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For Brazilian doctors, the choice of who lives and who dies causes great harm

RIO DE ANNEYRO – The patient was dead, the rare bed was open, and the ambulance operator was on the phone. It was time for Lara Kretzer to make a choice again.

“We have 15 patients who are ready to be transferred,” said the operator.

Kretzer, a doctor at Florianopolis Hospital, froze. The hospital in southern Brazil had only two openings. Thirteen people were about to be rejected, they would probably die. And he would have to live with the weight of that decision.

“I do not know how it will affect me in the future,” said Kretzer.

In Brazil, where the coronavirus is still growing. The daily deaths on Tuesday reach a record 3,251 people, this is already the life of a doctor. Endless sequence of life or death decisions ում collision with subsequent mental trauma.

Brazil, which has buried more COVID-19 victims than any country outside the United States, is experiencing a health care collapse. In three-quarters of state capitals, the critical care system is more than 90 percent powerful. There is little known place to transport patients anywhere in the country. Hospitals suffer from a lack of oxygen և drugs needed to intubate patients. The intensive care units are so overcrowded that they are taking back victims of other emergencies.

Now the country also lacks doctors. Failure to pay more has delayed expansion plans across the country, putting more stress on already overburdened healthcare workers. As the virus kills about 2,300 Brazilians every day, people accused of maintaining a broken health system say the daily massacre has pushed them to their limits.

More about the COVID-19 epidemic

In recent weeks, doctors have pushed their lungs through silicone valves. They watched as patients suffocated to death. They saw the waiting rooms transformed into halls of misery, where the dead remained unnoticed for hours. And they made the painful decision to leave their elders and the dying, because others had a better chance of survival.

Outbreaks appear to be exacerbated during what is being called a “massive injury” to health workers. But the unusual conditions in Brazil – the outbreak of the epidemic, the extreme shortage of supplies, the failed response of the government, the apathy – ignorance expressed by some Brazilians, the slow vaccination campaign – have left doctors and nurses trapped. No one knows when this will end or how.

In a recent study, researchers found that nearly nine out of 10 health workers reported working conditions “emotionally disturbed” during the epidemic. Other researchers say more than half of those surveyed in the state of Cear ներկայացրել showed signs of mental illness, including anxiety, depression, insomnia, suicidal ideation and signs of post-traumatic stress disorder.

“I have worked in Iraq and Afghanistan,” said Renata Santos, chair of the Doctors Without Borders Brazil board. “I have worked in areas where there have been active clashes. “But what I see in the reports of my colleagues working on the front lines with COVID is something we have never seen.”

In Florianopolis, Cretzer went through a list of patients with an ambulance operator. He was just watching the death of a patient who must have lived. But one of the sick patients was considered a priority. Now that they are both dead, here is another crucial decision.

This time he did not give priority to the most difficult of them. He focused on those who had the best chance of survival. He picked up the two, hung up the phone, and started working.

He does not know what happened to the other 13.


“They are no longer doctors”

From the day the coronavirus hit Brazil, the health care system struggled to withstand the onslaught. Air conditioners, hospital beds, oxygen are depleted in hospitals. Some had to make their own basic masks.

But this year, as the second wave rose և the patient ranks were duplicating again, officials complained about the new problem. The public health system had beds, but failed to hire enough people to control them. 60 available beds have been sealed in Bahia. In Rio, about 600 beds, almost half of its federal network, could not be opened.

“We have increased the number of intensive care units and hospital beds,” Romeu Ema, the governor of Minas Gerais, told reporters this month. “But now we have reached the point in Brazil where there are no more doctors.”

Cesar Eduardo Fernandez, president of the Brazilian Medical Association, said the country was underestimating the complexities of expanding its health capacity to overcome the underdeveloped virus. “It is not enough to invest money, to open hospital beds, to find a place in the hospital, to install air conditioners,” he said. He will not cut it in the absence of unprepared doctors either. Intensive care units will force most doctors to chew.

