Two punx from Bologna involved in the covid-19 emergency as a nurse and an emergency care assistant tell us about their experience during this period
Radio Punk: News and media have been focusing on scientists, experts and politicians giving you no voice. So how are you, people on the ground, doing and feeling?
P (nurse): During the last few weeks I’ve heard about some tv reports, one of them aired by R.A.I. [Italian public TV], where some of my collegues were interviewed, but the core concept is always trying to push the specific moment’s political agenda. I despise with every fiber of my being this new “hero” label we’ve been given by the ruling political class that, up to just one month ago, demanded superhuman performances from professionals crushed under excessive work shifts, on top of customary overtime and denied holidays and leaves of absence.
S (Emergency Care Assistant): In terms of the science involved we cannot say much. We just follow the guidelines that often change from one day to the next. The thing that makes us feel bad is that the media is focused only on doctors and nurses. They are often depicted as the ONLY heroes in this emergency. The problem is that we have no degrees or diplomas in the field and we do not exist as a work category in Italy. The difference lies in the fact that we often go to patients’ houses and we do not know what the situation will be there (this goes beyond the current emergency. All the information we have is that which the 118 operator sends us. This being a new virus, however, makes it so that many details are not given. In turn, this puts us in the situation of coming into contact with a positive or assumed to be patient without the required PPE. Some of us lost their lives because of this.
RP: Did you understand what was going on from the beginning? Were you given clear informations in order to work and face the emergency or were you left to your own devices?
P (nurse): We had to wait for days, after the first cases started appearing on national territory, before we had some guidelines from the healthcare direction I work for. I don’t want to and I’m not interested in going into details about said dispositions since I don’t have the tools to evaluate their effectiveness. We know one thing for sure because of these peculiar circumstances, and that’s that persistent cuts to the healthcare system brought an already fragile structure on the brink of collapse. The “bed hunger” in hospital structures, the lack of personnel, of garrisons and itineraries apt to the correct implementation of the diagnostic and terapeutic procedures a citizen expects from his own public health service are no news. Obviously I don’t identify as a “citizen” and I don’t feel part of a nation, these concepts don’t belong to my mindframe, I don’t live to work, on the contrary, as most people, I work to live, and I work in the healthcare system.
S (emergency care assistant): I would say that is not the case. The problem was underestimated for sure. Information was scarce at the beginning. We received the first directives as the first cases arrived in Italy however it being an unknown virus, all was subject to change. It was common for the measures to change every day.
RP: Do you have the right P.P.E. (Personal Protective Equipment): what I mean is have you been working safely?
P (nurse): I never worked in close contact with Covid patients, so, according to corporate rules, in order to prevent new possible contacts we have surgical masks on and we have the patients wear them too througout treatment. Up until march I was working in a day hospital where we would give chemiotherapy, I was then moved to another ward. Before all hell broke loose at the day hospital we always had our FFP3 masks with valve on in order to be protected while dosing antineoplastics, if I recall correctly those were lacking since mid-late february. It’s no news that the worker’s and patient’s health comes second if not third when profit comes into play.
S (emergency care assistant): All ambulances are normally fitted with each type of PPE one for each member of the crew. Once the pandemic arrived it became necessary to have up to 4 or 5 changes in a day. There was a time in which AUSL, local medical organization, had trouble filling out all the orders that came from the associations it has a convention with. Luckily the foundation I work for has invested in order to get us all we needed. As they are scarce, the problem becomes the management of the available PPE. For example, when there is a walking patient, the PPE is given to only one rescue worker. In this situation, the driver stays at a safe distance in order to not waste any.
RP: How did you live through this situation? Was there a lack of personnel?
P (nurse): Having an encreasing number of operators tested positive we came to have a substantial reduction of personnel. Keep in mind that our starting point was already subpar if compared to the granted services. There were some recruitment notices in mid march, but they were temporary contracts mostly adressed to temporary workers of the sector. I immediatly took advantage of that since I was proposed a new contract with a couple more safeguards (just vacation and sick leaves, nothing fancy) and I can’t help but wonder if we really had to come this situation where hospitals are suddenly flooded with patients to realize our lack of medical staff.
