This Wall Street Journal article is very interesting. "Eastern Europe in Dire Need of Doctors."

Wall Street Journal

‘It’s Like the Second World War.’ Covid-19 Is Tearing Into the Parts of Europe That Lack Doctors

Europe’s crisis is moving into poorer states that have exported doctors for decades. Now the bill from that exodus is coming due.

By Drew Hinshaw and Natalia Ojewska

November 27, 2020

MIĘDZYCHÓD, Poland—So many new doctors left Poland for better-paying jobs in Europe’s west that when Łukasz Rotnicki decided to stay behind he often found himself working 36-hour shifts, sleeping on the brown pullout sofa of a small-town hospital with too few staff.

That was before Covid-19.

On a recent Monday, the 36-year-old surgeon was on his 74th consecutive hour of treating coronavirus patients, broken by only a few short naps.

At the same hospital, a local nurse had recently been hospitalized, feverish and short of breath. Yet the staffing crunch was so dire that she kept working in the very Covid-19 ward where she was meant to recover, feeding the sick and turning them onto their stomachs before returning to her own bed in the same room.

Europe’s Covid-19 crisis is moving eastward, from the wealthiest and best-prepared countries on the continent into the poorer states that have exported doctors for decades. Now, as Covid-19 cases soar, the bill from that long exodus is coming due.

With 238 physicians per 100,000 people, Poland has the lowest such ratio in the European Union, nearly half the level of Germany, whose relative success in handling the virus owes much to its foreign staff. The average age of Polish nurses is 53, just seven years short of retirement.

Largely spared during the spring surge, Hungary, Slovakia, Poland and Romania braced for autumn by stocking up on ventilators. But they lack people to operate the equipment. As cases pile up, shifts that often spanned two full days before the pandemic are now stretching the limits of human endurance.

“It’s hard times, I think, it’s like the Second World War,” said Dr. Rotnicki, who arrived on a recent Friday morning at the Independent State Healthcare Hospital in Międzychód in western Poland and didn’t clock out until the following Monday. Hours later, three of his patients died. “I had to go home because I thought, I will maybe kill somebody,” he said.

The shortages, which have prompted strict stay-at-home orders through Christmas in Poland, are the consequence of a borderless Europe that has seen prosperous countries—particularly in Western Europe—soak up talent from regions that offer lower pay.

As a result, Italian and British hospitals are coping with Covid-19 with help from Polish, Romanian and Hungarian staff.

Back home, doctors and nurses who stayed behind are working dayslong shifts.

Katarzyn Koch-Brzozowska, head nurse at the Międzychód hospital, said that her nurses threaten daily to quit, but she has successfully fought to keep them. “I call them a million times a day, and I bake them cookies with every day off,” she said.

In Hungary, physiotherapists can earn five times their $600-a-month entry salary pulling shorter shifts in Germany, and in Estonia doctors can quintuple their pay by crossing over to Finland. In western Poland, headhunters drive in from Germany, blanketing windshields with pamphlets that promise five times more pay, two years of free language classes and housing.

As incomes have risen in the region, nursing has become a less attractive profession. Schools that were once selective are now struggling to recruit enough students. In Slovakia, a third of all graduates immediately leave the country, said Jana Bendova, a board member of the Slovak Society of General Practice.

The staff who remain in the region tend to be older and were educated under communism, when schools taught less English, or have returned after years abroad

At western Poland’s Healthcare Center in Bolesławiec, three-fourths of nurses have fallen ill. Nearly half of nurses have contracted the virus at the nearby Drezdenko hospital, where one recent morning, a visibly sick receptionist greeting guests complained of a fever. Nationwide, about a 10th of Polish nurses were quarantined as suspected Covid-19 cases last month.

Officially, the Drezdenko hospital has 126 beds, but only enough staff to handle about 80 patients, a number they have already breached. Shortly before the pandemic, the hospital had managed to convince two daughters of its own nurses, both medical-school graduates, to join the staff. But within a few weeks, both left for the U.K.

Authorities have drafted troops, nuns and lifeguards to help. At Polish hospitals, soldiers take temperatures of visitors and input data into computers.

At one hospital in eastern Poland, staff recruited nine lifeguards from neighboring Ukraine. But they were unable to do anything more than basic CPR; most of them soon tested positive for Covid-19.

Hospitals have sent maternity-ward doctors, pediatricians and even physiotherapists into Covid-19 wards where many patients die. In Dr. Rotnicki’s hospital one recent morning, a pediatric nurse, used to caring for young children, sobbed during her break after a patient had died alone, the staff stretched too thin to sit with him.

“They’re not used to working with death,” said a nearby nurse, getting ready to don head-to-toe protective equipment.

For years, regional governments have tried to entice medical-school graduates to stay behind, sometimes with pay increases. Many doctors survived on cash given to them by patients. Just before the pandemic struck, those pay hikes had begun to help, and emigration started to slow.

But problems remain. To staff public hospitals, Hungary’s government is pressuring doctors to give up private practice and their right to choose which hospital they serve, a move widely opposed by doctors. A survey from June by the Hungarian Medical Chamber found six out of 10 medical-school graduates intend to leave Hungary.

“We’d rather be cashiers at Aldi or Tesco,” said one doctor, who is barred from government rules from speaking out. “We’d earn more and at least have our weekends free.”

When Dr. Rotnicki graduated in 2010, a stream of classmates crossed the border to take work in Germany, in hospitals where he estimates as much as half the staff is Polish.

In October, the regional government called to negotiate how many beds the hospital would be able to take at once, settling on 40. Within weeks of the arrival of the first patient, 15 medical staff were out sick.

Dr. Rotnicki began working marathon hours. On a recent day, ambulances had brought 10 seriously ill patients by the afternoon. Two needed intubation and another, a diabetic, was already unconscious. Many required oxygen and had to be carefully rolled onto their stomachs repeatedly to assist their breathing.

Meanwhile, 100 miles south, construction workers were racing to finish a new 65-bed hospital exclusively for Covid-19 patients overflowing regional hospitals. In about a month, the builders expected to finish an infectious-disease clinic on a muddy lot, complete with oxygen lines and CCTV cameras in every room.

The problem, medical staff said, is who will work there.

“If I have one new nurse,” said Ms. Koch-Brzozowska, the nursing director, “it means another hospital has one nurse less.”

Appeared in the November 28, 2020, print edition as 'Eastern Europe in Dire Need of Doctors.'