This fall, Madona regional government selected Liga Serna, former Health Ministry’s deputy state secretary, between two candidates for the position of the board chairperson of Madona hospital. She left the position at the Health Ministry after 27 years of work in different positions. Her priority in Madona hospital is to attract new specialists, develop traumatology and rehabilitation services.

Since 1994, you have been working in the Health Ministry in different positions, Why did you decide to change your life, leave your position during the Covid-19 pandemic and apply for the vacant position at Madona hospital’s board chairperson?

The decision to leave the hospital was one of the toughest ones in my life. One of the main reasons was burnout, being in constant stress situation. The decision was also influenced by investigation in vaccine procurement. All criticism the ministry and people who work there received - I took it very personally. Also, while working for such a long time in public administration, I lost motivation. Many issues returned on the agenda with every new government, the same processes were started again. Everything that had been done earlier, was not good. Let’s do things differently - these are the words with which every new health minister comes.

Why did you choose Madona hospital?

Long-term work in public administration allowed me to understand people who work in the health care system, and the system itself. I applied for job in Madona hospital because I can use my knowledge and skills here.

How do you evaluate the work of Madona hospital after your first months in the job? What are the hospital’s strong points, and what are the weak points which you wish to improve?

Madona hospital is the third-level emergency assistance hospital, ensuring medical assistance in several profiles - therapy, surgery, gynecology, pregnancy and childbirth care, pediatrics, traumatology, neurology and acute rehabilitation. One the one hand, employees are the biggest value, but, the whole country, we also face shortage of specialists. This shortage is created by unnecessary competition among medical institutions. Not only doctors, but also nurses are overburdened. Possibly, wage and work environment would be the aspect that would attract specialists.

Speaking about wage, it is a matter that is regularly raised on the highest level, and, looking at next year’s budget, it is very sad, because the promises to increase wages for health care employees by 10% will not be met. It is attitude of politicians to residents’ health care and medics. Therefore, medics keep working is several workplaces, and it creates the unhealthy competition in the job market.

It is also important to provide modern environment and use the latest medical technologies. We support new ideas and we think how to develop new services. There is a huge potential to develop rehabilitation services. Our ambition is to develop traumatology and to become the leaders in eastern Vidzeme. European structural funds have been invested in upgrade of surgery rooms so that it is convenient for medics to perform surgeries and patients are comfortable.

The hospital needs to improve its information system, digitalize different processes. We also have to think about infrastructure improvements, expansion of the admission department. The hospital’s roof has to be renovated. The Covid-19 pandemic showed the hospital’s weak points - we have to invest in the ventilation system so that we are able to divide two safe patients flows so that the infection ward can be isolated.

Which specialists are needed most in the hospital?

Our hospital and the whole country are short of new gynecologists. As the society is aging, medics are also aging. New specialists are not coming to us, they choose the private sector, university hospitals. We are thinking how to solve this issue.

Maybe the local government may help with stipends, apartments to attract young specialists?

We have good cooperation with the local government. Since I am working, we regularly discuss all current issues. The local government also provides support to young specialists, pays stipends to resident doctors, provides the young specialists with housing, their children have a spot in kindergartens. I hope this cooperation will continue. Also, we received support from the local government to ensure vaccination of senior citizens at their homes. The local government provided transport and a driver. Together with the local government we are solving social issues because they are becoming a part of everyday life of the hospital. As there is no Covid-19 ward in Madona hospital, we admit therapeutic patients not only from Madona region, but also from Riga. Sometimes patients have been brought to us without clothes, without documents, therefore, when discharging them, we have to look for clothes, solve transportation. Those are people living alone, without relatives. We have to find an individual approach to every patient, make sure he/she gets home. We have a vacancy for a social worker who would take care of those patients who have social problems.

The hospital has had good financial results in recent years, you work with a profit.

It was before the pandemic. We will try to work with profit also now because the hospital has old traditions, a good foundation. We should continue to evaluate results of the provided services, maybe some of the services should be outsourced. We should work together with economists to develop new services that would bring additional funding to the hospital. We should look for opportunities to apply for projects. The local government also provides support in writing project applications. The cooperation with the local government is very good.

