Health center on the brink What's happening now 23:07 on April 28th
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Due to the spread of the new coronavirus, work is urgent at health centers around the country. The public health center has an important role to connect patients and medical institutions, but now both sides are facing difficult challenges.
The Kita Ward Public Health Center in Tokyo has provided support to 61 infected people so far. About 10 people such as doctors and public health nurses are in charge of everything from consultation services to coordination with medical institutions.
Last week I visited for coverage. I've been on the phone since morning.
Over 100 consultations were received on this day. The main people are ward residents who complain about anxiety and medical institutions that accept patients.
Most of the consultations are about PCR tests. It is said that this public health center consults with medical institutions and conducts inspections in principle, but it is difficult to meet all requests with the current inspection system.
(Dr. Takashi Naganuma
, the lead doctor) “I don't know what the correct information is because it is an illness that I do not want to overwhelm. So it is difficult to deal with it. The people of the ward and the medical institutions have no place to hit us only. Shin: After all, I feel various inconsistencies, but the only outlet is us. ”
What is more difficult is securing hospitalization.
On this day, I searched for the hospitals for two foreign patients who were confirmed to be infected. Fortunately, the hospital we were accepted into was soon found, but it is said that she may be refused more than 10 times.
Transporting patients is not easy either.
Since there are not enough staff now, I am using a private emergency service for mild patients, but the service was flooded with reservations, and it was about 5 hours later that I could arrange a car did.
In addition, it is necessary to wear protective clothing when collecting samples from patients and transporting critically ill patients, and training is also essential.
The Kita Ward Public Health Center has increased the number of public health nurses by five from this month.
Still, he complains that he has insufficient manpower to handle the ever-increasing work.
(Dr. Naganuma)
“As the number of patients increases, the number of tasks assigned to public health centers is steadily increasing, but the reality is that it is not enough for the public health centers alone to do. I'm doing my best, but how far will it end? , We also deal with all the anxiety. "
Public health nurses who are “abused”
The harshest work of the public health center is hunting down public health nurses both physically and mentally.
A female public health nurse in her 50s who worked at a public health center in Tokyo who responded to the interview revealed that she was suffering from over 100 telephone consultations a day.
(Women's public health nurse)
"I'm often abused by the terrible words," Why I can't get the test ", and I'm often dissatisfied with the fact that the phone doesn't connect. I can afford to share it with the staff around me. Since I don't have one, my co-workers start crying and breathing during evening meetings, and even when I'm told I'm going to threaten me, I can't keep my mind all day long and I can't sleep at night. It
is said that the nerves are worn down every day to deal with infected people.
(Women's public health nurse)
“I will wear protective clothing when I visit patients, but I am extremely careful because I can't get out of one hair, so I must not infect my colleagues or family. As I concentrate on each and every action, my stomach hurts due to tension. Since I can't even go to the bathroom, I also restrict my water. Some colleagues collided with abdominal pain and anemia after returning home. ”
Regarding future anxiety.
“I think that we are at risk of being infected by the virus because the immune system will decline if overwork continues. We can call for support from other areas in the event of a disaster, but this time it is not No. We can only do it ourselves, but if one person falls down, it will be a great burden on other public health nurses, so it is very painful. ”
"Just do your best"
A public health center that has difficulty responding to the new coronavirus.
At the end of last month, the National Health Center Directors' Survey conducted a questionnaire survey at the end of last month, and received responses from approximately half of the 257 public health centers.
In response to this response, multiple responses asked if there was support from other departments. Only 38% received support and 7.4% received support from outside experts.
On the other hand, more than 40% of the public health centers are open 24 hours a day to operate the "Returnee / Contact Person Consultation Center," which accepts consultations for people suspected of being infected.
Opinions such as "I feel the limit as a public health center" in the free description, "Many public health nurses are already exhausted because there is no personnel or budgetary allowance and" just work hard "" "Cluster measures cannot be taken in such a state" Is sent.
(Professor Toshiyuki Ojima, Hamamatsu University School of Medicine who summarized the survey)
“This situation has occurred because the number of public health centers has decreased considerably and there is not enough manpower. While professionals such as public health nurses are close to the anxiety of consultants No one can do it because it is a highly specialized work that asks about current symptoms and who they have contacted. While calling out to experienced people and requesting cooperation from external professionals as well, I think there is a way to sort the work, such as leaving the consultation counter to people other than public health nurses.Infectious diseases may continue to occur in the future, so when reviewing the health center system and how it should be in the medium to long term. I think that"
Health centers that are being consolidated or abolished nearly halved in about 30 years
There were 852 public health centers nationwide in 1992, but they were consolidated or abolished by administrative reform such as the Great Heisei era, and in April this year it was almost halved to 469.
For example, in the 23 wards of Tokyo, there were 4 public health centers in Setagaya ward and Ota ward in 1997, respectively. In the city of Osaka, the public health centers in the 24 wards of the city were integrated into one in 2000. In addition, in Yokohama City, each public health center in 18 wards of the city was consolidated in 2007, and in Nagoya City, each public health center in 16 wards of the city was integrated into one each two years ago.
According to experts, due to the progress of consolidation, the number of staff who concurrently work in the fields of infectious diseases and mental health such as this time has increased, and it is not possible to secure sufficient personnel.