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کمبود پزشک در کشور و به تبع آن، فشار کاری زیاد بر روی پزشکان امروز باعث فرسودگی کادر درمان و شهادت مدافعان سلامت میشود.
مدافعان سلامت در ایام عزاداری محرم با عشق و روحیه وصف ناشدنی در مراکز درمانی به مبارزه با ویروس کرونا میپردازند و امسال متفاوتترین روزهای محرم را تجربه میکنند؛ از طرفی عزادار سید و سالار شهیدان اباعبدالله الحسین (علیه السلام) هستند و از طرفی دیگر در غم از دست دادن یاران شهید مدافع سلامتشان به سوگ نشستهاند.
به گزارش «صبح امروز» و به نقل از فارس، شاید بتوان گفت از اسفند ماه سال گذشته تا به امروز، سختترین روزهای ممکن برای کادر درمان و به خصوص پزشکان و پرستاران سپری شده است. تنها پنج روز پس از گسترش ویروس کرونا در کشور، پرستار بیمارستان میلاد لاهیجان به شهادت رسید و شهادت شهیده نرجس خانعلیزاده به عنوان اولین شهید مدافع سلامت، کادر درمان و عموم مردم را بهت زده کرد. فشار کاری پزشکان در این روزها تا حدی بالا بود که 15 روز پس از شیوع ویروس کرونا در کشور، قائم مقام دانشگاه علوم پزشکی قم از فشار کاری زیاد و به آستانه رسیدن تحمل کادر درمان خبر داد.
آمار فوتیهای کادر درمان در ایران
طبق آمار سازمان نظام پزشکی تاکنون، 164 نفر از کادر درمانی کشور در راه مقابله با ویروس کرونا با ایثار و فداکاری فراوان به شهادت رسیدهاند که 60 نفر از این شهدا، پزشک بودند. به گفته جهانپور، سخنگوی سابق وزارت بهداشت: «تعداد زیادی، پزشک متخصص و اساتیدی مثل دکتر پیروی که سابقا ریاست دانشگاه علوم پزشکی بودند را از دست دادیم، در یکی از بیمارستان ها همزمان ۲۱۰ نفر از پرسنل به علت ابتلا به کرونا به مرخصی استعلاجی رفتند».
از سوی دیگر پس از گذشت دو ماه از شیوع کرونا؛ حسین فرشیدی، رئیس دانشگاه علوم پزشکی استان هرمزگان در یک نشست خبری، با بیان اینکه آمار مثبت ابتلا به ویروس کوویدـ ۱۹ در هرمزگان با یک شیب مشخص رو به افزایش است، گفت: «اکنون با کمبود شدید پزشک و کادر بهداشتی بهویژه در روستاها روبهرو هستیم. همچنین در بیمارستانهای استان نیز با کمبود پرستار هم مواجه هستیم».
کمبود پزشک در مناطق محروم
در همین بازه زمانی آریانپور نماینده مردم شرق گلستان افزود: متأسفانه در مورد حضور نیروی متخصص نیز شرایط خوبی در شرق استان نداریم؛ طوری که 70 درصد پزشکان متخصص و فوق تخصص در مرکز استان و شهرهای غربی فعالیت میکنند و این موضوع برای سلامت مردم منطقه نگران کننده است. در مکاتبه با معاون درمان وزارت بهداشت، درمان و آموزش پزشکی خواستار توزیع عادلانه نیروی متخصص برای خدمت به مردم محروم منطقه شدهایم و در همین رابطه قولهایی هم گرفتهایم.
عضو کمیسیون بهداشت و درمان مجلس از خدمات درمانگران در دوران کرونایی کشور قدردانی کرد و گفت: بر اساس استاندارد جهانی هر یکهزار نفر جمعیت، چهار پرستار یا به ازای هر یک تخت فعال باید سه پرستار وجود داشته باشد و این امکان در کشور ما فراهم نیست. مسئولان باید به پاس ایثارگریهای پرستاران ضمن انجام پرداختی بموقع حقوق پرستاران برای امنیت شغلی پرستاران شرکتی و غیره اقدام کنند.
