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Uzbek doctors on the front lines fighting against COVID-19
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«I am not sure, was it the fatigue over these months that affected me, but at that moment I suddenly wanted to transform from an adult male doctor to a small child and cry on my mother's lap. And in response to hear her gentle, soothing voice that says - everything will be fine,» - mentioned a pulmonologist from Uzbekistan.
The Covid-19 coronavirus pandemic has exposed the most vulnerable areas of healthcare systems around the world. While humanity is looking for a vaccine, doctors were the first to be thrown into the heat of the struggle. They were the ones who closed all the gaps in the ineffective systems.

According to official data, announced on July 30 by a representative of the Headquarters for Combating Coronavirus at a briefing for journalists, 540 doctors have been infected with the coronavirus in Uzbekistan. The official death toll of doctors, which was also announced during the briefing, is two people.

However, a video has been spread among the Facebook social network users of Uzbekistan, in which the names of at least fifty doctors who have died from the Covid-19 coronavirus are named.

Three stories about how doctors in Uzbekistan are fighting for the lives of patients and going through the hardest times of the global pandemic.
Our heroes did not want their name to be mentioned, for various reasons. Some are out of modesty, others because they fear the wrath of their superiors. Nonetheless, all of them are real heroes according to the opinion of ordinary patients.

O. M. a pulmonologist at a hospital in the capital of Uzbekistan. The doctor has a 20 years of work experience under the belt. For several months he has been treating patients with coronavirus infection.
- As you know, in our country the first case of Covid-19 infection was registered in March. Just a week before that, a close friend of mine was infected with coronavirus in the United States. He is also a doctor. His illness was in mid-stage. However, he infected his elderly father, who died after two months of fighting the disease.



When this virus reached Uzbekistan, I had no doubts about what I would do in the coming months. From the very beginning I was well aware of the risk I was taking. My mother tried to dissuade me from this decision. She asked not to risk myself. But I am a doctor, I would never forgive myself, if instead of saving people, I sat on the sidelines.
It was not easy to convince my elderly mother that it was my professional duty. But she had no choice but to accept my choice. My wife is also a doctor. She is a therapist at a family clinic. So, she and I perfectly understood that each of us is needed in our place.
For reference: Measures taken in Uzbekistan from the outset to prevent infection briefly contained its spread. In particular, from the first days after the detection of the disease, the activities of all educational and religious institutions, as well as the movement of international and domestic public transport, were suspended.

Places of mass gathering of people were closed, in particular, clothing markets, public catering points. Employees of all enterprises and organizations, regardless of their form of ownership, were given vacations, or they were transferred to remote work. All medical institutions in the country were transferred to an enhanced mode of operation.
- I am sometimes asked what my motivation was when I rushed to the front line. Was I not afraid to get infected myself or infect my family members, relatives? A while back I even became a casual witness to a conversation of strangers who were discussing that if the state had not prescribed such additional payments to doctors for working with infected patients, hardly a single doctor would have budged.
The state has appointed payments to doctors, who were in contact with coronavirus patients and who work in medical institutions in which the infected are placed. Such doctors were promised that they would receive monthly incentive payments of 25 million Uzbekistani Sum (UZS) (2,427 USD), nurses and laboratory assistants - 15 million UZS (1,456 USD), sanitary workers - 10 million UZS (970 USD), other employees - 5 million UZS (485 USD). In addition, 100 million UZS (9,708 USD) will be paid separately to medical workers who have been infected by coronavirus while working with the infected patients.
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- Yes, of course, such support from the side of the state is really important and valuable. But after all, when we went to treat the sick, none of us thought about money. Moreover, the due amounts were not immediately paid. Doctors did not ask about additional payments, but it was beneficial for some people.
In May of the current year, the Department of State Financial Control of the Ministry of Finance, during an audit, revealed a delay in the corresponding payments to 932 employees of 32 medical institutions in the amount of 19.6 billion UZS (1.9 million USD). The reasons are different.

