In Pavilion 5 of the Ifema convention center in Madrid, which has been turned into Spain’s largest field hospital to manage the rising number of coronavirus patients, there is neither two meters of distance between one patient and another, nor adequate personal protective equipment. The conditions of nurses and doctors are “shameful” and they don’t even have the computer program they need to work.

This is what doctors, nurses, guards and administration staff at the center told EL PAÍS this past weekend.

“There is greater risk of contagion than of being cured in this situation. It’s a disaster,” says one nurse.

Ana González, another nurse who works a a local health center in Móstoles and in intensive care units (ICUs) in different hospitals in Madrid, went to the field hospital on Wednesday to volunteer. “The patients are overcrowded …. It looks like [a scene from a] war, there are barely two steps between beds, there is one bathroom for all the patients, and they had gone 13 days without showering until a shower was installed on Friday. There are no stands to hold up drips, we are using broomsticks!”

These are just some of the dozens of complaints from health workers. The terrible conditions faced reached their limit on Sunday, according to Spain’s CCOO labor union, which argues that the protocol for personal protective equipment is not being met, that there is overcrowding, and that the changing rooms fail all safety measures aimed at avoiding contagion and stopping the spread of the virus.

Up until now, the field hospital has been run by volunteers, but many are thinking of refusing to work in these conditions. On Sunday, trash bags were handed out instead of caps to protect heads, and non-protective green gowns were put on with a plastic apron.

“The waiting areas and the changing rooms are being filled up with scrubs, caps and personal protective equipment that we have been using before with infected patients. There is not even a meter of distance between one person and another,” staff have told the union. This situation breaks all safety protocols set out by the Madrid region’s public health department for health workers and non-health workers who have direct contact with patients.

“[I work] three nights in a row and where I am there is no replacement. There are very few of us in Summa [Madrid’s emergency services] and the patients are very unwell,” says a nurse. “They are left exhausted by the fever, the diarrhea caused by [HIV medicine] Kaletra and an indescribable sadness.”

The regional government in Madrid has recognized that there was a “one-off organizational problem” on Sunday that led to complaints from professionals, but says that the field hospital is being provided with the necessary resources. “There are professionals who have decided to also cover their gowns, caps and shoes with plastic bags,” authorities added.

The CCOO union has warned that it would not allow workers to be threatened for refusing to work without adequate personal protective gear. In response, the Madrid regional government said that they had seen no evidence of such threats and encouraged staff to report such cases “because they would not be tolerated.”

Some health workers insist that the threats are real. One of them says they are “veiled but continuous.” “They don’t want people to know how things are being done and there is pressure all the time,” they explain.

The pro-public healthcare group Coordination Against Healthcare Privatization (CAS) says that “many patients from residencies were brought in directly, without a Covid-19 diagnosis” this weekend, and added that the field hospital did not have the resources needed to carry out the necessary analyses. “The computer program is not installed and there is no way of creating a patient’s history.”

Volunteers for 5,500 beds

Since the field hospital opened, 1,110 patients have been admitted and 424 have been discharged after recovering. On Sunday night 750 patients were in the hospital. The space is set to have capacity for 5,500 hospital beds and 500 intensive care beds. “But obviously they are not all there right now. Not even those that are there have the optimum conditions for patients,” says one family doctor.

Another family doctor, Carmen, 45, who works in a health center in Móstoles, received a call on Friday afternoon from her boss. They needed people at the field hospital “right away.” She told her husband, 52, who is also a doctor, and the two of them went on Saturday to Pavilion 5, the first of the three that the Madrid government converted to ease the strain on hospitals in the region.

“That first day was devastating. Nothing had been put together. It was all very makeshift, it was very cold. It is a sad site, a grey concrete hangar, with beds separated without screens, with no privacy,” says Carmen. The best part of the center was the attitude of the health workers. “We are all volunteers except for the internists who coordinate. The volunteers are very eager, we came to give it our all, to do what was needed.” But, as one nurse notes, “enthusiasm doesn’t protect you, and willpower doesn’t cure.”

That job is done by personal protective gear. Carmen arrives at 7.30am at Ifema and it takes the Samur staff at least 10 minutes to put on her four gloves, socks over her pants, fix everything in place with duct tape, a plastic suit that is “fearfully hot,” two face masks and protective facial visor “like welders wear, only transparent.” This is the highest level of protection.

“They are very heavy suits to wear, everything is tight and it’s very hot. We come out of them literally sweating. Working seven hours this way is very hard,” says Carmen.

But it is better than not having access to this equipment at all, says one nurse. “The dehydration under this weight of plastic and the marks and the injuries that it can give you, these are all things that we all want, rather than feeling completely unprotected, thinking that we are going to get infected and infect the patients.”

Prioritizing patients

Every patient at the Ifema field hospital has mild symptoms and has been transferred from a hospital in Madrid, a region which has been overwhelmed by the health crisis. When a patient arrives with more serious symptoms, or their condition worsens, the health workers have to make a decision.

“Some are transferred to ICUs in hospitals, but there are others, who because of their age or the fact they have multiple illnesses, are candidates for sedation,” says Carmen. The doctor from Móstoles explains the triage system: prioritize those with the greatest chance of survival when faced with a shortage of resources to help critical patients. “The ICU beds are limited. Sadly, you have to select patients. We can’t send patients over 90 to the ICU when a 30-year-old needs it… It’s very hard,” she says.

Enthusiasm doesn’t protect you, and willpower doesn’t cure Anonymous nurse working at Ifema

Since she started to work at the Ifema field hospital, Carmen has discharged five patients and her husband two. On Tuesday she had to sedate an 87-year-old woman, a moment she won’t ever forget. “It’s very sad but I am happy that I made it so that she would not die alone.” A day before her condition worsened, the woman suddenly improved and asked to speak with her daughter, by gesturing to her cellphone. Hours passed and when Carmen realized she was not able to do any more for the woman, she called the patient’s daughter again. This time, so that they could say goodbye. “I wanted for her to hear her daughter’s voice before she was sedated. [During the call] the grandmother smiled occasionally. I heard that they were talking to her about her granddaughter.”

Ana González, a 22-year-old volunteer nurse, does not go home when her shift ends “I stay in case someone gets dizzy and I have to go back in.” According to González, the working hours at Ifema are set by the protective suit: between four and six hours a day with one day off a week: “And that day, we work for free.” With the protective suit on, health workers cannot go in for more than six hours. But many staff who worked last weekend say that after experiencing the conditions on Sunday they may not last a minute longer. “And we can’t allow ourselves to take sick leave,” says one health worker. “The worst is yet to come.”

English version by Melissa Kitson.