S (emergency care assistant): As the emergency grew, the AUSL asked us a larger number of vehicles dedicated exclusively to the patients infected and thus our company had to hire more people. At the beginning the most exhausting thing was disinfecting the ambulance after transporting each positive or assumed positive patient. Something that could happen even 4 or 5 times in one shift.
Luckily, afterwards, an external service exclusively dedicated to sanitising ambulances was created. This made it so the service could be done in a timely manner which allowed us to actually take toilet breaks…
RP: Does the situation seem to be under control? How did you face it? Were you scared? Did you discuss it with your collegues?
P (nurse): I only know the situation of the company I work for, and yes, the response seemed to be adequate or at least it was trying to be so. Personally I wasn’t afraid of contracting the virus so much as to pass it on to my immunodepressed patients to whom it might have been lethal.
S (emergency care assistant): At the beginning that was not the case. Since the virus is new, we had no information. As things became clearer so they became “simpler”. I heard a variety of things from colleagues. I would say that the thing that we all had in common was the risk of infecting the people we have at home… I know of colleagues that have not seen their children since the beginning of this.
RP: What was the problem’s perception among medics/nurses/healthcare operators?Did you manage to work as a team?
P (nurse): As in every strictly hierarchical working environment “teamwork” is a very loose concept.Not that this situation required it more than our daily routine anyway. In my opinion perceptions were various, in a range that goes from panicking and trying every possible trick in order to keep those dreaded Covid patients out of one’s own ward to teaming up and taking turns in Covid wards so that everybody could take a breath.
S (emergency care assistant): The relationship between us rescue workers and ER nurses has not really changed. All that is, is handing the patient over. Actually, if before you had the chance to talk a bit, now, since we all wear possibly infected suits, we are somewhat further apart. I would say we socialised more with those sanitizing the ambulances. We are the lowest men on the totem pole and we began showing solidarity among us.
RP: This experience isn’t over yet but do you feel it gave you something on a personal level?
P (nurse): Maybe we, as healtcare operators, were less concerned than others since we kept going with our working routine. Certainly there was more tension, but at least we had the chance to earn a living.
S (emergency care assistant): To be honest it left me indifferent. My job always has to do with human suffering and death. I think that I am not saying anything original when I say that humans want to dominate the world and yet are dominated by fear. Before that was the fear of the immigrant that steals your job or the Muslim that wants to blow you up, now it is a virus that a colleague, a friend, a parent might have transmitted you. The only important thing is to have someone not to trust.
RP: Was the situation well handled locally?And nationally/globally?
P (nurse): I’m afraid I don’t have the tools to judge healthpolicy choices (maybe they were more economy than health driven, but whatever) made in the last few months beyond pub talk level, so let’s leave that for our next night at the pub.
S (emergency care assistant): As far as I had the chance to see in the hospital and retirement homes in the Bologna area, I would say yes. Notwithstanding that initial there have been quite a few errors of judgment, I saw entire ordinary medical practice units being transformed into Covid-dedicated ones. I saw ICU beds being conjured out of nowhere in order to face the emergency better. What is for sure is that the WHO was slow in declaring a world pandemic and thus, even when it came to each individual national level, the decisions by the governments were taken in an unseemly manner. Here we saw things getting done in the usual Italian way.
RP: What do you think about the public healthcare system and what should we do to highlight the dismantling of said system?
P (nurse): This question might need its own interview, it should be adressed to exeperts of this kind of issues, and I’m certainly not among them 🙂 From my point of view, given what I could see and experience first hand we certainly are in a situation in which cutbacks are relapsing on allotted resources. And I’m not necessarily talking about economical or human resources , but also about diagnostic itineraries resulting in a mismatch with the population’s broad needs. For example I’m referring to screening itineraries of the main oncologic diseases, but the same could go for a variety of other areas.