حافظان سلامت شرایط مساعدی ندارند
همچنین علیرضا زالی فرمانده ستاد مقابله با کرونا در تهران با اشاره به خستگی کادر درمان و حبس پزشکان و پرستاران در بیمارستانها، گفت: بالا بودن آمار ابتلای کادر درمانی به ویروس کرونا حکایت از این دارد که حافظان سلامت مردم در شرایط مساعدی قرار ندارند. ارتباط مستمر پرستاران و پزشکان با بیماران مبتلا به کووید-19 آنها را در معرض غلظت بالایی از ویروس کرونا قرار داده است و همین مسأله سطح درگیری و ابتلا را در بین کادر درمان، بالا می برد.
به گفته زالی، در پیک اول که شروع بیماری بود، تجهیزات حفاظتی به اندازه مکفی در بیمارستان ها توزیع نشده بود، طبیعتا جامعه پزشکی هم آموزشهای لازم را در زمینه مقابله با اپیدمی و نحوه ابتلا به بیماری و حفاظت عمومی ندیده بودند. اما در حال حاضر به رغم اینکه وسایل حفاظت فردی در دسترس است و آموزش های لازم دیده شده و تجربه گروه های پزشکی هم افزایش پیدا کرده است اما میزان ابتلا به چند دلیل بالاتر است.
زالی ادامه داد: مهمترین دلیلش این است که فرایند خستگی مزمن تیم پزشکی که یک مسئله غیرقابل اجتناب است، موجب شده سطح دفاعی و ایمنی افراد کاهش پیدا کند. طبیعتا وقتی افراد خستهتر میشوند و انگیزههایشان کمرنگ میشود از نظر سیستم ایمنی بدن در معرض خطر بیشتری قرار می گیرد. سطح بالای خستگی و فرسایشی بودن بیماری کووید ۱۹ موجب شده انگیزههای افراد برای استفاده از وسایل حفاظتی کاهش پیدا کند.
وی گفت: مطالعه میدانی در سه دانشگاه علوم پزشکی در تهران نشان میدهد ۲۳ درصد گروههای پرستاری و پشتیبانی بیمارستانها به رغم وجود وسایل حفاظتی در مراکز درمان به اندازه کافی از این وسایل استفاده نکرده بودند. در جامعه پزشکی این عدد حدود ۱۲ تا ۱۸ درصد است. به این دلیل که پوشیدن لباسهای کاور در فضای گرم و با تهویه نامناسب بیمارستانها کاری سخت است.
کمبود پزشک از عوامل تعداد بالای شهدای سلامت
در ابتدای شیوع بیماری کووید-19 در کشور، نبود تجهیزات محافظتی و یا ابتلا در مکانهای عمومی، دلیل بالا بودن تعداد شهدای سلامت عنوان میشد اما با گذشت زمان و تجهیز بیمارستانها و کادر درمان، این آمار بهبودی نیافت، به نظر میرسد بالا بودن فشار کاری پزشکان یکی از مهمترین دلایل بالا بودن آمار شهدای سلامت است؛ در همین رابطه دکتر محمد مهدی زمانی، متخصص بیهوشی و مراقبت های ویژه و درد، در صفحه شخصی خود از نبود پزشک جایگزین در بیمارستانها و فشارکاری بالا، گلایه کرد، همچنین از احتمال کناره گیری و استعفای کادر درمان به دلیل نبود کادر جایگزین و کمبود پزشک در آینده نزدیک خبر داد.
