In Bulgaria, those who do not live by the rules have rights. At the same time, an end to the coronavirus pandemic can be expected in 2022, “said Dr. Andon Arabadjiev, head of the anesthesiology department at Dr. Nikola Vasiliev Hospital in Kyustendil.
“And the worst vaccine is 10 times better than the missing one,” the doctor said emphatically.
Dr. Andon Arabadjiev
Here is what Dr. Andon Arabadjiev said about the coronavirus pandemic and what is happening in our country in an interview with “Monitor“:
– Dr. Arabadjiev, why did you choose this profession and work in Kyustendil, when many of your colleagues are fleeing to major hospitals in the country, others abroad?
– Since 2001 I have been the head of the intensive care unit at the Kyustendil Hospital. I can say that this position is not pleasant at all, as the responsibility is usually borne by one person. Our work is generally team work, when we have success, we are all united and happy, but when the treatment does not work for someone sick, the boss must be responsible. That is why I say that it is not attractive to be the head of such a department.
As for my choice of a city to work and live in, it has to do with the fact that I got married here. Otherwise, after two years in the ambulance, this was the only vacancy. It turned out that I was the only one who applied for the most unattractive place at a competition at that time, in 1992. I never had the attitude to go to work abroad, and for other hospitals in the country I received job offers but I always refused, it’s just my choice. I can’t live in the big city, I can’t stand the traffic and the noise.
– How many beds do you have, is there a shortage of staff?
– The only permanent thing in our ward are the beds and they are 10. Otherwise, we currently have five full-time doctors, two other colleagues are half and a quarter full time. There were years when we were the third level of competence, ie the highest, but then we were 9 doctors, 7 of them with a specialty. Then our sisters were at least 17-18, and now they are about 9-10. As for the nurses, they are preserved as a number.
As everywhere, the problem of staff shortages is glaring. This is not from yesterday, when we opened the ward in 2005, Professor Hinkov said that a crisis was beginning for the paramedical staff. At the moment, things are tragic for both doctors and nurses, according to statistics, out of 10 medical graduates, 9 go abroad. You can imagine that there are no real medical specialists left, and the average age of the workers is over 50 years old. In the coming years, I do not see other people than retirees who will stay to work.
In our specialty, for example, things are even more tragic because it is extremely important, responsible and at the same time we always remain in the shadows compared to other specialties. About 10 years ago at a congress they said that there were 700 anesthesiologists left in Bulgaria, but in my opinion this number is much lower now. Since I have been working, I can say that we have had several young colleagues in the ward – one went to France and the other to England. So in practice we have only two graduates for these years.
– Do you need any kind of apparatus, equipment?
– At the moment we have everything and we are well equipped. Along with the pandemic, we are even overwhelmed with more respirators than we need. However, there is no one to work for, again everything depends on the staff and the human factor. No matter how advanced the technology is, there is no way to work without people.
– The health care system seems to shift the attention from the provincial hospitals, more emphasis is placed on those in the big cities. How do you explain it?
“I can’t say why.” There are 4 or 5 big cities in Bulgaria and it seems that there is no life in the others and nothing is happening. After all, I know what I need to do and I can do it. As for patients, everyone has the right to choose where to be treated. I think this is a cliché that is repeated.
Some patients who have been treated in larger hospitals return dissatisfied. I can say that medical education is the same. Whether you work in Boboshevo, Kyustendil or Sofia, the one who can – can, the others can work in Istanbul – is still the same. One has to look for another health facility when the hospital where he falls cannot provide him with the necessary equipment, for example.
When a COVID-19 patient gets here and we have oxygen concentrators, we have respirators and staff, I don’t see the difference with other hospitals. There are some protocols for the treatment of coronavirus that each of us works on.
– A year has passed since the beginning of the pandemic, do you remember the first patient you admitted with complications?
– I remember the first patient. At the time, the disease was still little known, there was no need to gather people, and coronavirus patients were treated in the former department of pneumology and tuberculosis in Kyustendil. There was really fear and terror.
Then we had adapted two rooms with two respirators and we did not accept in intensive care because these flows did not have to be mixed. Whatever you do, whatever disinfection and whatever corridors you create, there is no way there will be no mixing at one time. There are people who suffer from another disease, but do not know that they have covid, have no symptoms and spread the disease.
