Good kisses from Guyana (with a mask)

At the age of 27, in order to get a change of scenery and to leave the hospitals of the metropolis for a while, Arthur (1) had chosen a medical internship in Guyana for the summer of 2020. It was just before the pandemic:

“I chose my period well, you will tell me: after the first deluge of patients in metropolitan France, the Guyanese wave. Without being a journalist myself, I will try to follow this quote from Albert Londres: “Our job is not to please, nor to do harm, it is to carry the feather in the wound.” This testimony will therefore necessarily be unique to me, with my vision as a caregiver, my bias as a metropolitan and the inherent bias in preserving anonymity while trying to remain faithful to what is happening away from cameras and institutional social networks. I will mainly talk about hospital and territorial management but will not address the issue of city medicine due to ignorance of the subject.

Read alsoIn Guyana, caregivers “keep their fingers crossed so that nothing goes wrong”

“Before talking about Covid, I would like to paint a quick picture of the health situation here: Guyana is currently suffering from a dengue epidemic, and for a long time that of HIV. And that’s without counting the problems that are much more frequent than cardiovascular disease or cancer. Take Saint-Laurent-du-Maroni for example, for a population pool of several tens of thousands of people, the number of hospital beds in acute medicine outside the Covid-19 period is … 30. It is not to sink into the miserable but it is certain that 30, that calms down … In total, there are three hospitals on the coast distributed in the big cities (Cayenne, Kourou and Saint-Laurent-du-Maroni) and centers of health dispersed in land and along waterways. We all know that the investment and skills of caregivers are very heterogeneous in the hospital… but here we can say that it is pushed to its climax. Before detailing the dysfunctions in the management of this crisis, I would like to greet some incredible caregivers: those who have been pillars of care in this department for several years, those who have set up services, those who allow the hospital to stand up. But alongside these staff, we find jumbled mercenaries who don’t care, those who don’t have the skills but don’t realize it, and those who feed their ego. In such a difficult environment, the contrast is striking.

Staggering lack of communication

“You have to adapt in Guyana all the time. We have to adapt to patients: to a sometimes exacerbated precariousness, to the different language barriers, to their paperwork problems, to their life outside the big cities of the coast. We have to adapt to the means: digestive endoscopies are Cayenne, urology is Kourou, ophthalmology is Saint-Laurent-du-Maroni. Certain biological examinations… it is the metropolis. So I can understand that we cannot work as I am used to in metropolitan France, that we have to juggle and make compromises. But some situations are just indecent. Not in France, not in 2020: we do not refuse to take a patient in his thirties in intensive care under the pretext that he is HIV and Brazilian. We do not die after having an epidural for childbirth. We are not saying that we do not care if we made a mistake because the patient speaks poor French and will not file a complaint. You cannot be unreachable when you are on call… I think that in metropolitan France, no one would accept some of the things that I have seen here. And that can be brushed aside with the back of the hand since “It’s that or nothing, there is no one else”. It is not acceptable, it is indecent. And still I’m lucky in my medical practice, I’m a guy, people listen to me. It sucks, but that’s how it is. This is clearly not specific to Guyanese hospitals: more than once when I was a student I was spoken to instead of my boss. But here it is exacerbated, I am ashamed to have to repeat what my female colleagues say so that less competent men listen to them. It is blatant, it is shameful.

Also read, the previous episodes of the Epidemic JournalEpidemic Journal, by Christian Lehmann

“The patients, at least as far as I have come across, have illnesses made worse by many social problems. Two like that in your room in metropolitan France, it burns you out for the day. Here it is everyday. Illnesses as in the books and patients who do not fit into the administrative framework. I don’t want you to imagine the Wild West by reading this, but there are so many great projects to strengthen or create, I think our fellow citizens deserve to be done better. So inevitably, when a pandemic emerges, we are not serene. We had two major advantages: a young population and a few weeks ahead of the mainland. We quickly forget the weeks in advance, they were squandered by internal quarrels between hospital management, crisis management and the ARS. It was almost as if we were discovering the problems day to day, with a beautiful ball of hypocrites constantly parading in the media and on social networks. I am very happy to see the director of ARS Guyane, Clara de Bort, pose on the tarmac of the airport with her staff and congratulate herself on carrying out Evasan (medical evacuations) in a beautiful cooperation with hospitals. Unfortunately, it has happened several times that some of these evacuations were announced on television or on the Internet… before warning the doctors who directly took care of the patients concerned. The first time it was a family who came to ask us at what time their loved one would be evacuated when we had not been informed …

