Interview | "This summer I would not remove my mask.  It is cumbersome, but it is a much greater benefit than the harm"

For the first time after the pandemic began, 12,000 hospital managers and directors will meet again in Malaga next Sunday in the 22 National Congress of Hospitals and Health Management of which the doctor will be president Jose Antonio Medina Carmona, Head of the Radiation Oncology Service at the Virgen de la Victoria Hospital in this city. As a prelude, this week a pre-congress conference was held in Seville where those responsible for the organization reflect on the consequences of pandemic and about the future, which involves the involvement of new technologies to give the patient a more direct and “immediate” treatment.

Dr. Medina saw how, at the beginning of the pandemic, the income from Covid multiplied by ten in 15 days, how it was necessary to convert his Malaga hospital into a “hospital Covid” that displaced diagnoses and treatments of other pathologies. A year later, alert of the fatigue shown by health personnel and that, despite the good progress of vaccination, we are still not at levels to behave as “if nothing happened.” For the moment, he believes that we should not let go of the face mask and he doubts that we will return completely to the normality of before. The pandemic, he says, has shown that “We are very vulnerable.”

In what situation are the hospitals at the moment?

In Malaga we are not bad right now, but I cannot give you an overview.

Has the overcrowding we experienced last year dissipated?

My feeling is that we are better, there are already vaccinated and there is not the care pressure that there was before, but it continues to exist.

How do you think we will be in the next few months?

I hope we are well, that with the massive vaccination that is being done we will reach a herd immunity that allows us to have, if not a summer like the old ones, something better than last year. It will also depend a lot on each one. I insist a lot as a doctor and as a manager that, regardless of the vaccine and the assistance that can be given, it is in each of us to do things well.

As a health worker, what do you think of the images of midnight when the state of alarm subsided?

Worrying If we are sensible and apply a little science, we know that, right now, the vaccination percentage is not so high as to say that nothing is wrong and we take off our mask and give it our all, and you have to take personal responsibility.

Does another summer with a mask await us? The United States no longer requires it indoors and there are communities here that ask that it not be used outdoors.

I wouldn’t take it off. It is a personal matter. I am a manager, not an epidemiologist or preventive, but I understand that right now the mask is an important element to take into account, such as washing hands or maintaining social distance. It is cumbersome, but I understand that it is a much greater benefit than the detriment. And although we are vaccinated we must continue to maintain precautions because we can be transmitters, that is also important.

What changes has the pandemic forced to introduce to hospitals from a management point of view?

It has been very troublesome, especially in the beginning. In the first wave, the hospital had to be transformed into a Covid hospital. It was a tremendous effort to organize the personnel and especially the work of the professionals. In Malaga, in 15 days we went from 25 to 250 patients admitted for Covid, it was the entire hospital. There were diagnostic difficulties, it happened all over the world and a tremendous amount of management was carried out and the professionals were very good. There were people who were not specialists in internal medicine and everyone collaborated, surgeons, nursing … We had to get this out and we all worked in the same direction.

“In the first wave, the hospital had to be transformed into a Covid hospital”

How are the toilets emotionally more than a year later?

It is complex. Each one experiences the pressure in a way. There is fatigue, because it seems that [la pandemia] it goes and comes back. People who work in the ICU, apart from work and affectation, we have unfortunately had ineffective treatments and everything accumulates. When you start to work, work and work but you have a horizon, you say well, okay. But when he comes back every so often, that is discouraging. As it happens in society, we are all wishing we had a minimum normality. Not the old one, because we will not have it, but a minimum normality

Will we never have it?

I do not know. This has shown that we are very vulnerable, do not be surprised that another one comes ahead, I do not know. But [la pandemia] has made it clear that things have to be done differently. Primary care has to take a tremendous leap and not just focus on hospitals. Good health is what is done through education, from when children begin to grow up and be in school, health begins there, with a good diet, a good economy and the last thing would be to go to the hospital. Would be ideal.

One of the most pressing problems last year was the lack of equipment. Is that fixed?

Just as there are things that were done wrong, the investments that have been made have come to solve the problem of the protection of toilets and diagnoses. Now there should be no problem. There is PCR, protection, beds … it is not a problem of lack of material but rather that there are more or fewer patients and fatigue, that we think we go out and come back.

What things have been done wrong?