We served the first patients in the former thoracic ward, after which, due to lack of human resources, the entire fifth floor of the hospital was adapted for a covid ward. The doctors from the pneumo-phthisiology department and we were on duty there when he needed us. We went there, intubated when needed and observed the sick.
This was not the most convenient for us, because we tore, for the smallest thing we got dressed and went there. Then the management of the hospital decided that 4 of the 10 beds in our country should be for covid patients. We made two more rooms in the intensive care unit, in which to operate, so that our work would not be hindered.
– You mentioned intubation, what is the percentage of people who survive after that?
– Unfortunately, the percentage of patients who survive after intubation is very small. At first we did not know much about the disease and if the intubation criteria were used, all patients at 90 saturation had to be intubated. Then, understanding the pathophysiology of the disease and its course, it turned out that the more intubation can be avoided, the better.
Then came the devices with a high flow of oxygen up to 40-50 liters, with which the success in the treatment of the most seriously ill increased. We discharged quite a few patients, albeit on oxygen treatment at home, but they were brought to a state where they could be treated at home.
– How do you explain the fact that young and healthy people fill the intensive care units?
– For me personally, the new strain is much more aggressive than the one in the fall. Many young people fell ill and, without any concomitant illnesses, suffered very badly, many of them lost their lives. Even the period of the cytokine storm has shifted – if before it was on the 10th-12th day, now it is on the 14th-16th day.
In a large number of patients it happened when he was about to be discharged and stable, at one point they suddenly got worse, without any explanation or reason. Now it strikes me that we have patients who have been with us for a month and are still not in good condition.
– After a severe covid, when can we say that a person is cured, is the recovery process long? What are your tips?
– There is still no definition of what exactly is a heavy covid. This disease affects all organs, but most often the manifestations are in the respiratory system. We seem to focus more on the lungs, but the coronavirus affects the liver, brain, kidneys… Not a small number of people have neurological complications, strokes, memory disorders.
In pulmonary complications after a severe course of the disease, recovery occurs after about 2-3 months, in others up to 6 months, everything is strictly individual. But definitely my advice is for patients to visit specialists and pay attention to their health.
– What is your opinion about the coronavirus vaccines, are you vaccinated yourself?
– Humanity has survived thanks to vaccines. The state provides everyone with the opportunity to be vaccinated completely free of charge, teams, medical specialists are provided, and at the same time people lightly refuse because they think that their rights are being violated.
It turns out that we who risk our lives never have rights. I don’t mind – let them not be vaccinated, but then they have no place in a hospital, because we who take care of the patients also have rights. In Bulgaria, it turns out that those who do not live by the rules have rights. Thanks to vaccines, humanity has survived, I personally have not even been tested for antibodies. Only three months after the illness did I get vaccinated. This also applies to all my relatives, including my daughter, who is also suffering from it and is currently seconded to a covid ward. Without thinking, I would get vaccinated with each of the vaccines. The worst vaccine is 10 times better than not being vaccinated.
People who are against vaccines have not seen seriously ill people, they have not seen people die, they have not come to see how their relatives react and how they feel. That is why it is very easy for them not to get vaccinated, but I sincerely hope that someday we, the doctors, will have rights and when a person uses public services and does not live by the rules, he will be sanctioned in some way. There is no way for us to fight to eradicate a disease that kills us, and at the same time to have 5-10 people who do not want to be vaccinated, and the disease to mutate and turn in a vicious circle.
– Do you see an end to the pandemic in the foreseeable future?
– Until 2022, I do not see an end to the pandemic, because this virus is unpredictable. At the moment, people in India are dying, everything is overcrowded, and this allows the virus to mutate, and indeed, no matter how much I don’t want to, at some point the vaccines we now produce may not be as effective.
However, this does not mean that they will not be made to deal with the new strains. The point is that all this prolongs the time of disappearance of the coronavirus.
Who is he?
Dr. Andon Arabadjiev was born in 1964 in the village of Marikostinovo, Blagoevgrad region. He completed his secondary education at the vocational high school in Petrich.
In 1990 he graduated from the Medical University – Sofia. He started working in an ambulance. Since 1992 he has been working in the Department of Anesthesiology and Intensive Care at MHAT “Dr. Nikola Vasiliev”
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