“Intensive care workers are trained emotionally,” he said. “They live with death, extremely sick people. But even they were physically and mentally exhausted. ”

Public health analysts now warn that one crisis is fueling another. A psychologist at a hospital in northeastern Brazil said his patients were complaining that they could not stop their patients from crying, that they were having panic attacks, that they felt powerless and could not continue.

Another psychologist who advises health care providers in southern Brazil said that appointments had tripled by 2020, with many presenting a “moral dilemma”.

It causes a great deal of guilt among health workers. They think. “I chose one and left the other.”
– Rita Prieb, Psychologist at Porto Alegre Clinical Hospital

“It’s a great deal of guilt for healthcare professionals,” said Rita Prieb, a psychologist at Porto Alegre Clinical Hospital. “They think, ‘I chose one and left the other.’ «

For North Rhine-Westphalia doctor Diego Vieira, February was a choice for a 20-year-old woman in her 90s. He worked in a rural clinic where resources were depleted. Both patients needed intubation, but the Fortaleza capital hospital had room for only one. The younger one had a better chance of surviving. So Vieira made her choice.

“The task was to explain the situation to the family,” he said. “They threatened to sue me for leaving their mother to die.”

It brings nightmares every night. He sees the young man weeping over the death of his mother, whom he infected after partying with friends. He sees patients in hospital corridors, on hospital floors, in plastic chairs. According to him, it is horrible to watch someone die from ashes without adequate care.

“Only people who have seen it know that,” said Viera. “The patient dies, suffocating in their own lungs, begging for air, looking at you in despair, asking for help. But if I do not have oxygen, how can I help? ”

“And then, imagine being on a 24-hour shift, only to get out of the hospital and see people on the street drinking, talking, gathering in large groups, as if nothing is happening.”


“I am on the abyss”

It contradicted everything he thought he knew about himself, but Duana da Frota Arajo felt he had no choice. He was about to come suddenly. Terrible thoughts invaded his mind. It was time to go home.

Arajo, 29, had only been at work for four months when Fortaleza contracted the disease. It bridged the gap between what he expected to be and the suddenness of his career. He hated to see suffering, but what bothered him most was his inability to do anything about it.

He told himself that doctors could at least cause patients a comfortable death. When fans were not available, there was always morphine. But then came an elderly man with pneumonia and heart problems. His hospital did not have the equipment to intubate him, so Arajo prescribed opium. But it also ran out. The equivalent of Tylenol was left to them alone.

“All we had to do was hold the phone so he could say goodbye to his family,” he said. “I felt completely helpless.”

I felt completely helpless. “
– Duana da Frota Araújo:

He resigned. One time he tried to return to work, but the anxiety intensified, and he left again.

“I want to go back,” he said. “I want to save lives for the rest of my life. But terrible mental stress. I’m on the abyss. “

That’s how a doctor in Manaus, Amazon, felt in January when he ran out of oxygen. At his hospital, everyone – doctors, nurses, nurses, physiotherapists – rushed to the patients who were trapped. They freed them from mechanical fans. Then they put the mask on the bag’s valve and began to push air into the lungs by hand, squeezing, releasing, squeezing, releasing for hours.

“It is tiring. “Your hands are starting to shrink,” said the doctor, who spoke on condition of anonymity because he was not authorized to speak in public. But he could not stop. The patient would die.

“Think about squeezing this bag for two hours in a row,” he said. “It started at 5 in the morning, I went until 7.”

Some days, another Manaus doctor, Renan Jack Emmont, finds it hard to believe what he saw. One of the patients was his age. 36. He is dead. One was his cousin, “at the peak of his life, full of plans.” The dead One was a relative of a colleague. “100 percent of his lungs are damaged.” Dead

Every day he is bombarded with more and more requests. In hospital wards. Desperate messages on his phone.

“My father needs a hospital bed.”

“Tell me about my wife. We have two children. ”

“My uncle needs a bed.”

There was a time when he felt only compassion. Now it’s excited.

Who has not lost someone? He thinks that.

“Who doesn’t need something?”



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