EMERGENCY CARE FACILITIES
Figure 4. Medical staff caring for patients from outside individual cubicles (Foianini Clinic, 2020).
implemented in the recent remodeling – with individual care cubicles – which were not common in Bolivia. In this country, the evidence-based design is not yet known, and even less its advances in the study of the benefits of individual rooms versus shared rooms, both in reducing infections and in reducing errors associated with the standardisation of spaces. Achieving this would have a significant impact on the possible care of more patients, with the city of Santa Cruz being the primary source of infections in all of Bolivia. On 22 March 2020, the newspaper El Deber stated: ‘Currently, there are 180 lung ventilators distributed in the public, private and social security health system, of which 120 are employed in the different public hospitals’2
(Fig 2). In several places in Bolivia, they
adopted the use of domes for COVID care, with a single space for several patients (Fig 3). During the first two months of the pandemic, the clinic’s staff suffered a significant burden of anxiety due to the uncertainty of the disease. Care for the patients within individual cubicles reduced the constant use of the complete material protection and PPE (personal protective equipment) because they should only use the full PPE when they enter the rooms where the patients were (Fig 4). Reducing staff fatigue was essential
to increase levels of attention and effectiveness in scheduling staff work. Not being constantly exposed to the fatigue caused by the use of PPE, allowed the staff to concentrate better and have less anxiety and fear than being permanently equipped, as was done in other centres.
Nurse Mariela Molina Rojas worked in the clinic and also in the ICU of the Bolivian Japanese University Public
76
Figure 6. Initial state of the rooms in block B.
Figure 5a. Standard rooms before the change.
Hospital, where a solution based upon domes was implemented as temporary construction with a common space for several patient’s care. “I worked in the domes; my experience in both the dome and the clinic is very different,” she said. “We dress in our overalls in the dome, and we are inside the dome for six to eight hours straight, and we rest for two hours, sometimes. It is exasperating and suffocating not to go to urinate, drink water, wash our hands, our face itches, and we have to endure. “On the other hand, in the clinic, the adaptation allows us to put on the full PPE to enter to the cubicle only, leaving us the possibility to remain the rest of the time dressed with the essential clothes, and it is
more feasible to sanitise when disposing of the PPE… we can concentrate on seeing the patient.”
Strategies adopted – discovering opportunities The infrastructure team had to guarantee that a new strategy was implemented during a period of time where the service providers did not want to know about entering a hospital that treated COVID, where budget restrictions existed, where the result of this investment should be preserved for the future operation of the hospital, and where the continuous support of the activities of the hospital had to be assured. The strategy determined was as follows:
l Determine which clinic area was suitable for rapid re-functionalisation.
l Quickly search for human resources, clinical staff (mainly nurses), cleaning support staff, and technical assistance staff for medical teams 24 hours a day, since equipment and criticality were doubling.
l Acquire more equipment for expansion. l Expand call centre support services. l Develop the telemedicine programme due to the drastic drop in attendance at check-ups and elective surgery.
Given these prerequisites, it was decided to use two of the hospital blocks to attend all COVID cases for emergency, hospitalisation and therapy, leaving the
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