What do you think about the Covid-19 crisis management in the country?

We have discussed the current situation with doctors at the hospital. It requires a deeper analysis why there are so many deaths in Latvia. The question about what is right, what is wrong is constantly on the agenda. I think that the first wave had to be followed by a thorough analysis, and this past summer an algorithm had to be prepared so that it is clear at what number of Covid-19 patients and what bed occupancy, new Covid-19 wards should be opened in other hospitals. At present, there is a feeling that there is no such algorithm. The prime goal was for all hospitals to open a Covid-19 ward without asking the hospitals themselves, without taking into account their opportunities, infrastructure, without analyzing bed occupancy in other hospitals which already had Covid-19 wards. In my opinion, investments had to be granted to all hospitals, not only university and regional hospitals. Of course, the biggest mistake was that in the middle of the crisis, the crisis manager was changed. Health Ministry’s state secretary Daina Murmane-Umbrasko was experienced, she started to manage the crisis, therefore it was a crazy decision to take her off tracks. Of course, it is also bad that people are working on the verge of a burnout, therefore many specialists have left different health care institutions. The remaining people have taken on additional workload and have been working in a stress situation since 2020.

What do you think about change of health ministers?

In my experience, ministers have changed quite a lot. I believe that it was not right to change ministers in the middle of crisis.

How has the requirement for mandatory Covid-19 vaccination affected work in Madona hospital?

Four employees have been suspended from their position due to failure to meet this requirement. When I came to work to Madona hospital in the fall, already 96% of employees were vaccinated. I believe that medics should present an example and get vaccinated. Our employees are already getting booster shots, thus, showing example to residents.

Does the hospital receive payment for the services from the state in due time?

We have a dialogue with the National Health Service. Of course, we would like a more operational action, but we are solving the urgent issues. The situation is not critical. I have heard though from regional hospitals that their payments are being delayed.

What do you think about the administration’s communication with hospitals? How regularly your opinion is asked before making decisions?

After request for resignation of the health minister, communication has improved. Once a week there is a remote meeting not only with regional, but also with second- and third-level hospitals. Two representatives from the hospital organization take part in the work of the operational medical commission so that we learn about the decisions better. We should be aware that there is a patient behind every decision. The hospital should inform every patient about postponing or resuming the service, besides there are procedures for which the patient should prepare in due time. It is not enough that I call today and tell the patient that the service is available tomorrow.

What problems should health system have to take into account in the future?

There should be a long-term view not only on restriction of scheduled medical services, but also on the impact of the Covid-19 pandemic because we will see the real consequences only in time. The biggest problems will be faced by people who have cardiovascular, oncological diseases. We have to plan that the number of acute patients will grow. There is a large share of people who have recovered from Covid-19, but it has left a negative impact on cardiovascular, lung and kidney health. We should also think what the impact of all restrictions on people’s mental health is. We should strengthen capacity of family physicians in the future so that primary health care is available to all people at any time. The main issue that should be done now - the virus should be curbed. We should listen more into the opinion of experts and decisions on restrictions should be made in due time. The Covid-19 crisis showed that the health care system and infrastructure is not ready not only to manage the crisis, but even react to it. It means that financing should be invested in infrastructure, health care management and human resources. Politicians should keep promises that were given several years ago, medics’ wages should be increased. We deficiently should develop telemedicine services and remote consultations. Covid-19 discovered the weak spots and opportunities alike. We should definitely improve technological opportunities for flexible and efficient compatibility of data. It is a matter of technical and legal solutions to link health information with other databases, such as registers of diseases and others. Disaster medicine plans should be updated. By attracting experts from the World Health Organization and other international organizations, we should evaluate the Covid-19 crisis management to establish responsibility of each involved person and to understand what has been done right and what has been done wrong. It is important not for the reason of punishing anyone, looking for the guilty persons, but for understanding how to act smarter in a similar situation in the future.