The welcoming to San Salvador was beyond anything we could imagine. Our team is humbled and excited to begin their work. Thank you to our hosts.
An intervention team from SAMU has been deployed to El Salvador in response to a call from their government to SAMU First Response at the beginning of July. The team of 28 is there to help them as they face the sanitary crisis caused by COVID-19.
Given the situation in El Salvador, the Ministerio de Salud made an official call to Carlos Álvarez Leiva, President of SAMU, to provide assistance to a national hospital in San Salvador, the nations capital. The hospital has been recently inaugurated by president Nayub Bukele. The hospital counts with 1,000 beds of emergency and ICU support, making it the biggest hospital in Latin America. The urgent petition comes as there is a great need of volunteer medical support at all levels for at least a month. This call also comes with a need for instruction and knowledge transfer, something deep into SAMU’s mission and structure.
To respond to the call, SAMU has gone through an intense selection process in which more than a 100 professionals from different parts of Spain have applied. On July 29th, the team of 28 professionals departed to San Salvador on a month long mission.
The volunteers reported for duty on July 28th at the Escuela SAMU facilities in Gelves, Seville to depart to Madrid on a bus organized by our team. On July 29 they left on a charter plane to San Salvador.
“We are a young team with a call to service and a willingness to share the institutional knowledge we have acquired during the last 30 years of missions and 20 years of training from our organization. We are eager to share the best practices that have been developed from the protocols on the fight against covid in Spain.” Says Juan Gonzales de Escalada, director of SAMU emergency services and leader of the mission.
The departure was attended by many of our local authorities who came to wish the best to our team as they departed on this trip. Among them were Rafael García Villa, delegate from the Human Resources and Mobilization office from the local mayor’s office; Carma Tápies, Leader of the Humanitarian Action office in the Andaluza Agency of International Cooperation; Christophe Sougey De Funes, French Consul in Seville; Ignacio de Cossío Pérez de Mendoza, Consul from El Salvador in Seville; Alfonso Carmona Martínez, president of the School of Doctors in Seville; and Pilar Cordero Ramos, Vice President of the School of Nursing in Seville.
Before the departure there were many emotional moments from our volunteers and their families as they wished them good luck and said their goodbyes.
“As a mother I am afraid, what she is going to do is dangerous, there is a risk of contagion but I understand that is her calling and I’m here to support” said one of the relatives from our volunteers.
As of July 29th there are approximately 270 new cases a day in El Salvador. 87% of the confirmed cases are in the nation’s capital. The Salvadorian Ministry of Health identified the first original cases of Covid-19 in the country back on April 10. At the beginning of July there were of 8,000 cases and 209 diseased. Health authorities predict the peak to hit in August and the country does not count with enough professionals to respond.
“The call for medical volunteers will create a long lasting impact in our country. We are excited to continue building our relationship with SAMU Foundation as we all continue the fight against the virus, always improving the condition of our community” as stated by the Government of El Salvador.
SAMU has extensive expertise in emergency interventions during catastrophes and has acquired a lot of know how in the fight against Covid-19. During the time of peak cases in Spain, SAMU was at the frontlines of the response, providing sanitary response by setting up temporary hospitals in Hotel Alcora, located San Juan de Aznalfarache in Seville, and the Residence del Tiempo Libre El Burgo, located in Línea de la Concepción, Cádiz, in order to provide medical services to elderly people with Covid-19. SAMU also participated in the transfer of Covid patients from Madrid and Toledo.
A team of 12 psychologists from SAMU are providing specializes services to patients and families in our emergency center temporarily located in the Hotel Alcora (Seville) and the Residencia de Tiempo Libre El Burgo de la Línea de la Concepción (Cádiz). These professionals are also supporting SAMU personnel that are currently working on the frontlines of the pandemic. From the beginning of the crisis they have already performed over 400 interventions.
“The task force emerged after observing the magnitude of the growing cases and the lockdown preventive measures taken to control the spread. We assessed the psychological consequences that people could suffer and on how we can best support from our position. At the same time, SAMU was advancing in two initiatives: the opening of the Hotel Alcora as a medical center hosting positive cases coming from retirement homes and the transfer of elderly residents from the center Alcalá del Valle to the Residencia de Tiempo Libre El Burgo”, explains Roberto Alconada Padilla, psychologist from the SAMU Wellness center and coordinator of this initiative.
The work of this team of psychologist is to assist the families of our patients as they are admitted, provide information about their transfers, health updates and answer their questions and anxieties that are presented when there is a family member that has tested positive for Covid-19. The team also provides the necessary tools when a person feels overwhelmed. All of these interventions are conducted virtually.
