The head doctor Vaclaŭ Januška told about the achievements of the capital 4th City Clinical Hospital, the fight against COVID-19 and the role of the medical team on the eve of the 60th institution anniversary in an interview to "Medical Reporter".
The origins of Belarusian urology
The history of the formation of Belarusian urology is connected with your institution. The Republican urological center operates on the basis of the profile department. At the same time, in recent years similar divisions have been opened in other areas...
Vaclaŭ Januševič, how would you continue the phrase: “Today the 4th City Clinical Hospital named after M. Saŭčanka is .... "?
A hospital with its own foundations that have been formed over 60 years and passed on from generation to generation. I try to preserve them all. Beside that, we have a strong team of professionals: 1 290 employees. But the inpatient facility is not small either – 888 beds, including 10 off-budget.
Urological departments (there are 3 of them) are designed for 180 beds. Ever since the time of Mikalaj Jaŭsiejevič Saŭčanka's work, all the key techniques for the treatment of congenital anomalies of the urinary organs, neurogenic urinary disorders, urolithiasis and other diseases of the urinary system have been mastered and implemented here. Of course, today the preference is given to minimally invasive interventions, but open surgeries are also performed. In addition, the department of X-ray shockwave distant lithotripsy and endoscopic surgery has been operating for almost 30 years. The presence of a radioisotope laboratory in the institution allows to quickly and accurately perform differential diagnostics and clarify the diagnosis.
The City Nephrology Center has been opened on the basis of the 60-bed nephrology department. By the way, in 1971 Mikalaj Saŭčanka performed the first kidney transplant in the BSSR exactly in our hospital. And a year before he also organized a hemodialysis department, which is the part of the nephrological center now. The department operates in three shifts and can simultaneously receive 27 patients.
The city center of vascular surgery was opened in 2003 on the basis of a specialized department. It provides planned and emergency medical care to patients with lesions of the aorta and main arteries, patients with venous pathology. After the angiograph was installed in 2014, patients with ACS began to receive medical care. By the way, today we already have 2 such devices. The center's specialists perform a wide range of high-tech surgical interventions. In particular, hybrid operations on the vessels of the lower extremities are carried out together with endovascular surgeons. This is very important since the number of amputations associated with vascular pathology is growing worldwide. In our case a person gets the opportunity to continue a full-quality life.
In addition, otorhinolaryngologists provide specialized assistance to all Minsk residents with ENT pathology around the clock.
Herniology and bariatric surgery are one of the most significant areas of the clinic's work. What results have you achieved?
We founded this area in the country. The city center of herniology and bariatric surgery was opened on the basis of the department of surgery for the treatment of recurrent and recrudescent hernias of the abdominal wall of any localization, incisional hernias of large and giant sizes, diaphragm hernias and others. But, of course, the main category of patients who are sent there are people with alimentary-constitutional obesity. As a rule, they come with a weight of about 200 kg. In such cases, ileo-shunting operations and the installation of bandages are performed. But the decision to perform surgery is made at the council, and the patient must undergo a preliminary examination by a psychiatrist-narcologist. And I must say that the center’s specialists have achieved good results over the entire period of their work. Many young women who could not become pregnant due to their excess weight, subsequently give birth to children. By the way, people from other countries also come for treatment.
To be honest, the surgery work has been suspended in our hospital now. Since March 22, the hospital has been redesigned into an infectious diseases hospital and retains this status up to this day. And now we accept only COVID-19 patients with acute surgical pathology.
Talking about foreign patients, where do they mainly come from for treatment?
They come from Russia, Ukraine, Germany, Lithuania. The department of plastic and aesthetic surgery with 10 beds is in great demand among foreign patients. It also has its own operating room with all the necessary equipment. The list of performed interventions is wide: from blepharo- and rhinoplasty to liposuction and elimination of body defects by adipose tissue transplantation. Of course this department suspended its work due to the epidemic situation, but two months ago the work was resumed. Although, again, due to the epidemiological situation and the closure of borders, the flow of patients has seriously decreased. Nevertheless, people come to us. They are attracted not only by prices: some want to get to a certain specialist which has positive reviews.
Ready for action
You have already noted that the clinic is still working with COVID-19. How did the institution prepare for the pandemic?
According to the order of the Ministry of Health, we started to organize training since the beginning of February: we taught doctors and nurses how to put on and take off PPE correctly. In addition, "clean" and "dirty" zones were marked in blocks according to the construction projects. Moreover, this issue was necessarily agreed with infectious disease specialists and epidemiologists. So we were completely ready for the start of the pandemic. It only remained to properly organize the work to avoid infections among the medical staff. Yes, some of our employees have personally encountered this infection. But they did not contract it at the workplace.
How did the nursing staff react to the changes in working conditions?