در روایتی دیگر هدی غلامی، سرپرستار بخش اورژانس بیمارستان ثامنالائمه (علیه السلام) گفت : «یک هفته از شیوع بیماری نگذشته بود که تعداد بیماران از حد پیشبینی ما فراتر رفت، کمکم پرسنل بیمارستان درگیر بیماری شدند. دو هفته بعد پزشکان و کادر درمان یکییکی از چرخه خدمت کنار گذاشته شدند و ما با کمبود شدید نیرونی انسانی مواجه شدیم. فشار کاری مضاعف باعث شد تا کادر درمانی شیفتهای بیشتری سرکارشان بمانند. بر هم خوردن نظم کاری سیستم ایمنی کارکنان کادر درمانی را تحت تاثیر قرار داد و تعداد ابتلا در بین همکاران هم به طور غیرمعمول بالا رفت».
شیوع کرونا زنگ خطر افزایش سرانه پزشک در کشور
طبق آمار سازمان بهداشت جهانی در کشور ما ایران به ازای هر 1000 نفر فقط یک و نیم پزشک وجود دارد و رتبه شاخص سرانه پزشک در ایران در جایگاه 87 جهان است. در واقع 86 کشور جهان نسبت به ایران در جایگاه بهتری قرار دارند. همچنین در بین 25 کشور آسیای میانه و غرب آسیا، ایران در جایگاه بیستم از نظر سرانه پزشک و همتراز کشورهایی همچون سوریه، مالزی، تونس قرار دارد.
در این راستا جهانپور سخنگوی سابق وزارت بهداشت با اشاره به کمبود شدید کادر درمانی و پزشک برای مقابله با کرونا گفت: «در سال های اخیر هم کمبود پزشک و هم کمبود پرستار داریم و سیاست های وزارت بهداشت به سمت این بوده که تعداد بیشتری پزشک و پرستار را هم تربیت و هم جذب کند».
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در همین راستا علی اکبر حق دوست معاون آموزشی وزارت بهداشت توزیع نامناسب پزشکان را یکی از علل کمبود پزشک در برخی مناطق کشور دانست و افزود: در خصوص افزایش ظرفیت رشتههای پزشکی گفت: منطقی کردن و مستند کردن پذیرش و ظرفیت دانشگاههای علوم پزشکی، بر اساس معیارها و تأمین منابع و نیروی انسانی است. ممکن است متقاضی برخی رشته ها زیاد باشد، به دلیل اینکه جذابیت برخی رشتههای دیگر کم شده و اگر وضعیت شغلی سایر رشتهها رونق بگیرد متقاضیان این رشتهها حتما کاهش پیدا میکنند؛ ظرفیت رشتههای پزشکی حدود 60 درصد افزایش پیدا کرده است و اثرات آن طی سال های آتی ملاحظه خواهد شد و اثرات آن از دوسال دیگر مشاهده می شود.
حق دوست تأکید کرد: در شهرهای بزرگ و شهرهای متوسط انباشت پزشک عمومی داریم و در مناطقی هم کمبود پزشک داریم، به کارگیری و تأمین منابع، برای جذب پزشکان باید مد نظر قرار گیرد، از سویی می بینیم که کمبود پرستار داریم و پرستار بیکار هم داریم؛ آموزش باید جزئی از بسته اصلاحی در زمینه تربیت پزشکان باشد.
هرچند به گفته مسؤولان وزارت بهداشت طی سالهای اخیر ظرفیت برخی رشتههای پزشکی افزایش داشته است اما نباید از این موضوع غافل شد که غافل ماندن وزارت بهداشت برای تربیت پزشکان طی سالهای اخیر و بی توجهی به افزایش زیرساختهای آموزشی دانشگاهها یکی از دلایلی است که امروز شاهد فشار بیش از حد به کادر درمان و فرسودگی آنها هستیم؛ تعداد پایین پزشکان موجب شده تا فشار کاری بسیار زیادی متوجه کادر پزشکی کشور باشد، از سویی شیوع بیماری کرونا زنگ خطر آسیب پذیری نظام سلامت از کمبود پزشک را به صدا درآورد. با توجه به لزوم آمادگی نظام سلامت برای مقابله با بحرانهای احتمالی بعدی، ضرورت تربیت پزشکان و همچنین افزایش ظرفیت پذیرش دانشجو در رشته پزشکی بیشتر از هر زمان دیگری احساس میشود.
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