Sweden

Sweden has long been held as a perfect example of socialised healthcare, that and the UK. I went there to find out how Sweden coped with the first outbreaks of CLBD-7

I’m speaking with a Doctor Anders Kask in a beautiful park. Judith meanwhile is next to some trees aggressively smoking a cigarette while watching some young men play football. She’s got her back to me and I think it’s the first time she hasn’t had her eyes on me. I swear she waits outside the toilet for me to finish, eyeballing the other patrons to see if they are international assassins.

I ask Dr. Kask how the healthcare system of Sweden coped with the early days of CLBD-7.

“Like everywhere else we didn’t know what was happening”, he says in thickly accented English, “People going mad in the streets, emergency rooms filling up with what we thought were psychiatric patients. And of course those who just slipped into unconsciousness.”

For the first time I’ve heard a doctor mention those who died. We are so fixated on those that were left alive we often forget those who died.

“It was the unconscious ones that we tried saving first – it’s all about triage. Triage is this wonderful idea thought up by the French in the first world war. You deal with the most serious life-threatening cases first, then the less serious and finally the walking wounded. We’ve been using it for years and it’s a good way to deal with problems coming in quicker than you can deal with.”

“In an emergency room setting you deal with unconsciousness before you deal with psychiatric problems, the unconscious patient can not wait to be treated. So you put your resources towards helping them while the other patients wait.”

“But there is one part of triage that often doesn’t get spoken about, and that is for the patients for which you can do nothing. You don’t treat them at all. The dead are dead and they remain so.”

“Of course, if we have the resources we attempt to resuscitate the dead – in 2010, the year before CLBD-7 we have a cardica arrest survival rate of 10.7%. Not a good rate, but better than a lot of other places.”

“What we didn’t know was that the unconscious ones were beyond our help. And even if we did know, how could we be sure that it was this new disease and not something that we could assist with?”

“It turns out that of those people showing symptoms of, er, I believe the colloquial is ‘being Clubbed’ around 20-30% would become unconscious, never to re-awaken, another 20-30% would become increasingly violent and the rest would follow normal, if rapid, onset of dementia. Around half of those who became violent, your ‘zombies’ if you will, further progress to a more normal dementia. Those who do not? Well, you have to decide what to do with them.”

But in those early days we didn’t know this, so we would have people brought in by ambulance deeply unconscious, some from stroke, some from diabetes, some from other causes, but a vast majority of them would be due to the disease. We had to treat them all the same, rule out the obvious causes and then find beds for them if they remained unconscious.”

“All the time of course our emergency departments were filling up with deeply psychotic patients”.

“So we were terribly stretched, in a normal week we might deal with three, maybe four or five patients who were persistently unconscious. Those who did remain so would normally go to the intensive care department. The ITU in my hospital has eight beds, and barely enough staff to run those beds. You see, it is not enough to merely have the physical bed, you also need the doctors and nurses and cleaners and all the others to staff that bed. Even working twelve hour shifts you need a minimum of four nurses to look after a bed for a week. And that isn’t counting the cover for annual leave and sickness.”

“And our staff weren’t immune to CLBD-7 themselves.”

I remember when one of our senior nurses was found by his wife unconscious in bed, he was brought in to us and when he was wheeled through the doors it was all we could do not to stop and stare at him. We knew then that the chances of him ever waking up were nearly impossible. We also knew that there were no beds in the hospital, no beds in any hospital.”

“It still shames me that he would be the first person we put on the general wards.”

“Until then, every unconscious patient went to ITU for one on one nursing care, now were were having to use general medical and surgical wards. While the nurses there did their best, they weren’t very well trained in the care of comatose patients. They also didn’t have the staff numbers, one nurse for eight or more patients? How could one person with some untrained helpers look after that many high dependency patients?”

“It started with the sudden deaths of the comatose, we were later to find out that many of these had died from an occluded airway, ‘swallowed their tongue’ if you would. This was because the ward nurses didn’t have the experience of keeping a patient’s airway open, not eight of them at once.”

“Then came the pressure sores, if you cannot move your body then where it touches the mattress, or even another part of the body, the circulation of the blood is restricted and the tissue starts to die. The position of patients should be changed every two hours at a minimum – and it just wasn’t happening, the nurses were too busy. Once a pressure sore happens the skin breaks down and falls away, and then it gets infected and starts to eat away at the patient.”

“I remember one woman who had a tiny spot of a sore on her sacrum, her backside. But the decay went much further, far up along her spine. She had a tunnel, a cavern, running along her back that you couldn’t see. Each day the nursing staff would dress that little spot wound, knowing that there was nothing that they could do for the metre long wound hidden just beneath the skin.”

“The thing I remember most? The terrible smell of infected wounds, Staphylococcus aureus was a big killer in those days and we barely had enough IV antibiotics to give them. After all you can’t give pills to a comatose patient. You would walk onto the ward and the smell would be like a physical wall – I can see why our predecessors thought that disease was carried by smells.”

“So we did our best, until the beds filled up, and then we made more bed, camp beds. Wards that were designed to hold twenty patients would hold twice that number. But the number of staff could not increase, where would they come from? Every country was having the same thing happen. The nurses that we employed from overseas were heading back to their home countries to look after relatives, and that meant our staff numbers dropped even more.”

“And CLBD-7 wasn’t the only disease, we still had people attending hospital with heart attacks, strokes, gall bladder problems – and they all wanted, and needed to be seen.”

“I think the American hospitals had it somewhat easier than us – their insurance companies stopped paying out for CLBD-7 treatment and so the hospitals would discharge them for patients that could pay. I don’t know what they did to those stricken who had no relatives to look after them. I mean, I have heard the stories, the terrible stories of ambulances taking them to places out of the way, under bridges and the like and just leaving them there, but I find it hard to believe that such things really happened.”

“It took us longer. No one in parliament wanted to propose what we knew would have to be done, and sure enough they got voted out the next year – but it saved many lives. The ‘Home Care Plan’ was passed and now anyone stricken who had a family would have to be cared for at home. There were some attempts at training the relatives as to how to look after the sick – but the funding soon ran out and so the information was put on the internet.”

“No one knows how the health service survived. I think that for a little while we just stopped worrying about death, just accepted it and did what we could to prevent it. We aren’t back to pre-outbreak levels, I don’t think that we ever will, but we are slowly recovering.”

I looked over to where Judith and the footballers had been, the field was empty and I couldn’t see Judith at all.

A few minutes later she sends me a text message to tell me to make my own way back to the hotel as she was following a lead.


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