“Another part of our work has been in working with people as they are admitted to our care. A lot of them present cases of depression, anxiety and disorientation” continues Roberto Alconada. Likewise the team is offering support and psychological treatment to health professionals, key elements of our interventions. “Being away from family, exposed to high risk situations and the simple exhaustion from the wearing of PPPs could cause a health professional to experience post traumatic stress disorder”. The interventions are carried our virtually with daily, weekly or biweekly calls depending on the case.
“The hardest interventions is when we deal with the grief after a family member has passed, often without the possibility of saying goodbye. That is the reason that our teams have taken as high priority to schedule video calls for our patients and their families” highlights one of our psychologist. “Being away from a family member because they have the virus creates a sense of anxiety and stress, even more when there is at a terminal state. For the family it is important to be present even from the distance. Bring able to accompany a parent in their last days helps later when they are in a process of mourning”.
“We are also helping families in their emotional processes through the country. A lot of them had no chance to say goodbye and they are dealing with difficult grief processes that can lead to greater issues as time passes. Our team supports the family before, during and after a relative is deceased”. Continues Roberto Alconada. He also explains that the society was not ready for this pandemic and that every person has to use their own resources to face the crisis. “As we face the uncertainty and lack of knowledge on how to face this crisis, it is important to have the right set of tools to help us cope with our new reality. Knowing that there is a professional at the other end of the call, someone that listens, understands the challenges and offers advice on how to manage the uncertainty helps the person deal with the crisis in a healthier way minimizing the potential of emotional damage”.
After the state of emergency was declared in Spain as a result of the global crisis caused by Covid-19, the 16th of March marked the closing date for all education centers in the country, at all levels. The closing force centers and teachers to change their methodology and go from an in person to 100% virtual in record timing creating a great challenge for the education community.
Distance learning has allowed a great section of the student population to continue with instructions. However, students with hearing impairment have not been able to advance their studies because interpreters have not been provided by public administration.
“This has created a great prejudice towards students with hearing impairment, alongside an increasing learning gap between them and other groups” explains Conchi Pérez, chief of student services at SAMU.
With this situation, SAMU has moved to develop a program of distance learning for students with hearing impairment. The program has been presented to the Agencia Pública Andaluza de Educación de la Consejería de Educación, and later shared to all other autonomies throughout the country.
The main purposes of this new program is to address the educational needs of this special group so they can level up with their peers. This will further help the social and labor integration. “This project is born out of the needs to adapt our educational system to work under the current sanitary crises created by Covid-19” says Conchi Pérez. “The main objective is to get the information that educators provide in their classrooms or from their homes and make sure that there is no learning loss to the students in the higher education and vocational centers”
In order for distance learning to reach all students equally, the program will have a virtual platform using existing technology, in which all students can connect at the same time and to provide an interpreter. That way the students will gave equal access to both the instructor and interpreters, maintaining a situation similar to their previous in classroom experience. This will be possible given the previous access to materials provided to interpreters so that they are ready to transmit what is needed to learn.
“The only thing needed is access to the platform to the students, instructors and interpreters, with reliable internet access and camera and audio capabilities” explains Conchi Pérez. “The student will have the opportunity to participate during online sessions, raising questions and answering at the same time as the rest of the students”.
SAMY wants to expand this program beyond the regular educational cycle into the summer break to supplement learning as it will be offered to other students during the month of July. This will allow all student to catch up with any learning loss emerging out of the pandemic. “If needed, this program can prolong into the fall, given the uncertainty with the return to in person schooling”
The area of Education Services at SAMU counts with a team of over 70 interpreters of sign language that provide in classroom services during the regular school year in education center in the province of Almería, Huelva, Jaén, Cádiz y Córdoba.
Starting on July 16, Fundación SAMU will also provide accompanying services for people with hearing impairment Comunidad de Madrid, for which it already counts with a body of 24 sing language interpreters.
SAMU’s engineering department has set up a digital production lab (FabLab), in response to the Covid-19 crisis. The spaces is intended to produce non industrial objects using a 3D printer. The lab produces face masks for children and adults, ear-saving pieces, face shields, and other pieces to adapt different products such as diving masks, into respirators so that students and health professionals could use them as practice equipment during training drills.
“During the pandemic, we all and in particular at SAMU felt de need to fight at all fronts and use all available resources to overcome the shortage of protection methods available a couple of moths ago. This is a proyect that has been undergoing for a while, to be quickly implemented” Explains Juan Antonio Tocino, responsible for the engineering department at SAMU. “The proyect was set to full motion on Mach 21, upon the arrival of the new 3D printer. That same week we started to print pieces to fight Covid-19”
FabLab has since produced over 300 units for different purposes. “This is an important amount given the limited space and the short time since the inception of the lab. We are looking forward to continuing to grow, receive the additional equipment needed and the official accreditation.” says Tocino.
