Patronažni program u borbi protiv COVID-19 / The struggle of patronage program during COVID-19

Snežana Perić

Služba polivalentne patronaže dugi niz godina funkcioniše pri Domu zdravlja Gračanica na Kosovu.
Polivalentna patronažna služba je jedna od bitnijih grana zdravstvenog sistema, koja ima za cilj
da svakim danom obavlja kućne posete u kojima radi na unapređenju zdravlja široke populacije
kao što su: trudnice, porodilje, novorođenčadi, odojčad, mala i predškolska deca, muškarce i
žene generativnog i postgenerativnog doba, osobe koje su u trećoj generaciji a imaju neku
hroničnu bolest poput dijabetesa, kardiovaskularnih, malignih obolenja.

Koordinator službe za polivalentnu patronažu i odgovorna osoba za besprekorno funkcionisanje
ove službe u Gračanici jeste Vladimir Petković. Specijalista intenzivne zdravstvene nege, Vladimir je gotovo
tri godine zadužen za koordinisanje i upravljanje ovom službom. Razgovor o svom poslu
započeo je sa nama listajući dokumentaciju koju mu na redovnom kratkom sastanku pripremaju
patronažne sestre svakog jutra.

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Iako nismo ispod maske mogli da vidimo osmeh na Vladinom licu ipak smo mogli da zaključimo
da je nešo pročitao što je izazvalo zadovoljstvo.

Znatiželjni šta je to izmamilo osmeh i raspoloženje primećeno u Vladinom glasu došli smo do
saznanja da trebaju da se organizuju prve posete blizancima.

„Kako je dan započeo dobrom vešću“ kratko je prokomentarisao Vladimir.

Pitali smo šta sada sledi, kako bira koja sestra ide, gde i kome u posetu? Gledajući u
dokumentaciju koju je prethodno dobio od zaposlenih u svojoj službi kaže da je svaka sestra
zadužena za određen broj porodica u kojima imaju od najmlađih korisnika do onih koji su u
trećem dobu svog života. A šta je najbitnije o prvom kontaktu što treba da znate kaže Vlada :
„Naše sestre se trude da taj prvi kontak učine što prijatnijim, jer se njime započinje poverenje
ne samo mame i bebe prema patronažnoj sestri već i ostalih članova porodice“.

Vladimir kao i patronažne sestre smatraju da je poverenje zapravo stub sa kojom oni započinju
obilazak pacijenta. Sama ta sigurnost i poverenje koje im pruža patronažna sestra je samo jedan
korak napred da njihovi pacijenti budu zadovoljni i ispunjeni.

Vlada Luksemburga je s početka 2015. godine  započela program podrške patronažnoj službi na Kosovu. Od maja 2020.godine u program podrške ukljčeno je i šest opština sa većinskim srpskim stanovništvom južno od reke Ibar. Na godišnjem nivou ova služba na terenu obavi i do 20 hiljada poseta porodiljama bebama i trudnicama.

Rad patronažne službe u toku pandemije

Koordinator ističe da su se od proglašenje pandemije koronavirusa uradili malu reorganizaciju u
njihovoj maloj ordinaciji u kojoj radi tim od 12 patronožnih sestara sada rasporedili u nekoliko
smena kako bi svojim primerom pokazali da se i u vreme pandemije mora strogo voditi računa o
fizičkoj distanci i korišćenju zaštitne opreme, koju su dobili od UNICEF-a.
Sastanak svakog jutra počinje u 07:30h, on je obično kratak jer se na tom kratkom dnevnom
brifingu upoznaju sa novim zadacima. Inače Vlada sa svojim timom radi i nedeljne planove
obilaska pacijenata kao i mesečne i one dugoročne koji zahtevaju više vremena i detaljniju
konsultaciju i drugih službi i stručnih lica.

Koordinator sestrama na nedeljnom nivou daje formulare koje one popunjavaju prilikom posete
osobi za koju su zadužene. Jedan formular je namenjen roditeljima i novorođenčadi a drugi je
predviđen za sve ostale njihove korisnike.

U tom formularu je sestra u obavezi da pored osnovnih podataka koji su neophodni za dalju
brigu o pacijentu i da obrati pažnju ne samo na ponašanje već i na zdravstveni izgled drugih
članova porodice.

