Hospitals “without protection against heat waves”

Report shows mortality 60% higher in hospitals without air con

Twenty years since a ‘recommendation’ that all Portugal’s hospitals should install air conditioning there are still those that do not have it. 

A study by public health institute Ricardo Jorge (INSA) concluded that a killer heat wave back in 2003 was much more deadly for elderly people in hospitals without air conditioning – and that finding has set alarm bells ringing following the most recent heatwave which DGS health chiefs say caused 1,000 ‘excess deaths’.

As Expresso explains: “Various hospitals had peaks of emergencies during the heat wave this month… the heat causes decompensation in diseases like diabetes and cardiac insufficiency” – decompensation meaning diseases become suddenly worse (and can prove fatal).

Thus, the elephant in the room now, is how many people died during the last heat wave because hospitals continue to offer very poor protection?

Expresso sets out the facts: “In the Tondela-Viseu hospital centre which caters for half a million people, for example, there is no air conditioning in many services and, according to doctors and nurses we spoke to, some patients felt ill during the heat wave, suffering clinical complications provoked by the sudden increase in temperatures”.

In cases where patients were found to be suffering from the heat, “portable equipment and fans” were used to help cool them down.

Hospital staff even took appliances to people’s homes to help them stay cool, the paper was told.

“Expresso contacted the hospital administration but had not received a reply by the paper’s press deadline”.

Journalists did manage to speak however with Xavier Barreto, the president of the Portuguese association of hospital administrators, who agreed that “some hospitals have structural acclimatisation problems because they were built many years ago. For new constructions, the law establishes there has to be an air conditioning system in place. But for the old ones – which are the majority – there were no such obligations during their construction”.

And then there is a another problem (highlighted earlier this week in Caldas da Rainha): some air conditioning systems are just not up to the task. Expresso gives the example of the A&E at Lisbon’s Hospital de São Joséone of the largest in the country” where the air con system simply “does not have the capacity to cope with exterior temperatures and the level of occupation in the rooms”.

Ana Fernandes of the Portuguese association of Cold and Air Conditioning explained that “while private hospitals have inspections for the renovation of their operating licences, the SNS health service has no form of control post-construction”. This can mean that hospitals with air conditioning systems even choose to turn them off “in order not to consume energy. This would not be unprecedented”, she told Expresso.

But it is in old people’s homes that the situation is “even more serious”, Ana Fernandes explains, as although health advice is that all health units should be equipped with air conditioning, ‘residential structures for the elderly’ are not considered a health unit in this context…

Expresso also sounds out meteorologist Pedro Miguel Sousa, working at IPMA (meteorological institute), and the co-author of a study published this year on the increase in mortality associated with heat waves. He was adamant: “the existence of air conditioning in all hospitals and old people’s homes where vulnerable people are concentrated would attenuate a large part of mortality associated with heat”.

“It would be a way of mitigating the problem”, he said – a much easier (and cheaper) way than trying to resolve the inefficient insulation in the majority of homes in the country.

“Portugal has a structural problem when it comes to the quality of housing”, he said. Homes are “not prepared for temperature extremes. It is enough to say that a lot of people in Portugal die from the cold, when we are one of the least cold countries in Europe. It is a chronic problem, difficult to resolve”.

Pedro Sousa stressed that heat extremes “kill a lot of people, and very quickly” – much more quickly for example than the cold.

With regard to Portugal’s most recent heatwave, between July 1-16, Pedro Sousa said there was an excess of more than 1,000 deaths – more like 1,200 – 1,300.

“In total there were 6,380 deaths registered from all causes – 1,600 more than the average for the same period (over the last five years). Take out the deaths from Covid (which are still running at around 15-30 people a day, generally advanced seniors) and you arrive at an excess of 1,200 – 1,300. There is no doubt that a large part will have been to do with the heat…”

It would not be difficult to extrapolate from the figures the number of people who died in hospitals without air conditioning, or in hospitals with poorly functioning air con systems – but for now Expresso has done its job: mortality is 60% higher in health units without climatisation, and all those in positions of responsibility in hospitals are aware that the majority of extra patients they received during the heatwave were elderly people with chronic ailments, in situations of decompensation.

But it’s not just the elderly at risk in hospitals with poor air conditioning systems. Newborns are equally vulnerable – particularly premature babies. CNN Portugal has featured a problem with the air conditioning unit at Faro’s Neonatal department (the only one available for birthing mothers today, as Portimão is once again ‘closed’ due to lack of obstetricians) which has been “affecting several patients”.

According to CNN, at some points, temperatures inside the neonatal unit reached 30ºC.

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