The micro-leadership of Spanish surgeons, key to containing the pandemic
Surgeon Sandra G. Botella was the initiator of the international campaign for solidarity confinement #QuedateenCasa, ahead of the government itself.
She foresaw it coming, but no one took her seriously. Sandra G. Botella, a gastrointestinal surgeon at San Carlos Hospital in Madrid followed the advance of the coronavirus in China and then Italy with astonishment, and knew that Spain would be the next to fall.
"I am a mother and daughter, I have my own home and I am also a doctor, just like my husband. I began to realize that nobody was doing anything to prevent the arrival of the virus in Spain and that the hospitals would end up collapsing. That was in early March. I talked about it at a dinner with medical friends and none of us understood why the Madrid Regional Health Ministry had sent us letters banning meetings and committees, but we were not told anything at all. Two days after that dinner, a friend and her husband, both doctors, contracted coronavirus. He was very sick, in fact he was the 70th patient," she said.
For Sandra, the celebration of the Women's Day demonstration on March 8 was a turning point. Many of the coronavirus infections occurred that day, when the Spanish government should have canceled the massive celebration. Why didn't they do so?
After spending twenty days "banging her head against the walls," Sandra decided to act on her own.
"The idea for Quédate en Casa came from impotence. Sending a message to the politicians was useless, but you had to reach out to the people on the street so that they would be protected — my family, the first ones. Since I have two teenage daughters, I thought I'd create a challenge through social media. The message was: Let's see who can stay home the longest to fight the coronavirus. Incredibly, it had such an impact that it reached even Canada, and three days after it was launched through Twitter, the Spanish government started asking people to be confined to their homes," explained the health worker.
Hospital collapses began to occur two weeks after the Women's Day demonstration. With no instructions on how to deal with it, surgeons like Sandra began to wonder what would happen if the doctors became infected at the same time. How they would be able to do surgery on their patients who were on the front line of contagion?
"If you try to attack the front line, which is urgent, the last concern is going to be the surgeons and other specialists. We had to protect ourselves. We couldn't all get sick at once, because in this chaos you need micro-leaders to organize in times of crisis and we surgeons are used to that, to working under a lot of pressure," said Sandra, who contacted the prestigious surgeon Salvador Morales, future president of the Spanish Surgery Association, to urge him to organize a joint action.
"They send you to the front line without a gun, but we are not going to abandon our patients because we have not become doctors or nurses to throw in the towel."
"Salvador was also very concerned. He told me that he had been talking to another Italian surgeon and had seen the horror on his face, so we set to work to prevent the organizational chaos in Madrid from spreading to the rest of the country," she said.
From that moment on, the work of Spanish surgeons has been relentless. They began creating protocols and documents based on experiences in China, Italy and Madrid to control the pandemic in hospitals. They sorted all the research and new information that was coming in, filtered it, and kept what was useful. Their papers are being used in countries like Italy and Portugal, and even the American College of Surgeons requested them.
Sandra doesn't understand the government's lack of reaction. Although the confinement measures are bearing fruit, the lack of foresight and health equipment, in addition to the "unfair" treatment that Spanish health workers are receiving from the administration led by Pedro Sánchez, are proving in the face of political inefficiency and excessive bureaucracy, that medical professionals are " facing it."
"Removing the confinement would mean testing the entire population as in Korea, because the problem is asymptomatic contagion. But they don't even test us. They are acting badly and late and we health workers are outraged by certain statements made by the government," said Sandra.
On the front line, nurses, paramedics and doctors are the ones who are most exposed to the virus, but they do so without proper equipment and are powerless to care for their patients as they should.
"They send you to the front line without a gun, but we are not going to abandon our patients because we have not become doctors or nurses to throw in the towel. It is striking that we are the country with the most infected toilets and the most deaths," she said.
"Now we have the adrenaline pumping to keep more people from dying, but when this is over we are going to have a lot of post-traumatic stress"
For the surgeon, the solidarity of the medical professionals has been key within the hospitals.
"We cooperate in what we can, we clean the patients in the ICU; if a colleague can't, I help him or her with anything," she said.
She also pointed out the great work of doctors in training, who've worked hard to ensure that the older doctors are not exposed to the virus.
"The residents are younger and have a lower risk, but they are working very hard. And on top of that, when they should have finished their training period, this May, they are told by decree that they will not be granted the title of specialist this year. It's a good thing they finally backed down thanks to the pressure we put on them from the various medical organizations", stated the surgeon, who added that her residents are not operating, but are treating patients with coronavirus. "We are organizing ourselves in spite of the politicians and they continue to mistreat us in this way.
Dr. Botella believes that this pandemic will end, that "we will win the battle" and there will be many changes in the Spanish health system. However, she is concerned about the post-traumatic consequences that medical professionals will have after the pandemic.
"A couple of weeks ago I met one of my nurses on the stairs and she broke down in tears. It breaks your heart. It's a cruel situation and the patient is alone, dies alone and buries alone. We're used to spending time with our patients and we can't do that anymore. Now we have the adrenaline pumping to keep more people from dying, but when this is over we are going to have a lot of post-traumatic stress, both for us and for the people in their homes," concluded Sandra.