Read alsoIn Guyana, endless confinement

“Finally, I would have had the right to the same speech here as at the start of the wave in metropolitan France:” No, but France is different, it will not be like Italy “,” No, but Guyana, that will be fine, it won’t be like in the metropolis. ” One day you will explain to me which part of “pandemic” you did not understand. I don’t know, honestly, how we could confidently say that everything was ready, that we didn’t need help and that everything was going to be fine. I feel like I heard Macron say that we never ran out of masks. Nobody one day could assume to say “It’s shit, but we will adapt as quickly as possible, everyone is on the front”? Must always put everything under the carpet? Fortunately, we had help, a lot of help, a lot of people who came to give a helping hand whether it was on their leave, on an agreement between hospitals, via the army or the health reserve. However, I would still like to underline the astounding lack of communication between hospitals, ARS and health reserve. You try to round up your friends to fill in the holes, put on the patches to keep it going and you finally discover that a whole team is arriving but no one has seen fit to warn the staff. You may even hear the phrase “There are too many reinforcements” while services are still understaffed. I know that in the end the whole technostructure will congratulate itself on the excellent management and will go with its little comment, but it is the caregivers who make it possible to hold on.

Infernal mixture of care, public opinion and political interests

“The health reserve I still have a few complaints. Throwing in the room retired general practitioners who have not done hospitality since their start of their careers and putting hospital workers in town, doesn’t that sound like a bad idea? I have no desire to be ungrateful to my colleagues, more than courageous, who volunteered to come, but maybe estimating the needs and positioning the reinforcements accordingly would be a good start. So inevitably when by ego we say that all is well in the services, we find ourselves hearing that a pulmonologist or infectious disease specialist is not necessary in Guyana. Anyway, we are no longer close. Ah and I greet you dear resuscitator colleague who did not want to see respiratory distress because you were eating. I do not forget you. Same for the reinforcements who complained about not being able to tour, I do not forget you either.

Read alsoIn Cayenne, unwelcome hunger: insufficient humanitarian aid

The climax of this infernal mixture between care, public opinion and political interests was the trial planned for plasma therapy (with plasma from patients who had developed antibodies). If we summarize the situation, a trial concerning the interest of plasma therapy in Sars-CoV-2 infection had started in metropolitan France and was to continue in Guyana. There are two advantages to this: to provide patients with a potentially useful treatment and to succeed in including enough patients to reach a robust conclusion. In a context of mistrust of health authorities, media hubbub and the habit of this department being left behind, announcing this news from Paris was very clumsy. Let us add to this that this was done not by a PUPH (university professor-hospital practitioner) but by a PUPH, Karine Lacombe, and it was gone. Everyone has gone there from their affiliations to promote themselves, deputy, local collectives, close to Didier Raoult’s IHU. And in this mess, in the end, people were therefore pushed to demonstrate to refuse the help of an infectious disease specialist and her team in a territory that badly needed it. Admittedly, the announcement was awkward, but we saw people chanting loud and clear that they refused therapeutic help. I thus saw a good number of messages passing to say that the Guyanese patients were not guinea pigs. It’s such a no-brainer: no one is ever forcibly included in an essay if they don’t want to. This is the very basis of our ethical principles. But obviously to say it would do a disservice to the conspiracy discourse. On the other hand, promoting the use of hydroxychloroquine without any proof of its effectiveness in Covid, that was to use patients as guinea pigs. Associations have been calling for the creation of a university hospital in Guyana for years… and when a university team comes to do research, the door is vehemently slammed in its face.

“All this reflects a profound ignorance of clinical research and its functioning. So I hope that some people’s political agenda was worth it. In all of these ego bickering, whenever politics take precedence over caregivers and scientists for the wrong reasons, it is the patients who drink. While the Guyanese are worth it that we are interested in their territory, that we invest in improving access to healthcare here and that it be worthy of France. ”

(1) The first name has been changed.


Christian Lehmann doctor and writer

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Traffic will be limited in Moscow due to the closure of stations of the red metro line :: Society :: RBC

Photo: Andrey Nikerichev / AGN “Moscow”

Four stations of the Sokolnicheskaya line of the Moscow metro will be closed from July 4 to 6, additional buses will be launched in compensation, which will lead to traffic restrictions. This was reported by the Moscow Department of Transport in Telegram.

“Traffic will be limited in the south-west of the capital – priority will be ensured for public transport,” the report states. They will close the stations “Prokshino”, “Filatov Meadow”, “Olkhovaya” and “Kommunarka”.