Thus, the Kashkadarya Infectious Diseases Hospital did not submit the lists of employees to the financial authorities on time. Because of this, 21 medical workers did not receive incentive payments of 373.6 million UZS (36,272 USD) for the second 14-day period of work.

In the Samarkand Regional Infectious Diseases Clinical Hospital, applications for the allocation of payments to doctors were sent on time. However, the regional health department did not approve the list of employees and did not file an application with the regional main financial department. As a result, 61 specialists did not receive timely payments in the amount of 1.2 billion UZS (11,605 USD).
Nine health care institutions of the Khorezm region also submitted applications to the Center for Sanitary and Epidemiological Well-being, but the employees of the department did not approve the list and did not submit it to the main financial department of the region. As a result, local doctors did not receive 1.7 billion UZS (165,049 USD) in time.

In addition, such violations were recorded in almost all oblasts.

Moreover, during the inspections, facts were also discovered when, instead of doctors, the lists of specialists who were entitled to incentive payments, without any reason, included employees who did not work with patients and who were being treated for coronavirus or were in quarantine.
- The strangest thing is to work in conditions when the patient does not see your face. This was the first time for me. Until now, the image of a twelve-year-old patient stands before my eyes. Her illness was mild.

But every time a doctor came to see her in a protective suit, she asked with sad eyes: "Doctor, will I not die today either?" I don't know why she was so sure that she had to die, and who inspired it to her. But each time she had to convince her otherwise.
In June, our interlocutor became infected himself.
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- From the symptoms I immediately realized that this disease has not spared me either. My lungs were affected by 60 percent. As a doctor, I understood perfectly well that there could be any outcome. I realized later that when you treat the sick, until you yourself endured this disease, you perceive it differently. When you yourself are among the patients, you look at it completely differently.

When I was in the intensive care unit, my mother called. We hid my illness from her. I spoke to her for two minutes, no more. Then, for the first time in many years, I felt like crying. I am not sure, was it the fatigue over these months that affected me, but at that moment I suddenly wanted to transform from an adult male doctor to a small child and cry on my mother's lap. And in response to hear her gentle, soothing voice that says - everything will be fine

I was able to overcome the disease. Today I continue to treat the sick patients. I only regret that there is no opportunity to see my mother and children. Last time I visited them was back in March. Since my wife and I are at work all the time, since March, my son and daughter have been living with my mother. We communicate only by phone no more than once a week.
We all burn out from the workload
"Professional burnout, lack of strength, desire - that's what I felt after a month of working with patients. Working in a regime when there are about 25 patients per doctor, when it is difficult to find some time for sleep, when you do not see patients for a long time - turned out to be a real challenge".


Infectious disease doctor Z.K. was among the first doctors who went to treat patients with coronavirus in Uzbekistan.
- Was I afraid of getting infected? To be honest, I didn't think about it at the very beginning. Fear probably came gradually. At the time when doctors began to appear in the news reports among the dead.
In general, doctors are used to working in conditions where the schedule is not standardized. Accustomed to sleepless nights. But dealing with the pandemic was not easy. For this, many were not ready either mentally or physically. Professional burnout, lack of strength, desire - that's what I felt after a month of working with patients. This happened despite the fact that every two weeks we changed our shift.

It turned out to be a real challenge to work in a regime when one doctor has about 25 patients, when it is difficult to find time for sleep, when you do not see your relatives for a long time. To be honest, there were even thoughts of leaving this profession.
At some point, I caught myself on the inside that I feel nothing for the sick patients: neither compassion, nor pity. Nothing. Empty. There was a feeling that I was a robot who simply executes the given commands. Here it became clear: professional burnout. I didn't know where to get the internal resources to continue the work. This condition has been experienced by many doctors.
You know, during the quarantine, not only the state, but also the public helped and supported doctors in every possible way. It's no secret that we did not only have time for sleep, but even to have a snack. However, many restaurateurs, and just sympathetic people, brought pilaf, barbecue, naryn, drinks to the hospital for doctors. Once, there was a note among the gifts, which has a message in child's handwriting: «Thank you, doctor».

