Starting a medical career in the midst of a pandemic

Report from a doctor in Bulgaria

Nari just recently became a doctor in the dermatology department in Bulgaria. She is now working additional shifts in the COVID-19 isolation ward as well. What does it feel like to work in such environment?

“They sent me and my friend from the dermatology department because everyone else refused. That’s kind of funny because we are taking nasal swabs which should be done by specialised doctors. They told us, you have to do the test because you are young and most unlikely to get the virus, but that is wrong because I know a colleague who has died from it in Spain who was 25. I mean, they just do that because it is easier to exert pressure on it because we are just at the beginning of our career.”

“Right now it is not that scary because we have found a routine. But two months ago when it started, when we first encountered the virus was frightening. There was no information available, we only knew that it is spreading fast, which led to a bit of panic. That’s when the dermatology department was essentially closed. There are still one or two patients per day, but these are very severe cases. That’s nothing, usually there are like hundreds of people checking in each day.”

“On that day I just went to the clinical laboratory and I had to put on the safety equipment. Nobody told me how to wear it. We have this huge overall and then two pairs of gloves and huge glasses. I had to teach myself on youtube, because there is a particular way to do it to ensure that you do not contaminate yourself while wearing it, to ensure that you do not get in touch with the virus or other bacteria. And there is also a certain way how to remove it again.”

It seems that the effects of privatisation can be clearly felt in Bulgarian hospitals at the moment. Access of testing is related to economic status, potentially leaving behind a huge number of people. This may not always lead to an allocation of rare test kits that would be beneficial for all. Better-off people with no symptoms are more likely to get tested than people with no means but who might have symptoms:

“In the hospital I am working at, we do not test COVID-19 patients in the usual wards (this seperation is not done everywhere). It is, in fact taking place in a caravan. Since the hospital is private and belongs to one of the best, we are in a fortunate situation. But the test is very expensive and not everyone can afford to take it. It costs 120 lev, about 60 Euros, and I think that affects the clientele that gets to access the testing facilities. People who get tested are mainly medical staff members from other departments who are suspecting to have it or rich people who can afford it who get tested. Even though there is also no general testing for nurses, doctors or other staff.

“The first time I was working in the caravan, I had seven patients, none of them testing positive. It was mainly people people who had travelled or just wanted to see whether they had it. People may not even have had high temperature or other symptoms. Once I had a patient who said ‘I am doing it because my wife wants me to do it since my son is a doctor and we might gt exposure’. But not even I got tested with the specific test, just the blood test. When we are taking the swabs, many people do not feel comfortable during the procedure, because it is unpleasant. They start to cough etc. and this may lead to the swab not even being taken correctly. So maybe that could be another reason why there are not too many cases (Bulgaria has about 1600 cases as of May 3rd). Sometimes it is not all recorded very well. It is very hard to tell at the moment whether those information are correct.”

“This picture you can see above was actually from the beginning when there was not too many people. Now we have up to 70 people coming in. One day when we had 70 people I took samples without any interruption for four hours straight. At the last patient, I cried, I was shaking because I was hungry and it was so exhausting. If you are just at the beginning of your career, it is really difficult to say something against this. I don’t know how colleagues are doing it, who work with masks on for 12 hours, no one should be doing that. So I had to call the nurse who is in charge of the testing ward and I told her and the doctor who is her supervisor that I feel horrible. I told them that they should not make us do such long shifts. Especially, because afterwards, we usually take shifts in the dermatology department. Just think about it, if I get exposed to a COVID-19 patient and after that, I go to another department, that is a risky system. But we raised this issue so they are now considering to change that.”

And what is happening outside the hospitals?

I don’t think people recognise what is going on in the medical world. They do not take the quarantine very seriously and still meet others and enjoy. My family is one of the few to follow quarantine rules. There was a time when there was applause at nine in the evening, that’s nice but that does not really make a difference. They have promised 1000 lev for all medical staff working on the front line, that’s like 500 Euros, that’s like a joke, it is ridiculous to pay people so little when you ask them to take high risks as well. There are many statements that everyone is grateful, but it does not really translate into higher wages. And then you have people who get very aggressive with staff in the emergency department (there has also been reportedly someone who ran away from the hospital after having tested positive for COVID-19).

I haven’t had the chance to see my friends for two months, or anyone who does not live in the same house with me. My family was worried for me at first but now they are getting used to it. I am thinking about them everytime I go to work, because I put everyone at risk. I have a sister and old grandmother who lives with me. And it is not fair, because they do not go out themselves. But it is my job and I am assigned to this task.

There are many reports of women facing violence by their boyfriends or husbands during the lock down. But luckily there is also a very open and public discussion about it.  That’s why a public hotline has been started and you can simply call it and get in touch with psychologists. Not only for domestic violence victims but also for people who face mental health issues during the lock down. (maybe women also suffering from economic anxieties of their partners as this may unload in the form of domestic violence).  

I am going to continue with this work this until the pandemic ends, which will hopefully be soon, because I also want to learn more. But people would also have to take the disease more seriously. Many suspect that the quarantine measures are only imposed to control people. To some extent that may even be true.

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