„W czasach epidemii i mniejszej dostępności specjalistów pacjenci z ranami i ich rodziny czują bezradność. W leczeniu ran kluczowe są systematyczność, cierpliwość, specjalistyczna wiedza i wsparcie psychologiczne – dlatego musimy nauczyć się leczyć przy użyciu sprawnej telemedycyny. Nie możemy teraz zostawić tych pacjentów” – mówi Prezes Stowarzyszenia Naukowego Leczenia Ran, dr hab. n. med. Marek Kucharzewski.
Marta Bogucka, ForumLeczeniaRan.pl: Panie Prezesie, co dla pacjenta z raną trudno gojącą się oznacza obecna sytuacja epidemiologiczna?
Marek Kucharzewski: Proszę sobie wyobrazić pacjenta, który przez 20 lat funkcjonuje z raną na nodze, która się nie goi, z której wydobywa się zapach nie do zniesienia, która utrudnia chodzenie, a jednocześnie pogarsza jakość życia. Do specjalisty zwrócił się dopiero po wielu latach, bo się zwyczajnie wstydził i miał nadzieję, że samo się zagoi. Taki chory cierpi, nawet jeśli rana nie sprawia bólu. Cierpi, bo jest odizolowany od społeczeństwa, wstydzi się swojego zapachu, boi się odrzucenia, wpada w depresję.
Rany trudno gojące się izolują skuteczniej niż kwarantanna. Jedyną nadzieją jest spotkanie dobrego specjalisty – pielęgniarki lub lekarza, który dysponuje najnowszą wiedzą i przeprowadzi pacjenta za rękę przez długi proces gojenia. A dziś? Panuje epidemia, brakuje personelu, pielęgniarki coraz rzadziej chcą ryzykować osobistą wizytę i zmianę opatrunku. Pacjent zostaje sam. I po prostu się boi.
Czyja to wina?
Niczyja. Musimy nauczyć się funkcjonować w nowych realiach. Ta epidemia to dla całego personelu medycznego i dla rządu naszego kraju ważny sygnał, jak ważna jest zaawansowana, sprawna telemedycyna. Jak ważne, żeby każdy pacjent miał dostęp do pomocy bez względu na miejsce zamieszkania i mobilność specjalistów. Dziś bardzo skupiamy się na leczeniu pacjentów z COVID-19, to zrozumiałe, ale epidemia nie sprawiła, że pacjenci z ranami zniknęli. Oni są i będzie ich coraz więcej. A zostawianie ich samym sobie to dla nich wyrok – przedłużanego cierpienia, depresji, amputacji. Nie można tego bagatelizować.
Co można zrobić, żeby poprawić tę sytuację? Jakie Pan proponuje rozwiązania?
Przede wszystkim trzeba działać i edukować, bo od ponad 30 lat mojej pracy zawodowej powtarzam, że edukacja jest gwarantem silnej, rozwijającej się medycyny. Pacjentów trzeba edukować, wiedza pozwala walczyć z lękiem, poczuciem bezradności. A ta bezradność prowadzi często do rezygnacji z leczenia. Rany trudno gojące się potrafią być dramatem, niedostrzeganym przez społeczeństwo. Potrzeba konsekwencji, cierpliwości i specjalistycznej wiedzy, żeby sobie z nimi poradzić. Dlatego edukacja pacjentów i przekazywanie prostych schematów działania jest teraz bardzo ważne.
Tylko kto to ma zrobić?
My już to robimy. Razem z Grupą Roboczą Stowarzyszenia Naukowego Leczenia Ran opracowaliśmy specjalne stanowisko dotyczące leczenia ran w czasie epidemii i komplet schematów leczenia przystępnych zarówno dla specjalistów, jak i pacjentów i ich rodzin. Czujemy się w obowiązku przekazywać naszą wiedzę tak, by była przydatna i przyczyniła się do poprawy czyjegoś zdrowia. Bo co mi po tej wiedzy, jeśli nie mogę docierać do pacjentów? Jeśli nie mogę opowiadać o skutecznych rozwiązaniach na konferencjach naukowych, bo nie można ich organizować? Razem z członkami Zarządu SNLR siadamy po godzinach i piszemy materiały edukacyjne o leczeniu ran, większość znajduje się w czasopiśmie „Forum Leczenia Ran”, kolejne zostaną wydane już niebawem.
Nie wszystkie przypadki zmieszczą się w schemacie, większość wymaga indywidualnych konsultacji.
I wtedy zachęcam do kontaktu przez skrzynkę mailową Stowarzyszenia Naukowego Leczenia Ran – kontakt@snlr.pl. Staramy się odpowiadać na wszystkie wiadomości. Mam takie poczucie, że reprezentując ważne stowarzyszenie specjalistów leczenia ran w Polsce, mamy społeczny obowiązek pomagania koleżankom i kolegom po fachu oraz pacjentom. Taki był zresztą jego główny cel – edukowanie, dzielenie się doświadczeniami, wpływanie na poprawę poziomu leczenia ran w całej Polsce.
A czy to nie jest cel wszystkich stowarzyszeń naukowych? Co wyróżnia SNLR?
