TIMECODE – Entrevisa Ximena di Lollo

00:00:00:00 - 00:00:54:11
The main problem in all this crisis is that care homes were not covered by the health system so the response has come a little later. In the first stage, efforts were focused on hospitals and saving lives at the ICU level and at the level of large-scale medical management. (2’42”) Then little by little it has adapted as the health authorities have taken on responsibility for facilities that were not normally in the health system. This implies a tremendous amount of coordination work where everyone has to readjust their roles and, even though we are still the same people working, we have to understand that the situation here has changed and this is what MSF brings, its focus on emergencies and on helping staff to adapt to this.

00:00:54:11 – 00:01:18:15
The health system was not prepared to intervene in care homes because they are normally not within its area of responsibility. I do believe that every patient, every resident, every older person, every grandparent, however you want to call them, has the right to dignified treatment, dignified care. They have the right to treatment, and this is what we advocate at MSF

00:01:18:15 - 00:01:37:01
[In the future, we need to be able] to ensure from the first moment dignified healthcare for the most vulnerable people. Although this is now finally being achieved, it should have been a priority. We knew that the elderly were the most vulnerable and, in a way, we neglected them.

00:01:37:01 - 00:01:39:23
We don't work with numbers, we work with people.

00:01:39:23 - 00:02:05:20
In this crisis, there have been more than 10,000 deaths in care homes for the elderly. In some cases, these elderly people have not had the possibility to say goodbye to their family, to be in contact with their loved ones, to say their last words. Little by little, we are getting closer and creating more capacity in this sense, but it has been very hard and many opportunities have been lost.

00:02:05:20 - 00:02:45:07
With elderly people, as a medical and human principle we try not to change their routines, not to move them, not to take them out of their comfort zone. And suddenly in this emergency everything has changed. We change the people who take care of them, we change it so that they have no communication with their families, we change their place ... and all this has generated a lot of stress in them, which was also supported by the amount of news they were receiving daily in the centres saying that they were the population at risk. And this has been very difficult, not only for the residents and for the people who worked with them, but also for the families.

00:02:45:07 - 00:03:00:11
Today we have a great challenge: dignified goodbyes. It is something that we are not yet achieving. Family members cannot see their elders in very critical situations. That is something we still have to organize.




00:03:00:11 - 00:03:15:02
The main sensation that we feel when we visit care homes both from the staff and the residents and families with whom we have had contact is tremendous anguish, a lot of fear and a lot of uncertainty.

00:03:15:02 - 00:03:36:15
The first thing that we generally find when we arrive at a care home, although there are exceptions, is a lot of confusion, a big lack of staff, staff who are on leave because they are sick, or staff who are also very afraid. A lot of work overload, a lot of confusion about the circuits they have to follow.

00:03:36:15- 00:04:32:08
In Catalonia alone, there are 1,100 care homes, and in all Spain there are 5,000. It is almost impossible to reach all of them and so during the process at one point we said we should expand capacity. And we defined a project that is virtual assessments of care homes whereby, through communicating with the cleaning staff and the use of a camera, they can show us their facility, their needs, and they can tell us what their human resources situation is, and what kind of patients they have. And then medical and logistics professionals from the other side of the camera can help them set up clean-dirty circuits, infection prevention systems and can help them to identify their critical points where they have to focus their efforts.

00:04:32:08 – 00:05:40:22
Without a doubt, the strongest experience I have had was in a particular context with a fellow nurse. We arrived and the situation was quite dramatic, quite disorganised. It was not clear which patient needed what, there was a very serious lack of personnel, there were very few people working who were making a huge effort. It was when we decided to lose a little this strategic perspective of general support and get down to work as the doctor and nurse that we are. And we decided to give support directly in patient care, giving comfort, giving basic hydration and accompanying the families as they said their last goodbyes.
It was very impressive to see how these patients, who were unconscious and who had gone without food for days, opened their eyes, improved and even got out of bed when they heard the voices of their families. This is something I will never be able to explain well enough, but it was certainly very significant.

00:05:40:22– 00:05:59:19
This is the humanisation of our objective. If throughout the intervention you have a strategic and supportive objective, in the end when you have a patient who is scared to death, thirsty, you have no choice but to put on a suit, to protect yourself and to protect them, and to act.