On the carriageway of Khoroshevsky highway in Moscow, the ground failed

Photo: gucodd / Twitter

7.8 km of temporarily allotted lanes will work, the following sections will be distinguished: on the access road to the Salaryevo slop-and-turn platform; on the section of the Solntsevo-Butovo-Vidnoe highway (between Kiev and Kaluga highways). In addition, traffic will be limited in the vicinity of the Kommunarka metro station, on the Kaluga Highway understudy in the area of ​​the Olkhovaya Metro stop for ground urban transport.

“Taxi access to these sites is also [будет] prohibited, ”said the department.

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The structure of Rosatom bought a building near the Kremlin :: Business :: RBC

Alan Baloev, director of the Cushman & Wakefield Capital Markets Department, believes this was beneficial to both the seller and the buyer. On the one hand, there are few investors who are ready to purchase an office for such an amount, on the other hand, it is not easy to find a site near the Kremlin.

Earlier, Dom.RF stated that all the buildings of the ministries would be sold at open auction. And former Prime Minister Dmitry Medvedev ordered them to get into commercial circulation.

It was planned to sell at the auction, including the former building of the Ministry of Industry and Trade in Kitaygorodsky passage, information about this was contained in the plan for holding auctions of the state company for 2020.

However, on April 18, Prime Minister Mikhail Mishustin signed a government order to transfer these facilities at market value without bidding.

In the spring of 2019, three federal departments – the Ministry of Economic Development, the Ministry of Industry and Trade and the Ministry of Communications – moved to the IQ-quarter skyscraper purchased for them in Moscow City. Agency rights to sell their former premises, including the building of the Ministry of Industry and Trade in Kitaygorodsky passage, were transferred to Dom.RF state corporations. The state-owned corporation sold a complex of buildings on Triumfalnaya Square in Moscow, which the Ministry of Economic Development had occupied before moving, for 2.8 billion rubles. (3.37 billion rubles. Including VAT). The buyer was Mezhregionrazvitie LLC, controlled by the Moscow City Property Department.


Artem Filipenok, Nadezhda Fedorova, Anna Pustyakova

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Industrial waste landfill caught fire in Norilsk :: Society :: RBC

Photo: EMERCOM of Russia

In Norilsk, a fire occurred at the Baikal-2000 LLC solid industrial waste landfill. This was reported to RBC in the press service of the Russian Emergencies Ministry.

According to the agency, the fire area is 1 thousand square meters. m. He was assigned the rank of 1-BIS. “There are no threats to nearby buildings. 26 people and eight pieces of equipment were involved, ”the message states.

Environmentalists presented a photo of pollution of water bodies near Norilsk

At 13:01 (9:01 Moscow time) the fire was localized.

A TASS source in emergency services specified that the landfill is 5 km from the city, the wind carried the smoke of the fire away from the village. According to the agency, if the wind changes direction, they will use a laboratory to measure the MPC of harmful substances.

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very cheap and long-known drugs help save the lungs with coronavirus

Cloving hospital on the basis of the Medical Scientific and Educational Center (ISSC) Moscow State University named after M.V.Lomonosov took the first patients on April 21 and completed his work on June 13. It turned out that it was possible to achieve the best treatment results for COVID-19 in Moscow. Over the entire period, 4 patients died, and among severe patients who got mechanical ventilation, the mortality rate was less than 14% (for comparison, the average for the city and the world was up to 70 – 80%). Eighteen doctors out of 220 employees of the hospital were infected with coronavirus, there were no deaths among the medical staff.

What approaches were used at the University Hospital of Moscow State University to achieve such results? We continue the conversation with the head. Department of Therapy, Faculty of Fundamental Medicine, Moscow State University, Head of the Department of Age-Associated Diseases, Medical Scientific and Educational Center, Doctor of Medical Sciences, Cardiologist Yana Orlova.

MEDICINE FOR COUGH FOR 80 RUBLES

– Most of those who are ill or are afraid to get sick are worried about fibrotic changes in their lungs. They say that you have developed special therapy that can reduce the risk of developing fibrosis. Is it possible?!

– Yes, we launched an appropriate clinical study. There are no final results yet, but we have developed clinical practice.

“What did you do to save the lungs?”

