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Results of OHHW2019, 11th Joint Conference on Occupational Health in Hamburg, 21 to 25 October 2019


Health protection for health workers in the face of a global shortage of skills, armed conflicts, humanitarian and economic crises. Declaration on violence against health care workers

(Hamburg, November 2019) More than 180 participants, scientists and doctors from 41 countries attended the 11th Joint Conference on Occupational Health in Hamburg at the invitation of the SCOHHW (Scientific Committee for Occupational Health for Health Workers). In light of a global shortage of health workers, the conference focused on the impact on health workers of armed conflicts, humanitarian and economic crises and the migration they cause. Forced migration currently affects around a third of the world’s population, and some 57% of countries are impacted by corresponding crises. At the same time, the health care sector is one of the fastest growing industries worldwide with a workforce that is 80% female, according to the WHO. “Cases of occupational injury and illness among health care workers are among the highest of any industry sector,” explained Gwen Brachman, Chairperson of SCOHHW. In addition, the daily work of care personnel generally puts a considerable strain on their mental health and their musculoskeletal system. A further risk is the danger of infection, e.g. with TB or hepatitis, as well as exposure to violence. At the same time, it is important to remember that there can be “no effective health care system without a healthy workforce.” Although the global shortage of health is indisputable, it must be taken into account that the availability of data varies worldwide and that different methods are used to collect them, said Christiane Wiskow of ILO Switzerland. Women work predominantly lower down in the hierarchy, and this gap is also reflected in their lower salaries compared to men. Almost everywhere there are disparities in access to health care services, according to Wiskow. Especially in poorer countries, there are not enough health workers, and this is even more pronounced in rural areas. The goal for everyone must be to create “productive jobs in freedom, safety and social dignity.” Stefan Brandenburg, managing director of the Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (German Employers' Liability Insurance Association for Medical Services and Welfare Work – BGW) referred to the ethical aspects when it comes to recruiting health workers from abroad, which many countries have to do. To avoid a “care drain,” the WHO has published the Global Code of Practice on the International Recruitment of Health Personal, which is also binding for the German Federal Government.

Health workers and migration
Given the forced migration flows triggered by crises, it is time to rethink health care systems, above all across national borders, according to Fouad. M. Fouad from the American University of Beirut. What happens to health workers who are displaced? How can migrants’ right to health care be guaranteed? The treatment of chronic illnesses often plays a role in this. The UN Refugee Council estimates that the majority of refugees are in low-income countries. Far too often, health care concepts are geared to a person’s citizenship. Access to health care services is also made more difficult by financial hurdles, e.g. in Lebanon, refugees have to pay a basic fee as a security on registering in the country on arrival. At the same time, migrant health workers are often not given an official permit to be able to practice their profession. In Lebanon, this leads to a complex “shadow economy,” in which “informal health services” are offered by Syrian health workers, but the responsibilities are not clear. According to Fouad. M. Fouad, it is important to clarify migrants’ rights in different countries, and to resolve how health care systems and migration influence each other.

Lack of resources
The skills shortage in the health care industry is also evident in higher income countries in the face of demographic change. In poorer countries, it is frequently caused by a “care drain,” where specialists emigrate to countries with better working conditions or are forced to migrate. Acran Salman Navarro from the NYU School of Medicine, USA, described how Chile is increasingly opening up to doctors from other countries, and talked about migrant flows to Venezuela from neighboring countries with a weaker economy five years ago. Now the tables have turned. “Some 7.5 million people have already fled Venezuela, including many health workers,” explained Igor Bello from the Venezuelan Society on Occupational Health. Tawanda Nherera of BOC Zimbabwe discussed an overall lack of resources, taking the example of the Central Hospital in Zimbabwe. There are too few workers in many hospitals in the country, partly due to the complex and long official application procedure that hospitals face when they want to hire doctors or nurses, according to Nherera. Not only human resources are scarce but also medicines and equipment. Essential items are lacking, such as drinking water, needles or disposable gloves. Doctors are not paid a living wage, and places on training courses are allocated via a non-transparent selection procedure that encourages corruption.

