"Every patient, every resident, every older person has the right to dignified treatment"

30 Apr 20

Ximena Di Lollo, MD, and coordinator of the Care for the Elderly in Residential Homes programme of Médecins Sans Frontières /Doctors Without Borders(MSF) against the Covid-19 pandemic in Spain. A few days ago, Di Lollo and her team received a call from one of the first care homes they had visited because the situation of the residents there had worsened.

MSF’s Montse Bartui and Maria Pagès, and Carmen Hernández (prevention coordinator at Accent Social) training staff selected to start working in this care home, which is being set to receive COVID positive elderly patients. Barcelona.

"There is no plan that is more important than being there"

I ask my fellow nurse to come with me because the elderly residents that are most seriously ill have been left alone and we have to go see how they are.

When you arrive at the care home there is a small transition – a strange moment when the world stops – before you pass from one place to another. A moment that lasts the time it takes to put on your protective suit and gloves and climb the stairs.

So, you realise, there is no clock, there is no phone, there is no plan that is more important than being there, at that precise moment, as if nothing else existed.

 

At that time, the goal is no longer the plan you had as the MSF residential home team manager – to create a healthcare intervention model for residential care homes with the greatest capacity and the greatest possible impact that we could apply to other areas of the country to save as many lives as possible.

"A look of fear & distress"

The objective is no longer that. And it becomes humanised. It does it at incredible speed: it has a face, eyes, a look of fear, distress, and confusion. And we humbly start to do our work. First, to get organised. Who is who? Where is everyone? Which of all the 20 residents in this home needs the most urgent care? Which have died?

With more order, thanks above all to the perfectionism of my partner, we begin the visit. But there is no strategy or tactic anymore. The time passes in a series of looks, of hands you hold, of caresses that calm the fear, also mine.. We enter an indescribable intimacy. I will never be able to recount it.

 MSF’s Montse Bartui and Maria Pagès, and Carmen Hernández (prevention coordinator at Accent Social) training staff selected to start working in this care home, which is being set to receive COVID positive elderly patients. Barcelona.

Laia's closed eyes open when she hears her son's voice on the phone. She is unable to speak, but her face comes alive as if the small capillaries that cross her transparent skin are suddenly filled with blood and oxygen. We all leave the room. We try, as much as we can in these circumstances, to create a space as serene and private as possible. Only one person stays to hold the phone. It is time to say to children, spouses, nephews and nieces, and grandchildren, as kindly as we can – as our colleagues Carme and Cristina, a palliative care doctor and psychologist, respectively, have taught us – that this may be the only opportunity to tell their loved ones what they need to, that it doesn't matter if somebody doesn't answer, that they shouldn't worry about the words, that they take advantage of this unique moment.

"Heal, you will heal some"

Many of the residents cling to our hands as if they belonged to the person appearing on the phone screen. Others say they are fine, that the ones that are tired are their caregivers, and some, incredibly, managed to hold a conversation. In all of them, without exception, there is a change imperceptible to the naked eye but that fills the environment with something similar to light or, whatever it is, it resembles light.

 “Heal, you will heal some; but your true mission will be to accompany your patients in life and in death, with the greatest respect you are capable of”

The confessions of fear, the questions about their companions, the requests for a glass of water, the hug that the sweetest woman I have ever met in a hallway gives me, the voices full of love from the goodbyes, the gratitude for life, the promises of reunions, all mix inside me in a strange way.

 MSF coordinator at Accent Social, showing her the circuits prepared to prevent infections among the care home staff.

These honourable moments that we witness, firm and broken at the same time, sad but honest, remind me of my first day at the faculty of medicine, when a very serious professor told us: “Heal, you will heal some; but your true mission will be to accompany your patients in life and in death, with the greatest respect you are capable of”, and so it has been.

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