if you compare the capital and the regions where the situation is most critical?

- I do not know. According to the experience of the First and Second Waves, we have weak horizontal connections between the regions - in one region, there is a wave, and it is practically absent in another. Everything is very asynchronous. Vitsebsk was flooded, but Minsk was not touched, then vice versa. From the point of view of preparation, naturally, Minsk is the best "armed" both organizationally and intellectually in terms of managerial decisions. It's not just about masks or "let's get vaccinated." There are a lot of decisions, they are daily, and the right decisions save lives. And not one or two seriously ill patients can be saved, but tens, hundreds, and thousands. This is how the right organizational decisions work.

If the area has flared up, then it will be worse. Imagine a district intensive care unit. Six beds, one doctor on duty, he has an emergency room, covid and clean zones, emergency operations (it's good when the planned ones are over). And that's one person. There may be a shortage of staff. The larger the city and medical facility, the easier it is with resources. It will be worse in the districts.

"The most unpleasant thing for medicine is burnout"

- In your opinion, who is responsible for the official numbers of cases and deaths, which no one in Belarus believes? What is the price of a lie?

- This is the highest management level. I understand why this is done. I don’t understand if people really don’t understand that this is a high price. It's not even about scaring people. Do you even understand what is happening? I don't think that people understand. Are they stupid? No. These are very smart people in high positions. They do not care about the cost of this issue, because, by and large, they personally may be less concerned about this. Although this is not true, maybe they think so.

- Do you mean that they will not get sick and their relatives will not get sick?

- They think that they will receive the maximum (help - ed.), and all other people do not matter. After all, as Okudzhava sang, "there is always not enough sweet gingerbread for everyone," and, in a period of overloading the health care system, access to important resources becomes valuable.

- Many doctors died due to coronavirus, many physicians work with maximum workload and risk. What is the price for medicine?

- The medical staff is sick again. My sister was ill; after three weeks, she got better. The most unpleasant thing for medicine is burnout. In the fourth wave, I would put this in the first place. Not even sickness and death of medical personnel. After all, now the medical staff have protective equipment and imagine how to deal with it, this is not like the first wave. Burnout isn't just about overwork and a lot of work.

Burnout is a bad organization. If there is a lot of work, a lot of shifts, and a person fusses while on duty and solves problems that he should not solve (sorting out who to help and who not, where to look for oxygen points, why there are again interruptions in oxygen), then, in the end, the person becomes indifferent. And the fight for each patient becomes less intense. In the intensive care unit, the issue of combating the pandemic is not solved, but the life of each person is decided in the intensive care unit.

In the first wave, there was a great emotional upsurge, including because there was support from society. Now it has subsided. Public organizations are now practically absent and do not help. But a resuscitator's dimmed eyes when working with covid are worth even more than when working without covid.

"When we start the fourth wave with repurposing, it means we're doing something wrong again"

- Probably, the oncologist, cardiologist, and ophthalmologist, who work with covid patients, have dimmed eyes since their departments have been redesigned, and people with other diseases have problems accessing medical care.

- When we start the fourth wave by repurposing and closing high-tech and very important types of assistance, it means that we are doing something wrong again. I understand why this was done in the first wave, the second, but the fourth... We closed the emergency surgery. Will it come back to us? It will. It's like people don't get sick with anything but covid.

“Masks, distancing, vaccinations are your decision. All in your hands"

- What is happening now in your department of anesthesiology and resuscitation of the Vitsebsk emergency hospital?

- Now the hospital is fully "deployed" for the coronavirus. Again heroism. But every heroism is someone's failure. People have personal experience, but no systemic, general experience can be traced. This is very insulting, it is very difficult for everyone. This is what discourages you when all your efforts rest against the conditions you have not chosen: you have been put in conditions where you are helping a much smaller number of people. And this is not good.

- What would you advise people to do or not do to keep themselves and their loved ones healthy and alive during the new wave of the coronavirus epidemic?

- I urge everyone to think about what you are doing in terms of a pandemic. As it turned out, no one else will think of you for you and your loved ones. A pandemic is not fiction. Until now, I come across the opinion that this is all invented and that this is all for chipping. This is crazy, especially from the point of view of the fact that it is already the fourth wave. Think for yourself. Masks, social distance, vaccinations are your decision. All in your hands.