I do not know who exactly this note was intended for. But it happened so that my colleague and I took it and read it. Both of us burst into tears. Then something inside seemed lit up. The second wind opened. And again, I was ready to stand on the front line.
Unfortunately, this disease took my father away from me. I still don't know where he got infected. We haven't seen him since the quarantine. We spoke on the phone only twice. I asked them to stay at home with my mother. I learned about their illness late. When they were already in the intensive care unit. Plus, they weren't in my hospital. As a doctor, I understood that the chances of recovery were small, but at the same time I believed in a miracle. Because our doctors managed to do the impossible before my very eyes. They fight for each life as for their own. They pulled people out of different states.
My mother's life was saved. But the miracle did not happen to my father. The disease has won. I didn't have time to mourn the loss. Since in June, after the relaxation of quarantine, the number of patients began to grow exponentially. And on the front lines, the struggle began again. Fight for every life.

The relaxation of measures and the negligence of residents to comply with sanitary and epidemiological rules led to the spread of the disease. Yes, it's infectious. Due to this, it is difficult to stop it. But due to specific steps, to some extent we can shorten the range for a while. This will ease the burden on healthcare, and doctors will have more opportunities for each patient.

… Once, when I was returning home, I saw people walking in crowds without masks, hugging. My head just sounded: "What are you doing? You should have seen what a struggle is going on in intensive care units for each patient."

As of September 21, 2020, 51 789 cases of COVID-19 coronavirus infection were recorded in Uzbekistan. 435 people died, and mortality is 0.84%. 47 932 people were completely cured of the virus, recovery is 92.55%. Uzbekistan ranks 56th in the ranking by the number of infected people worldwide.
When I am at home, I will reflect on the difficulties
«"Forgive me, now there is no time to reasoning – whether I'm afraid or not afraid. We need to work with the sick. The disease does not wait. Any our delay or wrong step can cost the lives of patients», - says a pulmonologist who has been in a hospital for a month in Zangiata district of Tashkent region.

A specialized multidisciplinary hospital in the Zangiata district of the Tashkent region was built recently. It has a capacity of 2000 beds. If necessary, it can be transformed and accommodate up to 4000 patients. It considers the specificity of the treatment of infectious diseases and the requirements of modern medicine. . In particular, all fixed beds are boxed, each room is autonomous and with separate ventilation. Each chamber has a separate entrance and exit. On admission, patients are placed directly into the ward through an airlock. All buildings, departments are connected by sterile and non-sterile corridors. "Clean" corridors are used only by doctors to carry out their duties. They pass through the sanitary checkpoints

- Patients come to us more often when there is at least 40 percent of lung damage. At the same time, doctors bear a great responsibility - it is necessary to carefully conduct treatment in order to avoid complications, so that there is no polypharmacy (simultaneous prescription of a large number of drugs, including unreasonable ones - author's note).

At the same time, there is pressure from the side of relatives. If the doctors fail to save the patient, there are many accusations from their side towards our lack of professionalism, etc. Unfortunately, we are not gods.
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The death toll in the world is already approaching a million. Yes, in most cases the disease can be overcome, and it does not go away in a severe form. But, unfortunately, there are those who have it in a severe one. In addition, if there are chronic diseases, then Covid-19, as a rule, aggravates them.

I haven't seen my relatives for over a month since we don't leave the hospital. There is no time to talk to them either. Perhaps when I am at home, I will be able to reflect the difficulties. But now it is the time to run to the sick.

After this our telephone conversation with the doctor was interrupted.
Recently, social media users of Uzbekistan have posted many unflattering reviews about this hospital. Many write that it was here that their relatives died. Losing loved ones is undoubtedly the most difficult challenge. None of us are being prepared for this. But there are many saved lives on the other side of the scale. And this is the result of the work of doctors who do not see their relatives for months, do not get enough sleep, become infected themselves, infect their families, die, but do not leave their post until the last.