– We used a combination of bromhexine and spironolactone (both are long-known very cheap drugs. – Ed.). Bromhexine is an expectorant that has been prescribed to patients with pneumonia and cough for many years. At the same time, experimental data showed that this drug can block a specific enzyme and impede the penetration of coronavirus into cells. True, it was on this effect that we counted to a lesser extent in inpatients, since such an effect is important mainly in the early stages of the disease. But the expectorant effect of bromhexine really helps patients with COVID. I heard that our colleagues in Peter launched a study of bromhexine for prophylactic purposes. We will wait for the results.

Coronavirus infected 18 doctors from 220 employees of the hospital, there were no deaths among the medical staffPhoto: Ivan MAKEEV

FIBROSIS OBSTACLE

– The second drug – spironolactone – is traditionally widely used in cardiology for the treatment of heart failure, severe hypertension. It has a small diuretic, magnesium and potassium-preserving effect, continues Yana. Orlova. – It has several mechanisms through which it can be useful in coronavirus infection.

Firstly, a mechanism that prevents the development of fibrosis in general in the body. There are works that, in particular, show that spironolactone reduces fibrosis in the heart. At the same time, it is known that the tendency to fibrosis is not local, but systemic – where there is more inflammation, there will certainly be fibrosis. And we see, of course, fibrotic changes in the “covide” in our patients. Therefore, we prescribed spironolactone as a drug for the prevention of this process.

Secondly, this drug blocks sex hormone receptors, in particular testosterone. Some published studies suggest that “high-testosterone” men suffer from “covid” more often and develop more severe fibrotic changes. Therefore, blocking these receptors for several weeks during COVID treatment may be useful in reducing the severity of complications. We are not talking about a longer intake, since male patients are unlikely to agree with a decrease in testosterone levels in the long term.

And perhaps the most important point. In almost all of our patients, we observed hypokalemia (a decrease in potassium levels. – Ed.). With coronavirus infection, potassium is intensely excreted from the body, and scientific articles even suggest that hypokalemia serves as the trigger for a cytokine storm. So spironolactone has a real chance to reduce the risk of this dangerous complication. But the main thing, in my opinion, is that lowering the level of potassium in the body is extremely harmful to the heart and triggers life-threatening rhythm disturbances, increasing the risk of sudden death. We, like all others, replenished potassium with droppers, but it was more effective to retain it in the body with the help of spironolactone.


Men certainly get worse than women;  the elderly are heavier than the young;  overweight people are heavier than patients without excess weight Photo: Ivan MAKEEV

Men certainly get worse than women; the elderly are heavier than the young; overweight people are heavier than overweight patientsPhoto: Ivan MAKEEV

WHEN PRESCRIBED PATIENTS

– Yana Arturovna, how many patients did you have on average?

– About 10 – 14 days. But someone and 50 days.

– Have you noticed signs by which it can be assumed that the disease in the person brought is likely to go the hard way?

– Such studies were carried out in the world, our clinical practice confirmed them. Men certainly get worse than women; the elderly are heavier than the young; overweight people are heavier than overweight patients. Men with a classic male type of baldness, a lot of facial hair, we can say brutal men get sick harder.

– Under what conditions did you discharge patients?

– We acted as close as possible to the recommendations Ministry of Health: so that the temperature for three days was not higher than 37.5 degrees; so that C-reactive protein (an indicator of inflammation) is lower than 10 mg / l, and saturation, that is, the level of oxygen in the blood, is higher than 96%.

“HEAD OF EPIDEMIOLOGY DEPARTMENT OF ITSELF WORKED AT SANPROPUSNIK”

– How often do you get sick doctors and nurses?

– In the first month no one got sick at all. We have a very powerful epidemiological service. The head of the sanitary-epidemiological department, a senior researcher, correctly organized the whole process, and for the first two weeks she personally worked in the sanitary inspection room at the exit from the “red zone” and helped doctors and nurses who were exhausted after the shift safely remove protective clothing.

Then both people’s fatigue and viral load accumulated. By the middle of the second month, sick people began to appear. There were no seriously ill patients. We treated part of the staff in our observation, part of it was treated at home. In total, 18 people were infected from the medical staff (less than 10%).

– Doctors take something for prevention? Vitamins C, D, Zinc?

– I saw the recommendations of American nutritionists, they speak out positively about taking zinc, melatonin and vitamin C. There were somewhat conflicting data on vitamin D. But we did not give any such recommendations to our employees. We have all the prevention was associated with minimizing contacts and other measures of epidemiological safety.

Physicians are the heroes of our time.“If you think that you are special and that a pandemic will not affect you, you are deeply mistaken,” listen to what the doctors who are fighting with coronavirus say

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Shortened work week begins in Russia :: Society :: RBC

A shorter work week has begun in Russia. Wednesday, July 1, will be a day off due to a vote on constitutional amendments. Thus, the Russians will work on Monday, Tuesday, Thursday and Friday.

