A The biggest climate catastrophe in the history of Rio Grande do Sul left Porto Alegre’s health system on its knees. On the morning of Friday, May 10, the count was disheartening: 36 basic health units were closed due to structural damage or with services interrupted to support temporary shelters, set up to receive the thousands of people left homeless by the flood. The others 98 health posts in the capital they worked, but under precarious conditions. There was a lack of employees and basic supplies.
At least two large hospitals experienced traumatic situations. In the early hours of the 4th, a Saturday, the Canoas Emergency Hospital (HPSC), in the metropolitan region of Porto Alegre, was quickly flooded after the collapse of a nearby dam. The patients had to be rushed out, while the water rushed over the stretchers and medical equipment. Three of them, admitted to the ICU and weakened, died during the rescue operation. The private Hospital Mãe de Deus, dedicated to highly complex treatments, was also flooded that weekend. His patients had to be transferred to another hospital in army trucks.
The Hospital de Clínicas de Porto Alegre (HCPA), a large university center, began operating dealing with radical rationing. The flood caused a shortage of three essential items for the operation of a hospital: water, oxygen and staff. Intensive care doctor for sixteen yearsRodrigo Kappel Castilho, who is president of the National Academy of Palliative Care, works shifts at the HCPA CTI. In testimony to Piauíbelow, he talked about what it’s been like working on the edge and predicted the lasting impact of the tragedy on the state.
“MI last shift at the ICU at Hospital de Clínicas was on the morning of Wednesday, the 8th. I woke up at 6:30 am to get to my shift, which would start at 7:30 am. I took a route through the highest part of the city, where there is no flooding. At the request of the city hall, everyone who could left Porto Alegre towards the coast. The city, therefore, was empty, with almost everything closed. I remembered the time of Covid. As an ICU doctor, I was also one of the few people transitioning at that time. It was a desert in the streets.
I arrived at the hospital and found neither war nor hysteria. It was the opposite: everything was quiet, sad, the atmosphere was heavy. The Hospital de Clínicas has a gigantic operation, it is full of doctors, students, employees. The movement was much lower than normal. Employees and friends had their homes flooded and lost everything. Many did not even reach the hospital because they had no way of traveling within the city.
There is no shortage of beds, but there is a shortage of water, oxygen and supplies. Through notices sent via WhatsApp, the hospital management gave instructions to doctors: everything needed to be rationed. Contain the use of oxygen and prioritize the use of wall-mounted ones, not cylinder ones, because there was a risk of them running out. They asked for caution when using serums, because there were no new shipments arriving at the hospital. It was also necessary to restrict laboratory tests, due to lack of material. Elective surgeries were canceled and medical students were advised not to go to the hospital (to reduce the flow of cars in the city). But the main problem was the scarcity of water.
The Hospital de Clínicas receives water from the Moinhos de Vento supply station, which was stopped by the rains and is not yet scheduled to return to operation. The hospital’s reservoirs last three days. To supply just 1% of them, three tanker trucks are needed. At this moment, we are prioritizing the use of water for procedures such as hemodialysis. Showers in patients’ and doctors’ rooms were turned off. For employees, only two showers remain in operation, but everyone is advised to save use and not take water home from the hospital.
As they cannot shower, patients are cleaned with wet wipes. Sheets cannot be washed. Doctors are only wearing the top part of the special clothing they need to wear in the ICU. Also to save water and reduce the flow of people, family visits were limited. Most of those admitted to our hospital come from other cities in Greater Porto Alegre, so their relatives would not be able to access the hospital, due to flooding. During the pandemic, we were one of the examples of training professionals in remote communication between patients and their families, but this time it is difficult to establish this contact. Some patients died without being able to speak to their loved ones beforehand.
After Covid, it was inevitable to think: this is another blow we are taking. But these are different situations, especially in relation to the demands of the ICU. During the pandemic, many people needed beds, and the shortage produced terrifying scenes. I heard things like: “oh, one patient died and another is coming” – and the other, in this case, was the wife of the person who had just died. So far, there have been more than a hundred deaths in the state. It is not a calamity that caused the collapse of the healthcare system itself. But it is a tragedy that, in the long run, will kill. In the ICUs, we can already see a little of what awaits us.
One of the patients under my care was rescued from the water and, due to stress and previous health problems, had a stroke. When I was leaving the shift, at 1:30 pm, another patient, who had also been rescued and also had a stroke, was about to arrive. A fellow doctor who came from another shift, at Fêmina – a public hospital exclusively for gynecology and obstetrics – took care of a patient with leptospirosis caused by contact with water contaminated by rat urine. She had very serious lung damage and needed breathing apparatus. Another patient suffered from complications of decompensated diabetes because she had been isolated without medication.
The health system is on alert, because we will not only deal with diseases related to flooding, such as leptospirosis, hepatitis and gastroenteritis caused by contact with water. We will probably have an explosion in dengue cases, which was already epidemic, because of the water that will remain in pools in several parts of the state. People who were left without access to medications and treatments also concern us.
As I am president of the National Academy of Palliative Care, I am part of an NGO called TJCC – Todos Juntos Contra o Câncer. We are trying to identify and help patients who need to follow cancer treatment and are unable to access their reference centers. There are hundreds of roads compromised in Rio Grande do Sul.
People who lost everything in the floods will, on top of everything else, suffer from financial difficulties. This can further limit access to medicines. Diseases, meanwhile, are getting worse. It’s a scenario that none of us imagined we would ever experience.”
