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The small village of Mazsalaca is located in the northern part of Vidzeme, near the Estonian border. The Mazsalaca hospital is specialized in palliative care and does not miss a patient. How has a city with such a small population been offering such services for years?
SHORT:
You should also work with relatives of patients in the countryside
Family physician Edgars Grandans, head of Mazsalaca Hospital, is also a member of the Mazsalaca District Council.
In the hallway, at the door of his wardrobe hanging on the wall, a powerful radio bed. Grandan says that he is there so that people in the hallway can not hear the discussion between a doctor and the patient. The interest in the health of the other inhabitants of Mazsalaca is high. The hospital itself is relatively new – built in the early 2000s.
"About 15% of the population lives in well-maintained homes and in many cases, there is a stroke and that the toilets are in place, it does not have any water drinking, home care is extremely difficult because this person must turn on the oven all day do It must bring in water, wash it, take it out, "explains Grandan.
Grandan explains that in rural areas, palliative care is more than just hospital work in the cities.
Working with parents at the patient's place of residence plays an important role, which must be adapted to the new living conditions after discharge from the hospital. The choice of palliative care was encouraged by Vilnis Sosārs, head of the palliative care department at the Riga University Clinical Hospital.
"Usually, in rural hospitals and district hospitals, patients played the role of a son-in-law because it was thought that surgical, traumatic and more radical services were the most important, and these patients I say , were a son-in-law.
And when we started working, we felt that patients had an important attitude and that they felt the key to everything. He was at the heart of this process, "says Grandan.
Patients also come from Riga
Most patients from Mazsalaca Hospital are Vidzeme, but they are also Riga patients. There is a total of 50 beds in palliative and social care.
"But that's not enough. It seems a lot, but we are very overloaded.
We also often do what we should not do – that patients are lying in the hallway. At any given moment, the demand for the hospital is quite high, "says Grandan.
The hospital has a lot of short corridors, walls made of wood panels. On the first floor there are family doctor's offices. Top – Palliative Care.
At the head of the hospital, Grandan says that they were one of the first in the rural area to turn to palliative care.
The patients in the room are both in the rooms and in the corridors covered by the curtains. The rooms are broken down by bad. Grandan tells you if a patient wants two TVs – get it.
"Here we have a dining room, but more staff are coming. Here, we are 100 years old who are sleeping. Man with a light spirit. Well, it's welfare, "continues Grandans.
Chaplain – believers and unbelievers
Then a small bright room with icons and a cross on the walls. There are chairs and even small electric organs. It is the chapel of the Mazsalaca hospital, where is worked the chaplain Marta Lulle.
"In Latin" pallia "is a coat, so" hide "," protect "these patients, let them be here to recover, and each chapel should have a chapel and a chaplain," she says.
Lull explains that in the palliative care unit, the chaplain works with all the people who wish it and that it is irrelevant whether he is a believer or not before entering l & # 39; establishment.
More importantly, the chaplain should not impose his presence on those who do not want it.
"Those who have been here for a long time, the sick, they have become friends, and I know what to talk about, and with a few words, I already know how it happened last week," says Lulle.
She noticed that here at Mazsalaca Hospital, the services of each chaplain were used differently.
"Each piece has its particularities – do we ask a father-in-law?" There are rooms in which we find ourselves in the hands – feel this close unit There are rooms that like to read a psalm. Because reading the scriptures is something special for people. It must be said that it is the elderly who are here. They know God since childhood and others are studying at school. They are relieved to find that there is no chance of hiding their faith here, "says Lulle.
She believes that the ability to fulfill one's spiritual desires is important for the maintenance of human health.
State-funded care is not always enough
For other questions, Ilzīte Celmiņa, social worker at Mazsalaca hospital, takes care of the hospital.
"You must know your loved ones, find out what he / she has at home, you must also know who will pay for him or what he / she should pay for." Local authorities, other family doctors need to be aware. It is never for us that we write without knowing that it must remain. Now, children also want to take a patient home, but he has learned to walk after a stroke – quite stable. So we showed how to make an elevator available to the toilet to make it easier to get up, the handle can be put in place. Well, you can equip your home to make it easier, "says Celmins.