Initially, a vote was scheduled for April 22, but at the end of March, due to the coronavirus epidemic, it was decided to postpone the procedure indefinitely.

On June 1, President Vladimir Putin signed a decree on a new voting date, which was chosen on July 1. The vote itself began on June 25, the upcoming Wednesday will be his last day. The head of state declared this date a day off.

Rostrud reminded of increased payment on the day of voting on the Constitution

Rostrud then said that employees working on July 1 should receive higher wages for that day.

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Power supply restored after Norilsk fire in substation :: Society :: RBC

In Norilsk, electricity was restored to residents and to the observator after a fire at a substation. This is stated in the operational report of the Ministry of Energy.

“At 19:06, after drying and repairing the equipment, the 35 kV substation GPP-36 was included in the work. At 19:27, voltage was applied to all consumers, ”the department said.

Earlier, the Ministry of Energy reported that on the morning of June 28, the roof of the building ignited at the NTEK energy company, which is owned by Norilsk Nickel.

Some residents of Norilsk and the observatory were left without electricity

Calculations of the Ministry of Emergencies and the departmental fire department of Norilsk Nickel arrived at the scene. As a result of the fire, the substation equipment was flooded. As a result, the residents of the city and the observatory were left without power supply, where citizens arriving in Norilsk are placed in quarantine.

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Some residents of Norilsk and the observatory were left without electricity :: Society :: RBC

Photo: Kirill Kukhmar / TASS

In Norilsk, there was a fire in the roof at the NTEK energy enterprise (77% – at Norilsk Nickel), as a result of which some of the local residents and the observer were left without power supply. This was reported by the Ministry of Energy of Russia.

According to the report, the fire occurred at 10:50 (06:50 Moscow time) on June 28. The EMERCOM of Russia and the departmental fire department of Norilsk Nickel were called in place. The fire was eliminated at 11:17 (07:17 Moscow time).

In Norilsk there was a discharge of waste in the area of ​​the Norilsk Nickel factory

Photo: Maxim Bogodvid / RIA Novosti

“There were no injuries and no damage to the equipment,” the department noted. The observatory for conducting quarantine events with people arriving in Norilsk, as well as some household users, were left without electricity.

During the extinguishing of the fire, the equipment with which voltage is supplied to consumers of electricity was flooded. Its drying will last until approximately morning of June 29th.

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Trump called NYT’s custom article on Russia and the Taliban :: Politics :: RBC

The president criticized The New York Times, calling it “fake.” The publication reported with reference to U.S. intelligence about the proposed Russian award for the killing of the US military in Afghanistan

Donald Trump

(Фото: Drew Angerer / Getty Images)

An article by The New York Times (NYT), in which the publication cites US intelligence on the conspiracy of Russia and members of the Taliban (banned in Russia) against the US, is the result of someone else’s order, suggested U.S. President Donald Trump. The head of state wrote about this on Twitter.

“Perhaps this is just another custom article of lime [The New York] Times, as well as their failed duck about Russia (accused of conspiracy with Russia during the 2016 presidential election. – RBC) Who is their source? ” – the president wondered.

In a separate post, Trump said that no one had informed him, nor Vice President Mike Pence, nor the head of the White House’s staff, Mark Meadows, about possible attacks by the Russian military in Afghanistan organized by Russia. “Everyone denies it, and [в Афганистане] there were not many attacks on us, ”Trump said, recalling that this information comes from anonymous sources.

Earlier, the White House also reported that Trump was not informed of a possible conspiracy of Russia and the Taliban against the US in Afghanistan.

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Two tower cranes fell in Naberezhnye Chelny due to a storm wind :: Society :: RBC

Photo: EMERCOM of Russia

In Naberezhnye Chelny on Saturday evening, two cranes fell due to a gale. This was reported by the press service of the Ministry of Emergencies in Tatarstan “VKontakte”.

According to the agency, the first 60 m high crane fell at a construction site on Chulman Street. He collapsed into the garage, damaging several buildings. Work at the time of the fall on the crane was not carried out, as a result of the incident no one was injured.

A second crane of the same height fell around 19:50 local time at the construction site of the Mezhdurechye residential complex. He fell into an open area without damaging other buildings. There were no casualties in this incident.

According to the Ministry of Emergencies, a storm warning was announced in Tatarstan on the evening of June 27 due to strong wind, rain and hail.

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