With great fanfare, the temporary hospitals were announced as a panacea to face the covid-19 health crisis in the country. Undoubtedly, the infections have been increasing, such as the effort made by health personnel to care for patients, but the offer of the authorities about these spaces fell short.
The pandemic was installed in Guatemala 17 months ago, during which time it was possible to advance in providing resources to the five temporary hospitals that emerged to give a break to the national hospital network, since they would focus on covid-19 patients, however , they cannot cope with the limited resources they have.
The tertiary care centers have been forced to enter the ring, at what price? By directing most of its efforts to combat the pandemic, neglecting the other diseases, the ones that have always been there and are on the rise.
- In the metropolis: In March 2020, the first Temporary Hospital was inaugurated in the Parque de la Industria. President Alejandro Giammattei said it would have 3,000 beds installed, and it would have the largest Intensive Care Unit in Central America. Everything was left in speech.
Seventeen months later, the hospital has 325 beds, of which 47 are destined for the intensive care area. They are insufficient for the number of Guatemalans in serious condition who arrive. Infections have already exceeded half a million in the country.
On September 1, the center no longer received new patients. There was no more space, no medicine and supplies to treat them.
Edna Marroquín, in charge of the communication unit of the Temporary Hospital of the Parque de la Industria, indicated that there is no set date of when they will open their doors to more patients. On Wednesday they were at 65 percent of their capacity, and there were only supplies for the sick admitted.
Opening more beds is not an easy option, as more medical and nursing staff are needed to attend to them. There are 379 on the nursing team, and 159 physicians.
- In Escuintla: The situation in the other temporary hospitals is not unlike that of the capital. In Santa Lucía Cotzumalguapa it was inaugurated a year ago. Last Wednesday the intensive was collapsed, there were 15 patients in an area with 11 beds. While in moderates they had 25 people admitted.
According to Axel Salazar, facilitator of the institution’s financial team, since August 15, 32 patients have been transferred from the Temporary Hospital of the Parque de la Industria.
In shifts there is a doctor to attend the intensive -14 patients-, while in bed a doctor to supervise between 20 to 25 patients daily.
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He points out that the situation is critical, and the increase in patients began to be noticed after Easter, it has reached 400 percent. The greatest concern is the lack of supplies and medicines, and the workload for health personnel.
- In Xela. The Quetzaltenango Temporal had an occupation of 92 percent on Thursday, and the critical area reached 72 percent.
“Patients have not stopped being cared for,” says María del Carmen Sajquim, spokeswoman for the Hospital Regional de Occidente and Temporal, however, they share the concern of other hospitals that at some point their capacity will overflow, as the cases that need hospitalization do not stop. August was the month with the highest number of patients since the pandemic began, with 372.
The place has 134 beds, of these 40 are destined for critically ill patients. The health team is made up of 300 people, including doctors, paramedics, respiratory therapists and laboratory technicians.
“The concern is that the contagion curve has not flattened, we have been like this for months,” says Sajquim, and more and more children are admitted.
- In Zacapa. The overflow of patients with covi-19 also affects the northeastern department. The director of the Regional Hospital, the doctor Guillermo Villatoro, who is in charge of the Estanzuela Temporary Hospital, indicates that there is a rebound in positive cases. Although this last center only receives moderate patients, of the 48 beds that are available last Thursday, 30 were occupied, when in previous weeks the admissions ranged between 12 and 15 patients.
The Estanzuela Center does not receive critical cases due to the lack of specialized personnel to attend to them, a resource that could not be hired. There are also no respirators, as they are distributed in the Regional Hospital where severe cases are referred.
- In Petén. The crisis at the Covid-19 Temporary Hospital is seen in the care of critical cases. The capacity is 14 beds with ventilation, and last Wednesday only four were unoccupied. In the moderate area there was still room, but due to the increase in infections, the scenario can change at any time.
There are no doctors who want to work with covid patients, says Isaías Gandé, deputy director of the healthcare center: “There are two places available and we still haven’t been able to fill them.” Among the staff there are 18 doctors and 270 nurses, which would be “insufficient if this overflows.”
A management problem?
In the opinion of Zulma Calderón, health defender of the Human Rights Ombudsman’s Office (PDH), specialized temporary hospitals for the care of covid-19 were one of the core points of the State’s strategic response plan and should have been the route to vent the reference and national hospitals, but it was not like that.
“The problems are repetitive in these temporary hospitals: the lack of personnel, the delay in payment of salaries, the continuous shortage to attend to the patients, the lack of budget and the little management to execute it, unfortunately these errors have not been corrected” , indicates Calderón.
So far, he adds, there is no comprehensive response plan from either the State or the Ministry of Health to amend the plan, which has been achieved by the Guatemalan Social Security Institute (IGSS). The gap between both sectors to face the crisis is “abysmal,” says the defender.
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In that vision for the future, Social Security will enable two modular hospitals in the coming weeks, one in the metropolitan area and another in Escuintla, which for now will be to expand Social Security care to covid patients. These will have four intermediate and intensive care units, medical residence areas, a morgue, workshops and maintenance.
The spaces will have hospital beds for observation and intensive care, electrocardiography, vital signs monitors, pediatric cribs, transport and mechanical ventilators, defibrillators, digital mobile equipment for radiography and ultrasound, among other specialized equipment.
These hospitals began to be built in May and the one in the capital’s zone 11 will have 240 beds, of which 31 will be destined for the Intensive Care Unit (ICU); while the one located in Escuintla will have 168 beds, of which 36 will be for seriously ill patients, reported the IGSS Department of Social Communication and Public Relations.
Calderón indicates that these beds will give a break to the institute’s hospital network, as they will remain installed when the pandemic ends.
For now, they will be dedicated to the health emergency of covid-19, and the call to hire health personnel to attend to it has already begun. After the crisis, both hospitals will be used as general hospitals and will benefit 3.2 million beneficiaries, of which 80 percent are concentrated in the capital.
Modular hospitals are made of prefabricated structures, which allows their installation in the short term. The investment is of Q165 million in infrastructure and Q69.5 million in equipment and furniture.