Podaci pacijenata su zaštićeni i smeštaju se u porodični karton. Vladimir ističe da „popunjavanje
ovog formulara nama zdravstvenim radnicima koji radimo u primarnoj zdravstvenoj ustanovi
Doma zdravlja Gračanica u mnogome pomaže i u izradi porodičnih zdravtsvenih kartona“.

Ono na čemu insistira Vladimir Petkovic, jeste da se prilikom
obilaska pacijenta uvek treba staviti akcenat na promociji preventive, kako ne bi došlo do
obolevanja ili daljeg napredovanja određene hronične bolesti. A sada posebno u toku
pandemije korona virusa svakodnevno patronažne sestre pozivaju sve hronične bolesnike da
pitaju za njihovo zdravstveno stanje i da se informišu o njihovovim potrebama.

Od proglašenja pandemije Vladimir kaže: „Da češće njihovi pacijenti pitaju o preventivi suzbijanja korona
virusa, onačinu zaštite, oprvim simptomima, šta uraditi i kako se ponašati ukoliko smatraju da
su inficirani Covidom 19, ta pitanja sve češće nam postavljaju hronični bolesnici kod kojih je u
velikoj meri izražen i strah za sopsteno zdravstveno stanje. Mi njima svakako putem telefona
pružamo ne samo savet već i psihičku podršku da se samo zajedničkim snagama i poštovanjem
svih propisanih mera možemo izboriti sa ovom pošasti koja je zadesila čitav svet“ zaključuje
Petrović.

I dok mi razgovor sa koordinatorom privodimo kraju, sestra Olgica pored dokumentacije počela
je sa pripremom torbe sa opremom koja joj je neophodna za obradu bebinog pupka.

DUPLA SREĆA

I evo sa Olgicom Ničić patronažnom sestrom započinjemo razgovor o tome kako se odlučila da
postane medicinska sestra.

Olgica kaže da ljubav prema deci, sa kojima je radila kao pedijatrijska sestra 15.godina ne može
da porekne da je osećaj sreće i zadovoljstva zapravo ono što njen život ispunjava i da je posao
došao više kao zadovoljstvo a ne kao svakodnevna obaveza.

I kako je Olgica dobila zadatak da posetimo blizance, požurili smo da vidimo kakva je to dupla
sreća ne samo za roditelje već i za Olgicu koja vredno, predano, savesno i sa puno ljubavi
obavlja posao patronožne sestre.

I evo nas u porodicu Stolić, presrećna majka Mirjana sačekala nas je još na ulaznim vratima da
poželi dobrodošlicu patronožnoj sestri. Olgicino zadovoljstvo se nije moglo sakriti ni ispod
maske na njenom licu, glas je odao kada je ugledala blizance kako leže i čekaju njihovo redovno
previjanje pupčanika.

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Lagano uzimajući prvo Mijata počinje umiljatim glasom da mu se obraća kako je „on jedan divni
maleni dečak“ koji će joj uputiti osmeh dok ona spretnim rukama polako skida gazu i previja
bebi pupak.

Mama Mirjana gledajući, i upijajući svaki njen pokret kako to sestra radi koristi priliku da Olgicu
pita za savet da li i nakon prvog previjanja treba to sama da radili ili će imati pomoć patronožne
sestre.

Olgica nastavlja sa laganim pokretima obrade pupčanika i još tišim glasom se obraća majci da će
ona i njena služba biti svakodnevno tu sve do trenutka kada pupčanik ne otpadne Mijatu i
Vukanu.

Kada je završila sa obradom pupčanika blizancima, držeći sada Vukana u ruci objašnjavala
porodilji na koji način treba povijati bebu širokim povojem zbog kukova, kako i kada treba
kupati blizance, kako ih naizmenično treba dojiti jer je to njihova osnovna hrana koja dojenjem
jača imuni sistem kod deteta, i objašnjavala joj na koji način beba oseća bliskost sa roditeljima i
da što češće trebaju praktikovati dodir „koža na kožu“ kako majke tako i oca.

I dok je sve to Olgica objašnjavala mali Vukan joj je u naručju zaspao. Smeštajući blizance jedno
pored drugog da nastave sa jutarnjim odmorom Olgica ističe „da je neopisiv osećaj raditi sa
novorođenom decom koja iako tek rođena znaju šta je ljubav i nežnost i svu sreću svoju opišu
tim malim osmehom koji ti pruže dok spavaju“.

