At the end of April, officials from the Russian Ministry of Health and the Ministry of Education proposed to involve medical students to work in “red” and “green” zones of hospitals during the coronavirus epidemic.
The Russian service of the BBC investigated how the ministries’ initiative is being implemented in practice.
The document prepared by the authorities and the preparations for its distribution, which began after the appearance of the order, have raised numerous questions in the student community.
Students at universities and medical schools were concerned that working in the “red zone” would be mandatory.
“If a student refuses to work in the “red zone”, it is not a reason to expel him. Nor can the refusal be considered a basis for academic indebtedness,” Health Minister Mikhail Murashko later explained the essence of the order.
In addition, it was unclear whether he was referring to summer school, which begins earlier than usual, or something else.
The BBC’s Russian service spoke to those already working in hospitals and students who have yet to find work about the challenges they face.
“We don’t have much resistance here, unlike in Moscow and St. Petersburg. But there have been many pranks from the dean’s office, of course, far too many,” says Elena (name changed at her request), a student at Ivanovo Medical Academy.
Neither Elena nor her classmates fully understand the status of the work for which they are being recruited.
“What frustrates them is that they do not understand if it is an internship or a practice, if there are consequences for not passing or not passing, how to go through it for out-of-towners. As a result, some of the students who agreed to be recruited for hospitals simply did not make the list… But with this attitude and lack of desire, there is no motivation, honestly. I’ve been nervous for three weeks, I can’t even plan my time or prepare for exams because every day there are messages in the chats that throw me off track”.
According to Elena, some of her classmates were ready to work in hospitals, but they never got internships.
We explain quickly, simply and clearly what happened, why it matters and what will happen next. The number of offers should remain: episodes. End of story Podcast advertising RUDN student Marina (name changed at her request) says that what happened in the first week after the order from the Ministry of Health and the Ministry of Education was reminiscent of chaos.
“On April 30, they sent a document in Excel format in which all 360 people in my class were asked to provide their personal information, including their name, first name, patronymic, SNILS (insurance number), phone number, current address, desired work area, whether they have any chronic diseases, and if they already work somewhere in a hospital,” says Marina.
The next night, the student says, she and her classmates had to take two online tests to receive formal approval to work with patients on Covid-19, and then there was silence for several days.
Throughout this period of uncertainty, students wondered if they would have a choice, whether to go to the “red” or “green” zone, and how to protect themselves and their loved ones in such a case.
“If I get sick, who will take care of me, who will pay for my medicine? In other words, I would have to go back to my parents, who are already elderly,” explains Marina.
A few days later, her classmates began receiving calls from health care representatives: “They called and asked where the boys wanted to go, to the ‘red’ zone or to the ‘green’ zone. At first, in the mornings, those who were called answered ‘to the green zone,’ they were given an address near the VDNH at a certain time, and there was distribution. But by the evening, the situation had changed: “They offered both “red” and “green” zones, but in the end they said there were no more seats in the “green” zone. No one pushed into the red zone, and they suggested that we wait until the green zone became available. So a lot of my group didn’t go at all. No one ever called Marina. Her official internship was supposed to end on June 1.
RUDN student Dmitry [he also asked that his real name not be used] told the BBC that he is not aware of any cases of forced distribution to “red zones,” but there is a nuance: “Let’s not forget that this division is absolutely conditional,” and a patient who eventually tests positive for the virus may be admitted to a department not intended for covid treatment.
He believes that the ministerial order on student recruitment has not only put students in a dead-end situation: “Many hospitals don’t know or don’t want to accept students, or they don’t have any vacancies, and a bunch of other factors… I tried to get a job at the polyclinic in my area, but they didn’t know what to do with me either, they just offered me to be a volunteer. Well, at least in the department I am interested in – the dental department”.
Many students followed the same path and decided to solve the internship problem on their own.
In early April, Yuliana Bogomolova, a student at the Svyato-Dimitrievskiy School of the Sisters of Mercy, was faced with a choice.
She wanted to combine her nursing studies with work in the charitable sector. However, with the onset of the pandemic, the amount of donations decreased and Yuliana’s employer found it difficult to pay for her work in the palliative care department.
“There was a situation of uncertainty, and I had no savings. I had to pay for my education, I had to pay for my apartment, and my parents are retirees. I realized that even now, if I went a month without a salary, it would be fatal for me. So I decided to get a job where people are needed. I got a job in the 15th City Clinical Hospital named after Filatov. I called everywhere – Kommunarka, somewhere else, but only they answered, so I went there,” the girl said.