S (emergency care assistant): The national healthcare service is actually region-based and thus it is impossible to trace a leitmotif in terms of what solutions to bring to the table. It is something that has to be considered in terms of what is before that. While in Italy there are a lot of private institutions. Most are accredited and support the public ones, especially when it comes to the clinic and long-term recover services. Meanwhile, they are not part of the healthcare emergency sector. We can consider ourselves “lucky” because the treatments are available to the whole population. Obviously, much like other sectors, the problem is that the business mentality and interests rule supreme to the detriment of the actual needs of the sector.
RP: This whole situation put you to the test, to say the least. Are you happy with the working choice you made? What has been your relation with the patients especially the infected ones?
P (nurse): I work to live and not the contrary, that said it can’t be disputed that wage labour in any form is a deprivation of personal freedom, often with the traits of blackmail (if I may use the term), where you sell your life to a boss that pays it back to you in instalments, and you’ll always be dependant until you’ll submit to this blackmail. Banalities aside, I’m happy with the work I’ve chosen, I don’t see myself doing anything else. Even in such a difficult situation I didn’t have the slightest doubt. The relationship with patients is very different now, we can’t even see each other in the face. This implies a coerced distance, painful especially for chronic patients.
S (emergency care assistant): I began working in this sector by chance and it now is the only thing I know how to do ahaha! Joking aside, it was a necessity at the beginning. However, in time I began to feel a sort of satisfaction in feeling useful to those that are in need. Even if it is a really hard and often dangerous job for one’s physical and mental health, I am satisfied as of know. I do not know what the future holds for me…
RP: Do you think there will be more safeguards, more concern for you as workers and some improvements?
P (nurse): As we were saying earlier I strongly doubt that. Gain comes before any human life, be it the one of an operator or of a patient.
S (emergency care assistant): That is what we are hoping for! As I mentioned earlier, my work category does not exist in Italy. It is often unfortunately associated with voluntary work and it is my opinion that it is an obstacle for us to be recognised by the law and as a professional for us emergency care assistant. For example, the Governor of Emilia Romagna, followed by other governors, established that a 1000 euros bonus will be awarded to the medical professionals that are involved in the Covid emergency such as doctors, nurses, social health workers, radiology technicians, GP but we are not considered in this category!
RP: Are you able to have some Covid free moments?Can you find some peace of mind after work and beyond your acquantancies’ (obviously justifiable) questions and curiosities?It’s important to understand whether people realise that, if it burdens you or if you came up with some “ways out”.
P (nurse): As every healthcare worker I felt lucky to be able to preserve my everyday working routine even though it proved to be overwhelming. Working a lot and staying home the rest of the time is certainly better than just being sequestered at home, but I must say there weren’t many Covid free moments
S (emergency care assistant): In a situation like so, I am one of those that spends the most time ouside of my home. While I do understand the needs of those that feel they have had their freedom curtailed, once I get back home to my girlfriend and my two four-legged friends there waiting for me, (they are the only ones that can stand me) they allow me to live my place like a space where I can flee my problems while I listen to a record or play Football Manager. I miss my friends, the Bologna Punx meetings and the gigs obviously…
RP: Can you tell us an episode or moment that gave hope/comfort/glee?
P (nurse): Nothing pops to mind at the moment, not because there weren’t any but, at least so I think, because my mind still has to process the whole story since it’s not over yet.
S (emergency care assistant): In this situation it is harder to establish a relationship with the patients. Often the service happens as fast as possible and there is always a feeling of tension and fear of becoming infected. The garrisons make communication even harder. Hope and a couple of smiles are there once the patient get discharged from the hospital. I would rather talk about my first experience with the Covid virus. During a transport, one patient coughed no more than twice and I right then thought that this whole deal was blown up by the media… The second one I transported was sent directly from the infected emergency ward to the ICU where they were intubated immediately. Without even being allowed the time to take off our suit, they gave us the task of removing a corpse from the infectious diseases ward. Outside of the room the nurse told us that the person sharing the room with the deceased had been told the deceased was to be moved to another ward. Because of that, me and my colleague had to go over the usual routine we use with patients, this time we had to do that with a deceased person inside a plastic bag. After the following shift I then met the crew of an ambulance coming from Piacenza with an intubated patient asking me for directions for the ICU…
For the first time in almost 10 years on the job I felt a feeling of unease.