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A health service at war with itself

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File photo
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The past week saw state health services organisation (Okypy) trading barbs with unions representing government doctors and nurses, the latter accusing the former of haphazardly managing the endeavour against Covid-19.

Be it down to a turf battle or something else, it was bad optics with the squabbling coming at a time of peak patient admissions.

Both the government doctors (Pasyki) and nurses (Pasyno) syndicates effectively accuse Okypy of lacking an action plan to tackle the coronavirus situation.

The unions say Okypy has misallocated resources and, rather than administrators prepping for the anticipated winter outbreak, they instead left contingency plans to the last moment and are now having to play it by ear.

In a blistering statement, government doctors went so far to as to blame the organisation for the current lockdown.

“When the coverage of available beds for the pandemic barely reaches 10 per cent of the beds under Okypy, and you force the government to impose a lockdown, you cannot speak of ‘organisation’,” the doctors union said.

“When you decide who gets to staff the coronavirus clinics [ward] the day before it happens, and issue orders the day before, you’ve lost the right to speak of ‘organisation.’ And when, months late, you scramble to convert clinics into Covid-19 wards, likewise you have no right to speak of ‘organisation’.”

Hitting back, Okypy countered that the doctors must be oblivious to the unfolding epidemiological situation and are muddying the waters as any decisions taken are done so in conjunction with the heads of clinics.

Okypy said the syndicate was kicking up a fuss simply because days earlier pathologists at Nicosia general hospital were asked to pull one shift at Covid wards every three months.

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Be it down to a turf battle or something else, it was bad optics with the squabbling coming at a time of peak patient admissions

Piling on, Pasyno alleged that nurses assigned to coronavirus patients are being dangerously overworked, some barely getting a day off in recent weeks, and said this was Okypy’s fault.

Escalating matters, the syndicate issued a directive to staff at Nicosia general hospital not to exceed the patients-per-nurse ratio in the Covid ward.

Pasyno instructed its members that the 47 nurses allocated there should attend to no more than 28 beds.

“Should administration increase the number of inpatients, it must also immediately see to adequate staffing. In order to safeguard the safety of patients against understaffing, we call on our members to treat only 22 patients in these wards.”

In a scathing response, Okypy said it was not up to the syndicate to decide administrative matters.

It also accused the nurses union of misinformation:

“Regarding the Covid-19 ward at Nicosia general hospital, with a capacity of 28 beds, under the formula being applied – and to which you agreed – the number of active nurses required is 36 and not 47 as you claim.

“Today [last week] there are 41 nurses assigned to the ward, of whom six are absent for various reasons, leaving 35 active nurses, but this does not affect the smooth functioning of the ward. Nor does it justify the inactivation of six badly needed beds for our fellow human beings.”

Okypy hinted it might take legal action against the union.

Its spokesman Charalambos Charilaou pointed out that in recent months they’ve hired over 250 nurses, cut beds and surgeries to gain more staff, “but unfortunately, during this critical period, over 20 per cent of nurses are absent for various reasons.”

Earlier, Charilaou said the absences were due to sick leave or maternity leave, or parents looking after children, or being contacts of confirmed Covid cases, or having the virus itself.

And he pointed out that up to 20 per cent of nurses were currently inactive for a number of reasons.

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The 20 per cent number does check out; Panayiotis Georgiou, general secretary of Pasyno, confirmed it to the Sunday Mail.

But the trade unionist played it down as “not abnormal,” because during a pandemic healthcare staff, like anyone else, either get sick or are confined home when contact-traced to a confirmed coronavirus case.

Georgiou said the 20 per cent sounded like a flimsy talking point pushed by Okypy, in a bid to divert attention away from its own shortcomings.

“We had an agreement all the way back in June for the hiring of extra nurses. But during the summer Okypy got complacent and left the hiring to December as the second outbreak raged,” he asserted.

What’s more, the 260 extra nurses hired needed training, and weren’t able to take up active duty until January.

Georgiou claims also that of the some 260 new nurses, 30 to 40 of them “ended up behind desks, assigned there by the ministry and Okypy.”

The trade unionist brought up another example which in his view paints Okypy administrators as inept.

He said the organisation’s plan to create a new Covid ward (with 30 beds) at Larnaca general hospital has fallen apart.

“Although space has been cleared at the Larnaca facility, they haven’t been able to find any doctors for the ward.”

It’s understood that at the moment Larnaca’s Covid ward, though fitted out, is not operational.

Irking the nurses union further, in recent days Okypy has commandeered a number of nursing students.

The idea seems to be that these students would earn practice placement points toward their diploma.

“I struggle to understand the thinking behind this – recruiting young people who are ‘green’, without a diploma or nursing licence, and they want to throw them into the grinder,” said Georgiou.

According to Pasyno, the health ministry has a list of some 800 licensed nurses who for some inexplicable reason aren’t being deployed.

Rather than commandeer private-sector nurses, or qualified persons who are currently unemployed, Okypy is turning to unlicensed nursing students, it said.

Fending off the criticism of poor management, Okypy’s Charilaou told the Sunday Mail one need look only at the results to judge.

“Cyprus has one of the lowest mortality rates among Covid patients in the EU, you can look at the ECDC data.”

He said that right now 350 nurses out of some 3,000 in state hospitals are on some kind of leave.

At Nicosia general alone, 200 nurses out of 1,000 are not currently working for various reasons.

“But listen to what happened yesterday [Thursday January 14] at Nicosia hospital,” Charilaou added.

“Two nurses were diagnosed positive for the coronavirus. From interviews conducted among their colleagues, it turned out that 16 others did not wear masks nor maintain proper distancing during their lunch break in the kitchen. So these 16 had to be sent home immediately as they were deemed to be high-danger contacts. Their disregard for the protocols means we’re now deprived of 16 invaluable healthcare workers.”

On the high percentage of absent healthcare professionals – “make of that what you will” – Charilaou said it was even worse during the first Covid outbreak in spring of 2019.

“Back then, out of 6,000 doctors and nursing staff, we had 1,250 on sick leave or maternity leave.”

As far as Larnaca hospital goes, the official said the new Covid ward is fully outfitted and ready to take patients if needed.

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The prepared ward at Larnaca hospital

The ward was supposed to open last Monday, following a meeting held over the previous weekend.

“We found doctors willing to work in the ward. But on Monday, at the last moment, these individuals changed their mind. That is what really happened there.”

He said the issue should be resolved in the next few days.

Lastly, regarding the ministry’s commandeering of inexperienced nursing students, Charilaou stressed that they won’t be used at all in Covid wards.

“They’ll perform ancillary duties, freeing up hands in other areas. For instance, at Nicosia general every day there are four to five nurses assigned to measuring visitors’ temperatures at the entrances. Now, the nursing students will do that, so those nurses can look after patients. We can’t spare anyone right now.”

Asked why the doctors and nurses unions are making waves, the official declined comment except to say: “Take a guess.”

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