Officially, Bogomolova is a nurse’s aide. In practice, the job is similar to that of a sanitation worker: in the intensive care unit where Covid 19 patients lie, one must not only monitor the patients and assist with procedures, but also, for example, clean the floors.
Like all medical workers, she had to learn to work with a full set of protective equipment: “I remember very well how scared I was for my own life before I went there. I had never experienced anything like this before, and then I realized that I could get sick and die… But after the first day – it was cool. You go outside… and it feels like paradise. Everything is fine. Nobody is dying. And you can breathe so easy. You can smell things. You just walk like you’re flying.”
At school, Julianna’s work in the intensive care unit of Filatovsky Hospital counts as practical training required by the Ministry of Health and the Ministry of Education.
Despite her previous experience in caring for patients in the palliative care department, the psychological aspect of working in the ICU has become a challenge, she says.
I worked for four years in a children’s hospice. I also had experience caring for dying adults. There were people who died in my arms, both children and adults. It is difficult in the intensive care unit [at my current job] because a lot of effort, a lot of medication, a lot of procedures, a lot of manipulation is done to a person, and yet they often die suddenly. In the hospice, death somehow feels… – More alternatives? – More alternative – yes. And there is no such convulsive pumping, stuffing everything into you. Well, it’s just two different ways. Here you try to save – and of course it’s justified. The only thing that comforts me is that all our patients in the ICU – they are deeply sedated, in a medical coma. I hope they don’t feel any pain. We are trying to save them. It works for some. It doesn’t work for others.
In May, the girl did not receive some of the promised extra payments to medical workers dealing with the coronavirus.
“Apparently, I don’t understand it the way they understand it,” Bogomolova said at the time. “In Moscow, we have a certain amount of financial compensation from the city government and the mayor of Moscow, Sergei Sobyanin. And there is also federal compensation. Nurses and doctors received both of these bonuses.”
“It is unclear where the catch is. But since there are disruptions throughout the country with ‘Putin’s’ money, we remotely assume that it is ‘Putin’s’ money,” Juliana surmised.
A few days later, a hospital official called Bogomolova and explained that, officially, a nurse is not considered a junior medical staff member. However, the hospital management appealed to the Ministry of Health to transfer the money anyway. As a result, a few weeks later, the hospital itself paid the promised 25 thousand rubles – an additional payment for April, says Yuliana.
Julia, a final-year student at Moscow State Medical and Dental University, has been working part-time as an ambulance nurse since February 2020.
The university has promised to count these shifts toward her internship.
Did you have any doubts when it became clear in March that a wave of [confirmed cases of Covid-19] had begun and work was becoming dangerous?
“No, we were provided with all the protective equipment, and when you work in an ambulance, every shift is a risk. In addition to infections, the work itself is dangerous, not all patients are friendly when medical personnel arrive,” explains Julia.
According to her, an important part of the job is to find a common language with the patient, so in addition to the necessary professional skills, the visiting health worker should also be a good psychologist: “Then the patients will be receptive to him and the visit will be without misunderstandings”.
The youth of a healthcare worker can exacerbate a patient’s lack of trust: “There are categories of people who are already prone to conflict because of previous negative experiences or just personal dislike of medical professionals. This category of people can immediately say: “You are young and inexperienced, I know better than you what to do.
Yulia has had COVID-19 before in a mild form: one night in April she had a fever, back pain and headache. The girl called a doctor at the local clinic, who gave her a 14-day sick leave. After a week, she returned with a positive test result.
According to her, many people have experienced a mild form of the disease, although there have been deaths among her colleagues.
“I can say that I was lucky, my body is young, I was sick for a few days. But I had to reduce physical activity, and shortness of breath appeared”.
The girl was supposed to graduate from the university this summer, but until the end of May it was unclear how she would be able to do so under the conditions of the epidemic.
“In theory, the summer internship should be mandatory for graduates, as it is a requirement for obtaining a diploma. The dean’s office does not provide any up-to-date information on this matter, nor on the dates of state exams and admission to residency. No one knows when the increased readiness regime will end and when a new order will be issued by the Ministry of Health,” said a graduating student in May.
In early June, the dates of the state exams she would have to pass were announced. The dates for admission to residency remained uncertain. It is possible that students who are somehow involved in work with the coronavirus will get an advantage when enrolling in residency programs.
The initiative of the Ministry of Health to give additional points to the results of entrance exams was published for discussion on the portal of regulatory legal acts projects on May 29.
According to Yulia, some of her classmates still haven’t received their assignments: “The dean’s office of our university does not provide any information about what will happen to those students who refused the internship, the DZM [Department of Health of Moscow] offers options for completion, but in case of refusal from the ‘red zone’ in most cases they say ‘stay at home.’