There was no panic. Of course, everyone has the self-preservation instinct. Therefore, those employees who were afraid of contracting a new infection were sent on work or unpaid leave. A few have decided to leave. But before that, I personally talked with everyone, offered to take time to rest and think. After all, I have been working in the clinic since 2012. Over the years, I learned to feel my team. So we never had any problems in communication. One nurse came several times with a letter of resignation. We talked with her. She was given an extra respirator to make her feel more protected. So this nurse didn’t quit the job. And now she admits that she is not afraid to work with covid patients: as she said, she’s used to them already.
I know that many doctors were afraid not so much to get infected themselves as to bring the infection home. Therefore, they isolated themselves in those difficult days. What can you say about your team?
The capital's doctors were provided with a hotel for the time of the pandemic, and many of our employees lived there. OJSC "MAPID" also helped us by providing several rooms in a hostel. Transport was organized to make it easier for employees to get to work. Although, of course, someone stayed overnight in the hospital: the flow of patients increased, and help could be needed at any time of the day.
Were the COVID-19 patients admitted immediately?
We started with first-level contacts. And at that time many of them were dazed, even in a panic. They seemed to feel normal and did not understand why they were locked in the ward, forbidden to go out into the corridor, etc. Although, I must say that the conditions for staying in our hospital are normal. In 2018, a new therapeutic block with 300 beds was opened. And first patients were hospitalized there. The block was built according to modern requirements: semi-private wards as in the infectious hospital. Then we started to admit patients exactly with COVID-19, including severe ones. Many passed through the department of anesthesiology and intensive care – for such patients 30 beds were allocated. We constantly consulted with infectious disease specialists. Yes, the medical staff had a hard time then. For example, it is impossible to get used to wear PPE for a long time at once. And besides that, the volume of work has increased. But in general I think that the healthcare system worked well during that period.
Have you provided assistance to such patients despite the duties of the head doctor?
I participated in consultations and went to the intensive care department obligingly. How could it be otherwise? An employee comes to me and says that he is afraid to work with covid patients. And from my side it would be wrong to calm him down if I didn’t meet such patients myself. Then I had to make decisions on the treatment tactics as a doctor, and deal with household affairs as a head. If there were no meetings, then I went to these patients for 2-3 hours. And my deputies visited them strictly every day.
Are COVID-19 patients still admitted now?
Yes, but there are not so many of them, and their condition is less severe. At the beginning of the pandemic, people were not particularly aware of the danger of a new infection. Therefore, they delayed seeking medical care. And now they are more informed. In addition, there is an opportunity to take an express test.
Are you expecting a second wave of the pandemic?
It is hard to tell. Because our hospital started working with covid patients in March and continues up to this day. Now we see a seasonal rise in the incidence of acute respiratory infections. But we meet it every year. Patients with a high body temperature, pneumonia are admitted, and their tests for COVID-19 are negative.
The sign of good management
You noted that you have a great team of professionals. How much this support is important to you? How do you organize the work with young specialists?
The team plays a big role for me as a head. When I first took the post of the head doctor, I changed the entire administrative apparatus. Because technically they are my assistants. All together we make sure that there is discipline in our hospital. And this is the sign of good management. In this case, it is more pleasant for employees to go to work.
In general, our team is very diverse. There are those who have worked in the hospital for over 40 years. Young professionals come. Let me remind you that students with high scores are assigned to clinics. These are gifted young people that know foreign languages.
We have organized mentoring for young personnel. And this is not only formal. This form of work is especially important in surgery and anesthesiology. The hospital performs many operations which are accompanied by long-term anesthesia. Therefore, we need competent specialists. By the way, mentoring is also organized for the nursing staff.
But in addition to work, we try to provide support to young people. In particular, the housing issue is under control. When we bring all the new arrivals together, each nonresident employee reports to me personally whether he has entered the queue to receive a hostel.
There is also such a tradition: all young specialists should know the history of the clinic and the biography of Mikalaj Jaŭsiejevič Saŭčanka.
What inspires you in your work?
Probably the pride that you are a part of the team of the 4th City Clinical Hospital named after M. Saŭčanka. Everything here was founded by Mikalaj Jaŭsiejevič, these walls remember him. The building of the urological block is awaiting reconstruction. But we decided that the changes will only affect the premises, and the appearance will remain the same as it was in the professor’s time. Now the construction of an extension, where the building will subsequently move during the reconstruction, is underway. In addition, the new building will be equipped with modern operating rooms, CT and MRT machines, a distant lithotripsy machine and endoscopic stands. At the same time, it is very important for me to save the team.
A modern operating room will be provided for the otorhinolaryngology department in the near future. The work should be completed by the end of this year.
Source: Medical Reporter.