Entrance to one of the Emergency Rooms in Istanbul. (Credit: Gonca Tokyol)

Başak Bayram, head of the pandemic clinic at 9 Eylül University in İzmir, a coastal town in Turkey, has just finished an extended shift. Outside the hospital, municipal workers clad in white jumpsuits and masks, wash the empty street with jets of bubbling water.

Municipal workers clad in white jumpsuits and masks wash the empty streets with jets of bubbling water. (Credit: Gonca Tokyol)

“There is a battle ahead of us, a war against the virus,” Bayram said, exhausted. “And the emergency room workers are on the frontline.”

As the novel coronavirus, also known as COVID-19, spreads around the world, doctors, nurses, and other health workers are becoming heroes to many. But like in many countries, in Turkey these heroes are also experiencing problems such as insufficient protective equipment, separation from their loved ones as well as long and exhausting working hours. 

For emergency personnel, the situation is worse. Since they continue to take care of regular ER patients, their workload has doubled and is now filled with more risks. 

According to Başar Cander, head of the Emergency Medicine Physicians Association of Turkey (ATUDER), university and major state hospitals in city centres do not have severe shortages of equipment. 

But the situation is not the same everywhere, as borne out by medical personnel in regional hospitals who spoke to Inside Turkey and requested anonymity for fear of jeopardising their jobs.

“We have big problems,” said 28 year-old B, who works at a hospital in the north-western city of Edirne. He said that hospital procurement was not keeping pace with the spread of the virus. 

“We’re suffering because we lack masks,” B wrote in an email, highlighting the need for the sophisticated N95 and FFP3 mask types which are currently in high demand around the world. 

These masks filter particles out of the air, and are commonly used by doctors caring for patients with airborne infectious diseases.

Normally, doctors would use a new mask for each patient or procedure, but B said, “We overuse and we re-use the masks we have. We surpass their exposure limits. We know it’s risky, but there’s nothing we can do.” 

C, a doctor who works in a hospital in İzmir, said that his department is among the better-prepared ones, and has the proper equipment. But even here, he said that health workers sometimes pay for necessary tools out of their own pockets. 

C, a doctor who works in a hospital in İzmir, said that his department is among the better-prepared ones. (Credit: personal archive)

“I worry more about my colleagues who work in remote areas,” he said. “They are in bad shape; some of them do not even have a regular mask.” 

C said that he has helped organise deliveries of safety equipment to his colleagues, adding: “Some of those health workers are doing COVID-19 tests. Can you imagine the risk they face?”

The Turkish Medical Association has repeatedly stated that hospital workers face equipment shortages, but Turkey’s health ministry denies the allegations. The Public Services Employees Union of Turkey (Genel-İş) has reported that a number of health workers who shared information about shortages with the public are now under official investigation.

All doctors agree that a lack of equipment increases health workers’ risk of exposure to the virus. C pointed out that test results arriving late is another risk factor.

“Tests we send to the ministry produce results in a day,” he continued. “Some hospitals have quicker test kits, which take 5 to 6 hours.”

In the hospital where B works, the average time for a test is up to three days. “We are on the verge of panic,” he said. “I am not even worried about my own health. I’ve accepted the high possibility of getting infected.”

Bayram explained that it is becoming increasingly difficult to isolate regular emergency room patients — victims of accidents or heart attacks, for instance — from those with COVID-19. 

“Since we don’t know which patients have the virus, all personnel need to wear protective equipment during their shift, but it is not possible for everyone. Some colleagues have become ill because they didn’t know their patient was also a COVID-19 patient,” she said.

Alev Kurtuluş, a 47 year-old resident of Istanbul, recently took her father to the emergency room of a state hospital for treatment of an embolism. She said that she had not noticed any new protective measures while they were there.

“We waited with at least 50 other patients. And even in the doctor’s room, there were other patients,” she said in a voice message forwarded to Inside Turkey by her son. Kurtuluş said that she had canceled future hospital appointments after a second visit, which she also found distressing.

The head of ATUDER, Başar Cander, points out that hospitals and the rest of the health system need contingency plans as infections spread.

“The important thing is to be prepared for the coming patient numbers, not just for the current numbers,” he said.

Turkey officially confirmed its first coronavirus case on March 11, with the first death six days later.

The government has taken a series of measures to try to limit the spread of the virus, from closing schools, suspending international and domestic flights, quarantining more than 30 towns, and imposing a 24-hour curfew for people under 20 or older than 60.

C believes that further measures should be applied in emergency rooms.

“The health ministry and the administrations of hospitals should declare that all ERs are pandemic clinics,” he said. “If they do that, they’re obliged to provide protective equipment for everyone.”

Not having the proper equipment also affects health workers psychologically. B said that he only has the chance to rest once at home, alone with his cat. The cafes and restaurants he would visit regularly in the old days have been shut down, and his friends are staying away as a result of the physical distancing measures.

Bayram said that almost all of the emergency room doctors she knows have changed their living arrangements to prevent their families or housemates from getting infected. Some have moved into friends’ homes, some live in hospitals, and some have checked into hotels.

“We have been away from our loved ones for more than 20 days,” she said. “All of my friends who are away from their children, their family, to fight this virus deserve a thank you and applause.”