Gender issues
“Health care facilities are often the target of attacks in the course of armed conflicts, again threatening the life of medical personnel in particular,” according to Rima Habib from the American University of Beirut. Women and men have different experiences in conflict settings: Women are more often the victim of sexual violence. At the same time, working conditions in the health care sector also affect their private lives, resulting a rise in divorce rates, among others. Shift work is considered a main cause of family stress. Viviana Gómez-Sanchez from the Latin American Association on Occupational Health emphasized the need to both keep pregnant women in work, and protect them against catching hepatitis B, whooping cough or flu by immunizing them within a certain timeframe. Danileing Lozada from the Venezuelan Society on Occupational Health presented different ways to adapt health work to the needs of pregnant women, for example by using robots to move patients, introducing ergonomic desks and chairs, and organizing work to avoid night shifts for pregnant women.

Prevention
The topic of prevention covered a wide range of aspects, such as preparing medical staff better for deployment in conflict zones, or protecting health workers against infections, cuts, and other accidents at work. Marjia Bubas from Croatia reported on an initiative to reduce the risk of accidents caused by tripping and falling by issuing non-slip shoes. Other aspects to improve working conditions for health workers include making better use of the opportunities presented by digitization, introducing artificial intelligence, or using exoskeletons to support patients’ mobility. As Andrew Imada, former President of the International Ergonomics Association USA, explained, a macro-ergonomic perspective that takes into account the employees’ entire environment can be useful to avoid the risk of injury, for instance, or the incidence of occupational diseases, and to improve the quality of health care provision for patients.

Violence against health workers – Declaration
Participants at OHHW 2019 issued the following declaration on violence against doctors, nurses and other employees in the health care sector:
It is a crime against humanity
  • to attack health facilities and to injure or kill health workers;
  • to prevent health workers from providing patient services, particularly in crisis situations;
  • to punish health workers for helping patients in need of care and treatment;
  • to restrict migrant health workers from delivering care or medical services to other displaced persons in need.
Therefore, the participants of the OHHW2019 Conference appeal to all national and international organizations to protect health workers from these crimes.

The program with abstracts of the talks can be downloaded from the OHHW 2019 website at https://www.ohhw2019.org. Slides from the presentations will be uploaded soon.
Contact: Prof. Dr. Albert Nienhaus, Mail to: albert.nienhaus@bgw-online.de
Organization
The OHHW Conference is organized by the International Committee for Occupational Health (ICOH) and its Scientific Committees (SC) for Occupational Health for Health Workers (SCOHHW), for Occupational and Environmental Dermatoses (SCOED), and for Woman Health and Work (SCWHW). The International Social Security Association (ISSA) with the Prevention of Occupational Risks in Health Services section is a cooperating partner. The conference is supported by the Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (Employers' Liability Insurance Association for Medical Services and Welfare Work - BGW) and the International Labor Organization (ILO).

Interview with OHHW Keynote Speaker

Dr. Stefan Schmiedel on the lessons learned about Ebola in Sierra Leone


(September 19 st, 2019) At OHHW 2019, Stefan Schmiedel, a specialist in tropical medicine, will speak about the lessons learned during the 2014 Ebola outbreak in West Africa and about sending health professionals into areas where the disease is endemic. Insights into the situation of the aid workers on the ground are given here in this advance interview.

Mr. Schmiedel, at the height of the Ebola outbreak, you worked for Médecins Sans Frontières (MSF) for several weeks in Sierra Leone. What prompted your courageous decision to go into one of the epidemic’s epicentres?
Here at UKE (the University Hospital in Eppendorf), we treated a patient in 2014 who had contracted Ebola, a 36-year-old World Health Organization (WHO) worker from Senegal, sent to us by WHO. We treated this patient and kept him under our care for several weeks in the treatment centre for highly infectious diseases, an extremely secure, isolated reception centre. He then fortunately recovered. The crisis occurred in West Africa in 2014, with many thousands of people contracting the disease. We now know that there were 25,000 cases of Ebola in Sierra Leone, Liberia and the Conakry region of Guinea. In Sierra Leone especially, the spread of the disease among the population spiralled out of control. The health professionals on the ground were overwhelmed and healthcare provision collapsed. Appeals were made internationally, amongst others by MSF, for trained medical personnel, to provide assistance. I was interested in taking part from the medical point of view, as well as, obviously, for humanitarian reasons.