Sestra polivalentne patronožne službe ispunjava svoj formular, razgovara sa raditeljima dece,
ostavlja svoj kontakt telefon kako bi bila na usluzi Stolićima ukoliko je potrebna bilo koja pomoć
oko blizanaca.

Mi smo na prvi pogled odnosa porodice Stolić i sestre Ničić mogli da zaključimo da poverenje
postoji.

Olgica nije zaboravila da još jednom napomene da se strogo mora voditi računa o higijeni
članova porodice koji borave sa bebama, da trebaju poslušati savete struke koje propisuju
fizičko distanciranja, redovno pranje ruku, nošenje maski u zatvorenom prostoru, i da trebaju
izbegavati kontakte sa ostalim članovima familije i zbog njih i zbog blizanaca kako ne bi nikog
izlagali potencijalnoj opasnosti korona virusa. Takođe je iskoristila priliku da tokom boravka u
kući porodice Stolić napomene da je redovna vakcinacija bebe veoma važna za imunitet dece.
Pa je tom prilikom preporučila da se kod njih u primarnoj zdravstvenoj ustanovi Doma Zdravlja
Gračanica mogu informisati o važnosti vakcinacije putem kratke video animacije koju su uradili
UNICEF i Forum za razvoj i mulietničku saradnju.

Poseta blizancima se završila a patronažna sestra Olgica Ničić je u svojoj smeni imala da obiđe
još jednu bebu i da istom pričom i završi svoj radni dan.

From: Snezana Peric

The polyvalent patronage service has been functioning at the Gracanica Health Center in
Kosovo, for many years. Polyvalent patronage service is one of the most important branches of
the health system, which aims to perform daily home visits in order to improve the health of
the general population such as: pregnant women, women in labor, newborns, infants, young
and preschool children, men and women of generative and postgenerative age, people who
have a chronic disease such as diabetes, cardiovascular, malignant diseases.

The coordinator of the polyvalent patronage service and the person responsible for the flawless
functioning of this service in Gracanica, is Vladimir Petković. A specialist in intensive health
care, Vladimir, has been in charge of coordinating and managing this service for almost three
years. He started conversation with us about his work by going through the documentation that
the patronage nurses are preparing for him at a regular short meeting every morning.

Although we couldn’t see the smile on Vladimir’s face under the mask, we could still conclude
that he read something that caused pleasure.

Curious to find out what elicited the smile and the mood noticed in Vladimir’s voice, we came
to know that the first visits to the baby twins should be organized.

“The day started with good news”, Vladimir commented briefly.

We were wondering what happens next, how to choose where does which sister go, and who is
she going to visit? Looking at the documentation which he previously received from the
employees, he say that each nurse is in charge of a certain number of families in which they
have from the youngest users to those who are in the third age of their lives.

Vladimir says that the most important thing about the first contact you need to know,is: “Our
nurses try to make this first contact as pleasant as possible, because it achieves the trust not
only of the mother and the baby towards the patronage nurse, but also of other family
members.”

Vladimir, as well as the patronage nurses, believe that trust is actually a pillar with which they
start visiting patients. The security and trust provided by the visiting nurse to them is just one
step forward so that their patients are satisfied and fulfilled.

Luxembourg Government has launched a program to support the patronage service in Kosovo,
at the beginning of 2015. Since May 2020, six Serb-majority municipalities south of the Ibar
river have been included in the support program. Annually, this service performs up to 20
thousands visits to mothers, babies and pregnant women.

At service during the pandemic

The coordinator points out that they have done a small reorganization in their small office,
since the proclamation of the coronavirus pandemic, where a team of 12 patronage nurses
work. They were deployed in several shifts in order to show by their example that even during a
pandemic, physical distance must be strictly respected, as well as the use of protective
equipment, which they received from UNICEF.

The meeting starts every morning at 07:30, it is usually short because they are introduced to
new tasks at this short daily briefing. By the way, Vladimir and his team are working on weekly
plans for visiting patients, as well as monthly and long-term ones that require more time and
more detailed consultation with other services and experts.

The coordinator gives the forms to nurses on a weekly basis, which they fill out when visiting
the person they are in charge of. One form is intended for parents and newborns and the other
is intended for all other users.