I think it is difficult to say because you have to do a broader analysis with a time perspective. Say what has been done wrong when a pandemic comes, that nobody knows, nobody knows, for which nobody is prepared. I say nobody in the world, because it also happened to the Chinese, it is happening to India. It is very difficult. At the political level, everything is very radicalized and very influenced by social networks and there has not really been an impass where public authorities and managers have been able to have time to think about what to do. It was all very fast, like the disease itself. At the rate that the emergencies were coming, it was impossible to say ‘we stopped and thought. You had to act.

“There has not been an impass where public authorities and managers have been able to have time to think about what to do. Everything has been very fast, like the disease”

Some measure that is the result of urgency or lack of reflection?

It has been an accumulation of things. I think the de-escalation after the first wave was rapid, basically thinking about the economy. I understand that with certain things you can be wrong or close, and you want to be right. And you risk many things because a country is unemployed … You have to eat because, if not, the disease is another.

Do you think the state of alarm should have been prolonged a little longer now?

There I don’t know what to say. I think it has been different [que la desescalada] because now there are vaccines, it is very different. What I would appeal to is the answer is individual, it is a question of each person, but I am not going to get wet in that.

As an oncologist, to what extent has the pandemic displaced the treatment of other diseases?

Between 20-25% of patients diagnosed with cancer. Cancer are almost global. The pandemic has caused people to stay at home, to be afraid (we are all afraid), to paralyze activity and prevention campaigns. There are patients who come with more advanced stages than was normal and we have also seen a decrease in care, which we are recovering little by little. The impact in oncology has been seen, but also in other pathologies. When you do a monograph on Covid from a hospital, you don’t see the part of diseases that are there.

“The pandemic delayed the diagnosis of between 20 and 30% of cancers, now we are practically in normal activity”

How long will it take to get back on track?

I think we are practically in normal activity. At least the area in which I work, right now I would say that we are almost normalizing the activity.

I ask him about something that is a recurring complaint: the prohibition of accessing hospitals as companions, even ultrasound scans that only mothers can attend. Is it still necessary to maintain these restrictions?

I, who am an oncologist, understand the complaints. But a hospital is not your home, there are patients, diseases and the possibility of contamination. And limiting access, both to rooms and companions, is an efficient measure because close contact of a positive can infect the patient and staff. I see that measure very prudent, [aunque] the cases will also have to be seen. But right now I see the restrictions on access to hospitals as very prudent. We will see a little later, but for now I see them well.

“A close contact of a positive can infect the patient and the staff, I see very prudent the restrictions of access of companions to hospitals”

In his welcome greeting to the National Congress of Hospitals and Health Management to be held in September, he says that the health world is going through “moments of uncertainty”, what do you mean?

After the year of the pandemic, it has been shown that we have a good health system and we continue to have it, but that there is room for improvement. The challenge from now on that the pandemic is under control is how we want to approach health in the present and in the future. We are witnessing very important changes at the health provision level. For example, technology companies like Amazon are going to join in providing health.

How?

He has made a commitment to healthcare in the United States based on telecare, on a doctor at home, immediately. It is a very important paradigm shift when it comes to understanding health care.

What will this paradigm shift lead to in healthcare as we traditionally understand it?

As our motto says “Health 4.0.”, The patient already present and in the future is hyperconnected, he wants to intervene in how the health system is organized around him, he is going to claim his place and we must give him an answer that is defined Health 4.0, a medicine based on scientific evidence but that can be done in another way. Let the patient speak more and more. We are going to do what really matters to the patient and affects him, hand in hand with technology.

“The new paradigm of health is that the patient can participate in decisions, why the hospital is only open tomorrow or why there is no activity on Saturdays and Sundays”

Can you give me an example?

If I ask for an appointment and they give it to me for two months, I want immediacy. Let someone answer my problem with a device. That if I have a problem with diagnostic tests, they are done as quickly as possible. That when they have to attend to me I can participate in the decisions, for example, why is the hospital only open in the morning if I can go in the afternoon or why there is no activity on Saturdays and Sundays. They are examples that we have to begin to address.

But that means ending waiting lists or allocating more financial resources to extend hours in hospitals and clinics. What contribution does the public administration have to make to make this a reality?

Well [ríe], what managers do is try to make the health policy of the country or the autonomous community as efficient as possible, that is the manager’s mission and it is independent that it is [un hospital] public or private, we have to do the same efficient management since it really adds value to the person. When I say value, it is that when doctors and health workers act on the patient, that he not only finds only the medical question. When we operate on a knee, the clinical experience is different from knowing if the patient can go to work or their expectations when having surgery have been met, for example, because before he could run and now he cannot. That these parameters are also contemplated, not only the operation. That is the challenge we have right now.

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