How did you find the situation on the ground, and what were you able to do in practical terms?
I was the medical director in charge of one of the treatment centres, of which there were four at the time, and I tried, as far as circumstances permitted, to provide medical care, continuing in fact what others had already begun. One of the epicentres of the epidemic lay in Kailahun, a remotely situated town in Sierra Leone. In September 2014, at the time when I was in West Africa, the outbreak was just reaching its peak. Our hospital had only 100 beds and all of them were occupied by Ebola sufferers. Every day, around 10 new patients were brought in and the same number died. We lost about 50 percent of our patients. In the region at the time, Ebola was the only thing that was still being medically treated. Aid organizations and WHO naturally also recruited local staff, and they were very successful in this. In addition, the Ebola treatment centres received staffing support from Europe, the USA and Japan.

What did the treatment look like?
A rather conservative programme of medication consisting of antibiotics, fluid therapy and nutritional therapy, anti-malaria medicine, analgesics and antipyretics. We cannot be entirely sure whether the treatment led to a decisive improvement in survival rates. There are no verified data on this, but of course we hope that it did. I believe that it was crucial, having given the people something to eat and drink, to keep feeding and giving them plenty of water. Ebola patients are too weak to do this for themselves. Death from Ebola is agonizing and it is also traumatising for those affected to witness the suffering and death around them. At the same time, the rest of the health care provision in Sierra Leone was, under the circumstances, certainly not as one would have wished.

What measures were available to the medical staff to protect themselves from infection?
We wore protective suits that cover the whole body. As you can imagine, that isn’t exactly pleasant in the heat. It’s strenuous to work in those conditions, and it makes communicating with patients virtually impossible. In these situations, keeping safe is always down to teamwork. Even putting on the protective suit is carefully scrutinized, and minutely regulated every step of the way. However, most danger is attached to taking off the suit, because at that point, the wearer has already been in contact with the virus. Someone is always standing by to help and disinfect, with a further member of the security staff checking that everything proceeds as it should. Furthermore, we were kept in isolation in the camp. It is not so much at work, where strict precautions are taken, that danger lurks, but in private life, for instance when visiting someone at their home or shaking their hand. Of course, we were not allowed to do such things. We really were shut away from everything, like being confined to barracks.

What psychological protection is available for healthcare workers taking part in such a demanding humanitarian operation?
There was so much work, so much pressure, that we weren’t conscious of the psychological and physical stresses while we were actually in Kailahun. We stayed in the camp seven days a week, together day and night in a small group, in circumstances that were far from luxurious. That is exhausting. But you don’t feel the full force of the stress until after you get home. While we were out in Sierra Leone, we were always very aware of being privileged and genuinely safe, also because not one of us suffered from the disease.

Aid organizations like MSF can call on decades of medical experience in disaster relief. The organization has, for example, made sure that it only sends mentally stable professionals with several years’ experience into the Ebola area, ones already used to working in the tropics and to humanitarian operations in developing countries. Preparatory training was given concerning safety aspects, but also in the management of psychological stress. Psychologists in the camp came for supervision and kept an eye on us, ensuring that the team functioned well as a unit, and also looking out for any healthcare workers giving cause for concern and who were in need of repatriation. During the catastrophic Ebola outbreak, periods in the field were limited to four weeks. This was a special precaution, since healthworkers normally stay out for six weeks. Before flying back to Germany, we were again offered psychological aftercare in Amsterdam.

None of this, however, should make us forget how motivating it is to do something as meaningful as this. What has stayed with me is how well the group cooperated, their team spirit and teamwork.

Can you describe what the situation was like for medical personnel from the area?
 In the camp, protective measures were the same for everyone. Unfortunately, there were repeated cases of staff getting infected in the course of their private life, through contact with people outside the camp, through living with their families and so on. How the local health workers’ situation developed after the crisis, bearing in mind the breakdown in the healthcare system, I cannot say.

Did you have to contend with people’s reservations, either in Germany or in the actual crisis region?
In 2014, the idea of flying an Ebola victim to Germany met with a lot of opposition. Up to then, such a thing hadn’t been an option — someone as ill as that was not to be transported across national boundaries. Fears ran high that the disease would be imported as a result. In reality, with the safety standards in operation and the medical knowledge about the disease and its progression, there was no danger.