In that form, the nurse is obliged to, in addition to the basic data that are necessary for further
care of the patient, pay attention not only to the behavior but also to the health appearance of
other family members.

Patient data is protected and placed in the family file. Vladimir points out that “filling out this
form, helps a lot in making family health records, to me and my colleagues who work in the
primary health institution of the Health Center Gracanica”.

What Vladimir Petković, insists on, is that whevisiting a patient, emphasis should always be
placed on the promotion of prevention, in order to prevent illness or further progression of a
certain chronic disease. And now, especially during theCoronavirus pandemic, nurses invite all
chronic patients every day, to ask about their health condition and to be informed about their
needs.

Since the proclamation of the pandemic, Vladimir says: “More often, our patients ask about the prevention of coronavirus control, the method of protection, the first symptoms, what to do and how to behave if they think they are infected with Covid-19. These questions are increasingly asked by chronic patients in whom the fear for
their own health is also very pronounced. We certainly provide them, not only with advice, but also with psychological support over the phone, so that only with joint efforts and by respecting all prescribed measures we can fight this plague that has befallen the entire world, “concludes Petrović.

And while we are concluding the conversation with the coordinator, the patronage nurse
Olgica, in addition to the documentation, started preparing a bag with the equipment she
needs to process the baby’s navel.

DOUBLE HAPPINESS

And here with Olgica Nicic, the patronage nurse, we are starting a conversation about how she
decided to become a nurse.

Olgica says that her love for children, with whom she worked as a pediatric nurse for 15 years,
cannot deny that the feeling of happiness and satisfaction is actually what fills her life and that
her job came more as a pleasure and not as a daily obligation.

And as Olgica was given the task to visit the twins, we hurried to see what a double happiness it
is not only for the parents but also for Olgica who does the job of a patronage nurse diligently,
devotedly, conscientiously and with a lot of love.

And here we are in the home of the Stolić family, the overjoyed mother Mirjana was waiting for
us at the front door to welcome the patronage sister. Olgica’s pleasure could not be hidden
even under the mask on her face, her voice gave off when she saw the twinslying and waiting
for their regular navel wrapping.

Taking baby Mijat lightly first, she begins to address him in a sweet voice as “he is a wonderful
little boy” who will give her a smile as she slowly removes the gauze and wraps the baby’s navel
with her deft hands.

Mother Mirjana, watching and absorbing every movement as the patronage nurse works, uses
the opportunity to ask Olgica for advice on whether she should do it herself even after the first
dressing or if she will have the help of the patronage nurse.Olgica continues with light
movements of processing the navel, and in an even quieter voice she addresses mother that
she and her service will be there every day until the moment when the umbilical cord falls off to
Mijat and Vukan.

When she finished processing the umbilical cord of the twins, now holding Vukan in her hands,
she explained to the mother how to wrap the baby with a wide bandage because of the hips,
how and when to bathe the twins, how to breastfeed them because it is their basic food that
strengthens children’s immune system, and explained her how the baby feels close to the
parents and that they should practice skin-to-skin contact with their mother and father as often
as possible.

And while Olgica was explaining all this to mother, little Vukan fell asleep in her arms. Placing
the twins next to each other to continue with the morning vacation, Olgica points out that it is
an indescribable feeling to work with newborn children who, although newborn, know what
love and tenderness are and describe all their happiness with that little smile they give you
while they sleep.

Polyvalent patronage nurse fills out her form, talks to the parents of the children, leaves her
contact phone number so that Stolić family can contact them anytime, if they need any help
with the twins.At first glance, we could conclude that there is trust between the Stolic family
and nurse Nicic.

Olgica did not forget to mention once again that the hygiene of family members staying with
babies must be strictly observed, that they should listen to the advice of the experts that
prescribes physical distance, regular hand washing, wearing masks indoors, and that they
should avoid contact with other familiy members, both because of them and because of the
twins so as not to expose anyone to the potential danger of Coronavirus. She also used the
opportunity to mention during the stay in the house of the Stolic family, that regular
vaccination of the baby is very important for the immunity of children. On that occasion, she
recommended that they can be informed about the importance of vaccination in the primary
health institution of the Health Center Gracanica through a short video animation made by
UNICEF and the Forum for Development and Multiethnic Collaboration/FDMC.

The visit to the twins ended, and the patronage nurse Olgica Nicic had to visit another baby in
her shift, and to end her working day with the same story.