Janne L. Punski-Hoogervorst
Dutch MD passionate about Mental Health, Public Health & Human Rights

Nurses on strike: Foreboding of a healthcare disaster?

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On Monday July 20, 2020, Israeli nurses went on a nationwide strike, trying to draw the governments’ and publics’ attention to the increasing workload experienced in the hospital systems throughout the country. With a staggering increase in COVID-19 patients over the last couple weeks – mainly due to failing government directives as well as ill-considered behaviour from many individuals in the society -, the physical burden as well as mental weight of working within the healthcare system are expected to keep on rising, possibly reaching a breaking point in the near future.

Although an agreement between the Ministry of Health, Ministry of Finance and the National Nurses Union was achieved, it is highly doubtful if the promise of extra medical personnel can save the nearing healthcare collapse. An extra 400 doctors, 2000 nurses, and 700 supporting staff: where is this staff coming from? And is this really enough to cover the increasing workload in the countries’ 44 general hospitals, 12 mental health clinics, 29 specialised healthcare centres, and hundreds of residential long-term facilities and first-line clinics?

“The nursing system is collapsing. Forty coronavirus wards have been opened, but where do you think they took shifts from?”
– head of the Nurses Union, Ilana Cohen, in interview with Reshet Bet

The Nurses Union more than rightly so urged for action ‘to prevent expected doomsday scenario for public health system’. But what does it really mean: a collapsing healthcare system, forced to run on emergency aid?

First, forget about all non-emergency healthcare: scheduled operations, outpatient check-ups, second/third opinions, minor and big procedures: sometimes only becoming available after months of waiting for an appointment to become available. Laboratories around the country are already refusing some non-urgent routine testings to make both their staff as well as testing facilities available for the increasing demand for COVID tests. More and more wards will have to be closed to commit to isolation requirements for infectious patients, thus making less available for other hospital admissions. Healthcare students – either general or for more specialist functions – including medical residents will have to be put into emergency COVID wards to provide healthcare they’re not necessarily prepared for.

Israel wouldn’t be the first country having to deal with a healthcare system flooding with COVID-19 patients, ultimately leading to far-reaching measures that need to be taken. One of the first signs of the emergency situation in Wuhan, China, was the building of the Hueshenshan Hospital, to be completed on Feb 2nd after only 11 days of construction. At the height of the outbreaks in e.g. France, Italy, and Spain, governments were forced to open emergency hospital settings in convention centres, sport stadiums, and similar large buildings. More recently countries as Poland, Russia, and Serbia set up large field hospitals in close collaboration with their armies. Other examples are South Africa, Dubai, Morocco, even the USA: under their extreme COVID-caseload convention centres are converted into hospitals, and field hospitals pop-up around the country.

These are mainly examples of how to deal with the increase in patients admitted to the hospitals for medical treatment. However, the problem is larger than an increasing caseload alone: there is an additional decreasing amount of healthcare workers available to carry the load, due to drop-out caused by both physical and mental health issues. Issues arise due to quarantine requirements in accordance with the Ministry of Health guidelines, either with an active COVID-19 infection or because of possible contact with a confirmed case. Other important negative consequences of working in current stressful conditions are fears of developing symptoms and fear of possibly bringing the illness to loved ones, and more general psychologic difficulties e.g. compassion fatigue, burnout, anxiety or depressive symptoms, symptoms relating to the experiencing of a traumatic event including acute and/or posttraumatic stress disorder, and general moral injury.

It is additionally important to note that Israel’s healthcare system has certain characteristics that already predict difficulties in upscaling in case of emergencies, such as the current pandemic. In Israel, the number of available hospital beds is relatively low with 2.2 per 1000 population, compared to an average 4.1 in European countries. Even in normal situations, the occupancy rate in the hospitals is 94%: indicating the limited ability to absorb new patients on a high frequency.  Thus, the Israeli healthcare system has a limited ability to handle emergencies due to the low upscaling abilities in hospital admissions [source: Taub Center].

To make up the balance, we are thus facing at least the following complications:
– the Israeli healthcare system is relatively unfit to deal with public health emergencies
– healthcare workers face a higher workload and are put into stressful situations with a higher chance of negative psychological consequences
– there is a higher dropout of healthcare workers caused by quarantine and other direct COVID related physical complications

A major collapse of the Israeli healthcare system might be a doomsday scenario. But there is currently no reason to believe that without making major adjustments we are not heading towards a failing system. We’ve seen it happen in other countries, and not just those with a worse system to start with. With the COVID cases still increasing every day, and currently also an increase in percentage of patients in severe condition, we might soon be facing serious consequences. The Nurses Union’s strike should be taken as an omen for a healthcare crash, and thus must deserve more attention from both government and public.

And because sometimes a picture says more than a thousand words. These are only some examples from around the world, to illustrate that the healthcare collapse is a real and serious possibility. There is still the chance to prevent this from happening in Israel, but changes need to be made, and the time is really now.

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About the Author
Dr Janne L. Punski-Hoogervorst is a Dutch-trained medical doctor with clinical experience working in mental health care, both in clinical and outreaching settings. She made Aliyah in April 2019, and currently conducts academic research in post-traumatic stress disorder. Her publications are aimed to spread awareness about public and mental health, as well as promote psychological health in a daily life context.
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