Epidemic Exposes Hospital Flaws
In Argentina, Swine Flu Has Spurred Health Workers to Demand Better Conditions
By MATT MOFFETT
http://online.wsj.com/article_email/SB125288935212607589-lMyQjAxMDI5NTEyNjgxODY5Wj.html
The children's hospital in San Miguel de Tucumán, Argentina, handled lots of tough cases during a recent swine-flu outbreak, but none more wrenching than the sudden deaths of two of its own nurses in July.
One of the dead was 37-year-old Débora Molina, a single mother of three who worked two nursing jobs, but was still so poor that colleagues had to pitch in to buy her coffin. Now, hundreds of angry health professionals in the city have launched a series of demonstrations and work stoppages, seeking a safer workplace and better salaries.
Agence France-Presse/Getty Images
Technicians wear surgical masks at a hospital in Buenos Aires province, where some of the most severe cases of swine flu were being treated in June.
Argentina illustrates the stresses the H1N1 epidemic is placing on health-care workers, who are both healers and a high-risk group. The World Health Organization recently said that when a vaccine is released, health workers should be the first to receive it.
Even as the H1N1 flu wave that killed more than 500 Argentines subsides, Argentina's health workers are campaigning to improve deficient work conditions exposed by the virus.
The 21st of November Group, a nurses activist organization, has tallied seven nurses who died of symptoms consistent with swine flu, and scores of others who fell ill. It says hospitals delayed implementing safety procedures and distributing protective respirator masks, especially when the outbreak was peaking in June and July. Government health officials said workers are exaggerating the toll, and that some of the recently deceased nurses have tested negative for H1N1.
Health workers have rallied twice in front of the national Health Ministry, and also held a nationwide protest. On Monday, the Argentine Senate is set to hold hearings on a bill introduced in July to improve conditions and pay for nurses, many of whom earn between $300 and $500 a month, and often must take second jobs to make ends meet.
Overall, swine flu has claimed more lives in Argentina than anywhere but Brazil and the U.S. As of mid-May, the federal Centers for Disease Control and Prevention had received 48 reports of H1N1 among U.S. health workers, some of whom it said weren't making adequate use of protective gloves, gowns and surgical masks. At least one U.S. medical worker -- a 51-year-old California cancer nurse -- has died of swine flu.
In Argentina, a handful of doctors and auxiliary workers also died during the epidemic, activists and unions say. Analysts say Argentina's flu-response problems grew out of an overly decentralized hospital system largely controlled by provinces and municipalities. Lacking a strong central authority, Argentine health-care workers were "soldiers going to war without a general," said Dr. Jorge Yabkowski, president of the Federation of Health Professionals union.
"No one thought of sending respirator masks out to the countryside," said Mabel Pages, a nurse in a clinic in the small town of Alta Italia. Ms. Pages's 43-year old daughter, Maria Fabiana Donadio, also a nurse, came down with the flu after working without a respirator mask, and died in July. Ms. Pages said Ms. Donadio had battled lupus, an immune system disorder that left her vulnerable to the flu.
At Buenos Aires's Juan P. Garrahan Pediatric Hospital, administrators initially issued respirators only to doctors or nurses in intensive care, but not to other workers, such as laboratory technician Carlos Taboada, according to the hospital union. Mr. Taboada contracted the flu in June while extracting blood samples, and recovered after a couple of weeks of rest.
The union said that after Garrahan auxiliary workers began refusing to do their jobs without respirators, the hospital began distributing them more widely, albeit only one mask per worker, per week. The hospital union says that partly because of the delay in getting masks out, 175 of its 2,800 workers were being treated for flu symptoms at the peak of the outbreak in July.
Dr. Jorge Lemus, the health minister of the city of Buenos Aires, said there was only a brief period when respirator masks were in short supply, and only in certain hospitals. But interviews with workers at several hospitals suggest the problem was widespread.
Alejandra Ledesma, a nurse at Buenos Aires's Maria Ferrer Respiratory Rehabilitation Hospital, said she was reluctant to continue working without a respirator mask one day in late June, so nursing supervisor Patricia Avedaño gave her own to Ms. Ledesma. The next day, the 44-year-old Ms. Avedaño came down with fever, according to her medical log, and was administered the antiviral drug used to treat swine flu. Ms. Avedaño died three days later. Dr. Lemus said Ms. Avedaño tested negative for the flu virus. Ms. Avedaño's sister, Lorena, said she believes the city doesn't want to acknowledge swine flu as the cause of death.
In some places, the flu turned health workers against one another. On July 1, in the city of Concordia, Dr. Nestor Hirschfeld was diagnosed with swine flu and went to the local hospital for treatment. But Dr. Hirschfeld, the hospital's only pediatric surgeon, was then pressed to perform emergency surgery on a badly injured three-year-old girl.
About a dozen nurses and surgical assistants refused to accompany Dr. Hirschfeld to the operating room for fear of catching the flu from him. Dr. Hirschfeld, wearing a respirator mask, carried out the operation with a hastily assembled backup team.
The girl died from her injuries a few days later, not of swine flu. The hospital has filed an administrative and criminal complaint against the workers who declined to work with Dr. Hirschfeld. The workers' union is defending them, saying that Dr. Hirschfeld was exposing them to danger.
Write to Matt Moffett at matthew.moffett@wsj.com
Printed in The Wall Street Journal, page A8
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