14 May 2020

Sometimes Andreas Wladis and his colleagues at the Centre for Teaching and Research in Disaster Medicine and Traumatology feel like annoying alarmists, calling into a void. No one is listening, or if they are, they don’t want to take in what is being said. “To try to be prepared, to see around the corner, and to build up strategies. That’s the core of disaster medicine. But getting the responsible parties to listen in time, that’s not easy.”

Professor Andreas Wladis
Andreas Wladis, professor of disaster medicine.

At the Centre for Teaching and Research in Disaster Medicine and Traumatology at Linköping University, Andreas Wladis’ office chair is empty. This is because when this remote interview is held, Andreas Wladis is in Stockholm, at Saint Göran’s Hospital. He is working there with COVID-19 patients, and other seriously ill people.

“Cancer patients, for instance. Most planned surgeries have been cancelled, but obviously, some have to go ahead.”

Apart from surgery, he works overtime with the COVID-19 patients, doing what he can to help – often on weekends.

“You’ve got to go outside your comfort zone, to provide help where it’s needed. Everything – everything! – is about the pandemic. It’s like a wet blanket covering the entire Swedish healthcare system.”

Andreas Wladis is professor of disaster medicine. His doctor’s role has taken him out into the world, including to several countries in Africa, and most recently to Geneva where he was head surgeon at the International Committee of the Red Cross. His work at the Centre for Teaching and Research in Disaster Medicine and Traumatology involves numerous educational initiatives – a large number of courses are held every year for professions both inside and outside the realm of medicine.

“Everyone who works in disaster medicine has known that a pandemic would appear within 15 or 20 years. We have been nagging about this at conferences, most recently in September 2019 where we had representatives for the National Board of Health and Welfare, the regions, the Civil Contingencies Agency and the universities. Everyone has known, but in reality, we humans often put off dealing with threats that aren’t imminent.”

A shock to the entire Swedish healthcare system

Is the current pandemic classified as a disaster for Sweden?

“Strictly speaking, no. In a disaster, the medical system cannot uphold normal quality standards, and so far we’ve been able to give our patients excellent care. We haven’t had to reduce our quality standards in any significant way. However, the pandemic is a shock to the entire Swedish healthcare system, and I’d classify it as a ‘serious event’. This means that healthcare resources are used in a different way, but with intact quality levels.”

Andreas Wladis on a mission for the International Committee of the Red Cross. Photo credit: private. Andreas Wladis praises the enormous efforts being made every day to fight the pandemic in Sweden.

But he already sees several things that society can learn from the pandemic – he identifies what he thinks is a major structural shortcoming at the national level.

“There’s no clear national leadership, as a result of Sweden’s governance system. The various government agencies have their areas of responsibility, which they manage well, based on the legislation in place, I do want to stress this. But we have no general who is leading the entire, overarching practical implementation at the national level, everything from the number of intensive care beds and drug supply to PPE and other working environment issues for staff.”

This lack of practical leadership at national level can be one reason why elderly care homes were initially forgotten, which is also an important lesson to learn. Again it’s about national structures, according to Andreas Wladis.

“Elderly care homes aren’t part of the healthcare system. They’re managed by the municipality, and municipalities in Sweden are autonomous. There is a lack of clarity in the governance. Some groups are missed – the elderly, as well as sufferers of dementia and mental illness. Who speaks for them? No one. These groups require extraordinary measures in a pandemic, but they are left to themselves. Moreover, employment in elderly, psychiatric and dementia care is low status, so the workers have trouble being heard.”

Wants to investigate direct and indirect consequences

As a result of this realisation, the Centre for Teaching and Research in Disaster Medicine and Traumatology and other LiU researchers have applied for funding to investigate the direct and indirect consequences of the pandemic. Direct consequences include how the most vulnerable are affected, in terms of unemployment, drug abuse, physical abuse. These people include those with mental illnesses.

“It’s important that we academics study the direct consequences of the pandemic as well as its medium and long-term consequences. Could it be that we will see more indirect deaths from COVID-19 than deaths caused directly by the disease? For instance we want to study what happens with suicide and attempted suicide, as well as domestic violence.”

Another research question is, how does an ongoing crisis affect criminality?

“A strength of the work at our centre is that our research spans across different disciplines. As a surgeon, I can collaborate with a criminologist, and this opens up new ways of viewing the world for all of us.”

Looking at the past, what can we learn from previous disasters? Andreas Wladis cites the 2004 tsunami in southeast Asia, where a thorough post-event analysis of what worked well and poorly was made.

“Unfortunately our experiences from there have already started to be forgotten. When the event is still fresh, it seems important to retain that knowledge, but later on we tend to forget it; the event no longer seems so relevant. No normal person can imagine today, in 2020, that this will be the case after this pandemic. But if you ask in six years’ time about pandemic preparedness, it will be a different situation. There will be other challenges, other fires for our government agencies to extinguish.”

Andreas Wladis believes more in leadership from the regions than from the national government agencies.

“People who attend our courses and conferences are interested in what we have to say about disasters; it almost becomes a sort of disaster-medicine pornography, if you’ll pardon the expression. But what we say doesn’t really sink in with the government agencies. It’s a psychological matter. Sweden is a peace-damaged country – disaster scenarios feel improbable here.”

“This is where expertise in disaster medicine is so important”, concludes Andreas Wladis.

“We mustn’t give up, we have to remind people of the importance of being prepared for unusual events. So we’re equipped when, for instance, the next pandemic comes.”

Translated by Martin Mirko


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