In the end, both Hamburg politicians and the Federal Government behaved in an exemplary manner — and they had to give their consent before we could treat the infected WHO aid worker here.
While the care of the Ebola patient was taking place, the hospital carried on as usual. And in Eppendorf, the staff looking after him had volunteered for the job, taking on the burden by working extended hours.

On the ground in the crisis region, the stigmatization was often traumatic. Fear-stricken couples failed to look after each other, parents to look after their children, children after their parents. Survivors were frequently not allowed back into their village.

Have medical experiences been gained that are now of help in, for example, the Congo or Uganda? It is still unclear what substances and medicine can be used to impact or halt the disease. However, vaccines have since been developed that were not available at the time of the 2014 crisis. They are already in use today in, for example, the Congo and Uganda.

Dr. Stefan Schmiedel
works as the senior physician in the Department of Infectious Diseases and Tropical Medicine at the University Medical Center Hamburg-Eppendorf (UKE). His work covers, among other things, internal medicine, infectious diseases and tropical medicine.

New Keynote:

Mason D. Harrell on “Health Workers at Risk”

(August 1 st, 2019) One of the highlights of the Occupational Health for Health Workers conference (OHHW2019) held from Oct. 22.- 24. 2019 in Hamburg will be the lecture by Mason D. Harrell:

“DANGER! Health Workers at Risk: Working with Refugees, Immigrants, Migrants, Displaced Persons, and Persons in Areas of Conflict”

Working conditions for conventional health workers in classic work environments, such as hospitals, clinics, or labs have been well defined in both the developed and developing world, but there are more particular issues for health workers providing the same services to refugees, immigrants, migrants, displaced persons, and persons in areas of conflict. Working conditions significantly differ from their training and regular practice. Combining with the plethora of unfamiliarities, hazardous working conditions tumble together when complications from supplies, water, electricity, internet connection, finances, mental fatigue, and physical exhaustion pile up.

Adaptation and resilience are the foundational attributes that ensure the safety and success of these health workers. Success is achieved by not just working with one’s own team and the patient population, but also constructively collaborating with local authorities, health workers, national and foreign military, and aid organizations. Health workers must apply and adapt their training and safety practices to their new working conditions. These demands require raw talent and learned skills. Health workers must constantly adapt to the ever-challenging and changing work environments – they must think outside the box while working outside their comfort zone.

Mason D. Harrell, Medical Director, III M.D., M.P.H., FACOEM
Harvard-trained, double board-certified physician in Occupational Medicine, Public Health and General Preventive Medicine. Medical expert work with the Massachusetts Institute of Technology (MIT), the World Health Organization (WHO) and other. Currently, active duty Navy Lieutenant Commander, Medical Division Officer, and Flight Surgeon supervising 75 medical professionals.

Expert in occupational injuries and illness, including chemical exposures and sensitivities, heat injuries, environmental intolerances, asbestos, dust, mold, air quality, heavy metals, radiation, toxicology, causation, fitness for duty, return to work, malingering, work stress, disability, chronic pain, primary care, and urgent care.

OHHW 2019

International Journal of Environmental Research and Public Health (IJERPH) offers reduced publication fee

(July, 5, 2019) The International Journal of Environmental Research and Public Health (IJERPH) will support the Occupational Health for Health Workers (OHHW2019) conference held from Oct. 22.-24. 2019 in Hamburg.
A special issue of the journal is devoted to the proceedings of the conference. For further information, please see the IJERPH Special Issue Flyer (below). A reduced publication fee is offered. Upon application, a further reduction is possible.

The OHHW is one of the world’s largest international congresses in the field of occupational health and safety for healthcare workers, where experts from all around the world gather once every two years to share their experience and knowledge. 

11th International Joint Conference on Occupational Health for Health Workers
“Global Shortage of Health Workers”
22 to 24 October 2019
Hamburg, Germany

Contact

  • E-Mail:
    info@ohhw2019.org
    Albert.Nienhaus@bgw-online
    corinna.bleckmann@bgw-online.de