Although palliative care is a paid service in this hospital, the demand is still strong.
Grandan is convinced that this is not simply due to the fact that the surrounding houses are rarely landscaped. There is also a short stay paid by the state in palliative care units.
"This is linked to the state-funded palliative care unit located in Valmiera, about 46 kilometers away. It works well, but the problem is that the state has planned that patients would be paid a case. Regardless of the fact that he sleeps 5 or 35 days, the state pays a certain amount for a case. Hospital funding rules for large, multi-profile hospitals require them to be treated for seven to ten days.
In many cases, the pain or exodus of decompensation is, in many cases, sufficient, but in many more cases, these problems are not solved, "explains Grandan.
If a person needs to be fed with a catheter or if there is a lot of bedding, this can not be solved at a time when the patient can stay in a state-funded palliative care bed.
Many, including loved ones, need to be involved, so fast that a few days of care is usually not enough.
"It is always necessary to work with parents and it is extremely necessary because parents can be explained a lot more, and the impact of parents on the patient is a little more important. This is why parents need to be informed of the diagnosis. They have to talk about how they talk to the patient, "explains Grandan.
The Mazsalaca hospital is also fighting for the workers
Funding for hospital care comes from both the state and local government, but is mostly paid for by patients.
"We have a day care center that is partially funded by the state, but it is relatively smaller. Then there are those who pay for themselves. Although this payment is much lower for us than elsewhere, it represents a heavy burden for many of its members. And the third is the local government – they have enough single people who have to put the municipalities somewhere. If this person can take care of herself, maintain, walk, she is usually placed in a retirement home. But we have these patients with pressure ulcers who need medical help. In a way, the same oxygen as to give it, "says the director of the hospital.
The patients are mainly suffering from serious oncological and neurological problems.
Only 4 out of 50 patients at Mazsalaca Hospital are able to go to lunch themselves. They must be treated. It is not easy either, because, as in almost all areas of health care, it is necessary to fight for workers.
"Well, we are trying to make sure that the salary is adequate, because if it is not enough compared to the big hospitals, Valmiera is 46 km away and she will sit on the bus and go to work. in many cases, the potential for growth is greater – I will not hide it – of course, we can not afford a psychologist with this type of funding, it is more difficult, but we have a chaplain, she comes with her sisters.
But the biggest problem is that our doctors are getting older. I see this as a very big problem in the future.
Of the doctors currently working at the hospital, I am just not retired, and not so far away. The rest are retired, "says Grandan.
Looking to the future
Despite this, Grandan hopes to have the future. He sees the improvement of the palliative care system and thinks that, little by little, everything will be better.
"I think it's better than in the early 2000s. I do not think it will get worse and worse. I think it's not right. Initially, there was only one palliative care department at the oncology center. There were also palliative care hospitals – Irlava, Iecava, Livani, Mazsalaca. It was also all around 2005.
But about seven years ago, in all multi-profile regional hospitals, palliative care units were opened, "explains Grandan.
Agnese Vanaga, director of the Mazsalaca Hospital, cares for palliative care patients in the neighborhood. It confirms what has already been mentioned – extremely few buildings are built.
"As for whom. The living conditions in the city may be better, but in the countryside, the beds they have do not have a functional bed that they can rent. Dry toilets, custom chairs are personalized. Well, they sleep, they have diapers. The living conditions are not good, so many want to put these patients here for care, "admits Vanaga.
Mazsalaca is only one example of extreme demand in palliative care. However, it is one of the few hospitals to have chosen palliative care as the area of activity.
The need exists everywhere in Latvia, but few institutions have taken this path.
And here too is not easy – there is a struggle for employees all the time. Must compete with large neighboring hospitals, such as Valmiera. It is also necessary to think about what will work in the field of palliative care in the future, because the average age of doctors is high and even this one. However, all of this can be done if the people on the ground are working with their own work and placing the patient and their loved ones in the palliative care circuit.
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