In Seville, like other parts of Spain, there is a move for people and organizations to print 3D products to supply what is needed to fight Covid-19. In Seville, the FabLab with one of the biggest production lines is the one at the Escuela Técnica Superior de Arquitectura de la Universidad de Sevilla, which counts with over 150 volunteers and has produced close to 20,000 PPEs, according to the University.
“During the pandemic there has been a great spirit of collaboration at the international level and we have set to the community all available models to facilitate printing. In the case of hospital grade respirators, there had been a model published to adapt a scuba mask, but there was none for a portable respirator. This was developed by SAMU and open to the use of the 3D community” Mentions Tocino. “The spirit of collaboration among the 3D community has allowed for the open dialog on the usage of models and best practices”.
SAMU has been working with different 3D printing groups that focus on medical and technical equipment, among which there is a radiology 3D center supported by the American Radiology Society. The team has also counted with the support of Ama Moreno Ballestero, MD at the Servicio de Radiodiagnóstico y Medicina Nuclear del Hospital Virgen Macarena de Sevilla; and Javier García Sola, Architect with the Sociedad Estatal de Correos y Telégrafos de España.
More than 64,000 people have tested positive, there are over 4,000 in ICU and over 4,800 have died. Those were the numbers of COVID-19 in Spain as of February 27. Numbers that will tragically continue to grow. Madrid is one of the regions mostly affected in the country by the epidemic. More than half of the diseased nationwide are from this area. To this, there is a growing number of healthcare professionals infected and under quarantine. With over 10,000 workers affected, hospitals have experienced an important shortage in the times of crisis. To this end and following a call from the health department of the Junta de Andalucía, SAMU is working to provide support to the province of Malaga as well as in mobilizing special units to the Comunidad de Madrid.
SAMU has mobilized three intensive surveillance units, a high capacity vehicle and four units of volunteers with over twenty medical professionals to support operations in Madrid in order to safely move a group of senior citizens that have tested positive to COVID-19 to treatment centers throughout the area. This is a highly demanding job, both physically and emotionally because it forces medical teams to work with protective gear which distances them from patients and are extremely uncomfortable. To add to the arduous routine, the personnel has to follow strict guidelines to disinfect and change after each shift. “Taking care of you to be able to take care of others” is as Juan Gonzales de Escalada, SAMU’s Chief of Operations describes it.
At the same time, SAMU is working on the transfer of 28 COVID patients from a senior residence in Alacala del Valle in the province of Cadiz. This mission, authorized by the Junta de Andalucia, has been set in motion as a virus outbreak had been identified in the residence, affecting both residents and their supportive personnel. Originally, a group of six health professionals from SAMU were mobilized to the residence. The team was composed of one doctor, one nurse, two emergency technicians and two nurse assistants. The team was led by Andres Rodrigues, a nurse, who conducted a survey of the situation, analyzed the conditions of the elderly and recommended their transfer to a temporary hospital that SAMU had set in the Residencia El Burgo, located in La Linea de la Concepcion. After this, the medical team proceeded to a full disinfecting cleanup of the residency.
For the transfer of the patients, SAMU provided one bus, six ambulances and two special support ambulances. The transfer counted with a caravan from the national police. During this time, a team of other five professionals were setting up the temporary hospital in La Linea. A day after the transfer, a large number of agents from security and health services from the state sounded sirens in honor of the elderly at the doors of the temporary hospital. Sirens and applauses were followed by SAMU’s team, who showed their solidarity and gratefulness with applauses from inside the premises. Neighbors from the municipality held a large sign that read “You are also our grandparents”.
Today, 24 SAMU professionals are caring for a total of 28 patients. The security measures are high and all personnel count with the proper PPE.
“This is a hard and pure humanitarian action, as says our boss Carlos Alvarez Leiva, it’s a textbook crisis” Says Andres Rodrigues, supervisor of the temporary hospital in La Linea. “I am very surprised. I have been to many humanitarian missions in places like Siria and Libia, but I never imagined to be living such a situation in this part of Europe”.
On another front, SAMU continues to provide services in Malaga, where it moves between three to four patients on a daily basis. In addition, the Empresa Publica de Emergencias Sanitarias has requested that SAMU presents a contingency plan of up to 150 workers ready to support all stages of the crisis. Fortunately SAMU’s personnel has received training on the use of PPE and are used to working in high risk areas including working under areas of viral infections. According to Gonzalez de Escalada “its about taking the most extreme precautions”.
At the closing of SAMU’s march magazine edition, we are still in action helping in all fronts of the crisis with a plan of action and a series of projects to support the local authorities such as the set up of homeless shelters in Madrid and Seville, and the opening of a temporary hospital in the hotel Aljarafe in Seville, aimed at treatment of the elder population. SAMU’s General Director, Carlos Gonzales de Escalada has put his entire organization and resources to the disposal of local authorities and the society in general to contribute to its maximum capacity in the solution of the current health crisis.
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