Julia combines her shifts with exam preparation.
“On an ambulance, they take students into account, unlike working in a hospital,” she says. “If you are employed part-time, they will not give you extra shifts and will try to accommodate your schedule.”
But it is not easy for everyone to combine practical training and studying without pain.
RUDN student Anna [name changed at the girl’s request] told the BBC that she tries to take online classes while working in the “green zone” of a hospital near Moscow.
Out of three options – wait for the distribution from the Ministry of Health, arrange to work independently in a polyclinic in Moscow, or look for a job in the area of residence in the Moscow region – the girl chose the latter.
There were few opportunities for training in her specialty – dentistry, she believes – because the authorities in Moscow required dental offices and clinics to provide only emergency care during the self-isolation period.
“They don’t need students now,” Anna says.
In the end, she decided to find a place for herself in a polyclinic at one of the hospitals in the Moscow region: “To be one hundred percent sure that no department would call and send you to the same Kommunarka, it was pointless to wait.”
Working in the “green” zone is no less dangerous than in the “red” zone (in the photo: doctors during a consultation at the Moscow City Clinical Hospital No. 52)”.
The daily work, she says, looks like this: “You bring in a person with a fever, a cough. You take the blood pressure, you take the temperature. You fill out the paperwork. And then you refer them. If they have a fever, the ambulance will pick them up and take them to the hospital.
Like many other students, Anna is convinced that the “green” zone can be no less dangerous than the “red” zone: “You don’t get a protective suit. Even if people come and cough at you – well… Here you just put on a surgical mask [a set of cloth uniforms], they give you three pairs of shoe covers that are tied up with strings. They should also give you three pairs of gloves, but we only wear one. One mask. A cap. And a gown on top.”
Usually, says one student, nurses work from 9 a.m. to 5 p.m., but sometimes they have to stay at work until 8 or 9 p.m.: “I’m also studying at the same time, and it’s hard to combine the two. So I’m sitting at work, [at the same time attending online lectures], and they’re calling my last name. But I can’t answer the question because I’m not at home, I’m at work. I got home late last night and I have an exam the next day. What should I do? I really want to sleep. And I don’t have the energy to study. In this respect, everything is not well thought out and it’s difficult.”
The document with the signatures of two ministers, which regulates the direction of university students for practical training, has still not been published on the official site of legal information.
The Ministry of Justice informed the BBC that the Order “On the Organization of Practical Training” No. 378/619 has not been received for registration. However, this does not mean that it is powerless.
As Sergey Belov, the Dean of the Faculty of Law at St. Petersburg State University, explained to the BBC, there are clear criteria for which regulatory documents come into force only after their registration and official publication.
According to the rules for the preparation of ministerial acts, orders that “affect the rights, freedoms and duties of a person and a citizen” must be registered, as well as those of an interdepartmental nature, regardless of the duration of their validity.
Whether the act of registration issued by the department is subject to the decision of the Ministry. If the Ministry of Justice or the court, while examining the documents of the department, determines that the ministries were obliged to register the order, but failed to do so, it will be canceled. Until then, the order will be considered valid,” Belov clarified.
In response to the BBC’s inquiry, both the Ministry of Health and the Ministry of Science and Higher Education said that a joint decree does not require registration with the Ministry of Justice.
The document “has an organizational and regulatory nature in terms of organizing medical student practice by the heads of educational institutions subordinated to the Ministry of Health of Russia and the Ministry of Science and Higher Education of Russia,” the authorities explained.
“During the students’ internship, the requirements of the current labor legislation are met, including in the case of their employment during the internship period in a medical organization,” officials claim.
Olga Zinovyeva, managing partner of the law firm “Onegin” specializing in medical disputes and medical law, believes that the order of the Ministry of Education and the Ministry of Health has all the characteristics of an act that should be registered and fully meets the criteria for such registration: it affects a wide range of individuals, the duties of rectors and students, their rights and freedoms, and clearly has an interdepartmental character.
The fact that the document is actually implemented without registration, affecting the interests of an unlimited number of people, according to Zinovieva, can have serious consequences.
“If in the course of time it is established that the basis for sending students to Covid hospitals was an illegitimate order, then the involvement of students in providing assistance to Covid patients will also be legally invalid. This, in turn, may lead to a mass recognition of the violation of students’ rights by involving them in such assistance. Therefore, the Ministry of Justice should draw attention to the illegality of this order as soon as possible,” the lawyer said.