Mam to szczęście, że w Zarządzie SNLR zebrali się sami najlepsi eksperci leczenia ran w Polsce: prof. Jerzy Strużyna, dr hab. Anna Chrapusta, prof. Tomasz Banasiewicz, dr Grzegorz Krasowski, prof. Marzenna Bartoszewicz, prof. Zbigniew Rybak, prof. Waldemar Kostewicz, mgr Zuzanna Konrady, mgr Joanna Piszczek i mgr Anna Mirosz.
To interdyscyplinarne, doświadczone grono.
Do tego współpracuje z nami w ramach Grupy Roboczej wielu doskonałych praktyków. Wszyscy chcemy działać i dlatego powstają filmy edukacyjne dla pacjentów, wytyczne, schematy, za chwilę także webinary. Siłą SNLR są eksperci, którzy nie tylko mówią, że coś zrobią, co jest cechą wielu towarzystw naukowych, ale przede wszystkim działają. Są otwarci na edukację i chętnie dzielą się doświadczeniem. Nie boją się nowych mediów. Wiem, że wspólnie zrobimy jeszcze wiele dobrego dla leczenia ran w Polsce.
Jak wygląda teraz kontakt specjalistów leczenia ran z pacjentami?
W większości pewnie telefonicznie, jak zresztą zalecamy w naszym stanowisku. Uczymy pacjentów robienia odpowiednich zdjęć rany, żebyśmy mogli na odległość ocenić jej stan, rozmiar, barwę, ilość wysięku. Za pomocą filmu edukacyjnego o zmianie opatrunku edukujemy pacjentów, jak w sposób bezpieczny zrobić to samodzielnie. Robimy, co możemy, żeby poza naszymi obowiązkami w szpitalach, przychodniach, być stale w kontakcie z pacjentami.
A co z edukacją pielęgniarek i pielęgniarzy? Od 5 lat prowadzi Pan bezpłatne regionalne szkolenia z leczenia ran. To koniec tego cyklu?
Cykl „Postępowanie z raną przewlekłą” od ponad 5 lat prowadzę z wydawcą czasopisma „Forum Leczenia Ran”, Evereth Publishing. Na ten rok mieliśmy zaplanowanych ponad 20 spotkań z pielęgniarkami w różnych miastach w całej Polsce, ale rzeczywistość epidemiczna zmusiła nas do przełożenia większości tych wydarzeń. Ale nie poddajemy się – przenosimy się do internetu. Pielęgniarki wciąż mogą na nas liczyć. Jak tylko będziemy mogli wrócić do realizacji bezpłatnych spotkań dla pielęgniarek, natychmiast to zrobimy. Nic nie zastąpi osobistego kontaktu i rozmowy o konkretnych przypadkach.
Dlaczego to Pana zdaniem takie ważne, żeby edukować pielęgniarki i pielęgniarzy w zakresie opieki nad raną?
Pielęgniarki są najbliżej pacjenta. Dodatkowo cenię sobie pracę z tą grupą zawodową, bo pielęgniarki są zazwyczaj bardziej niż lekarze otwarte na nową wiedzę, chętnie sprawdzają możliwości poprawy jakości terapii. A nie oszukujmy się, leczenie ran to przyszłość, bo pacjentów z ranami będzie przybywać. Mamy obecnie do czynienia z postępującym starzeniem się społeczeństwa, a także z coraz powszechniejszym występowaniem chorób cywilizacyjnych takich jak otyłość, cukrzyca, miażdżyca naczyń obwodowych, nadciśnienie, nowotwory. Wszystkie te czynniki będą wpływać na to, że pacjentów z ranami trudno gojącymi się będzie coraz więcej. Pielęgniarki i lekarze muszą posiadać aktualną, pogłębioną, rzetelną wiedzę, by skutecznie tych pacjentów leczyć.
Na jakim poziomie jest Pana zdaniem wiedza o leczeniu ran w Polsce? Czy polski system ochrony zdrowia ma jeszcze jakieś lekcje do odrobienia w tym zakresie?
Wciąż mamy dużo do zrobienia. Leczenie ran w Polsce niestety odbiega od światowego poziomu. W wielu przypadkach nie jest ono prowadzone zgodnie z najnowszymi standardami i wytycznymi, stosuje się przestarzałe metody terapii i nieskuteczne opatrunki. Dla pacjenta ma to poważne konsekwencje. Źle leczona rana znacznie pogarsza komfort jego życia i ogólny stan zdrowia.
Problem ten widać bardzo dokładnie, jeżeli przeanalizuje się statystyki dotyczące zespołu stopy cukrzycowej, która jest w naszym kraju jedną z najczęściej występujących ran trudno gojących się. Pacjenci cierpiący na zespół stopy cukrzycowej są narażeni na amputacje kilkadziesiąt razy bardziej niż reszta populacji. Rocznie 14 tysięcy chorych na cukrzycę przechodzi amputację stóp. Dzięki poprawie jakości wiedzy o leczeniu ran, jaką dysponuje personel medyczny, można znacznie zmniejszyć liczbę wykonywanych amputacji, a jednocześnie poprawić jakość życia chorych. Tylko teraz musimy to robić dodatkowo w znacznej mierze przez internet i telefon.
Telemedycyna to przyszłość leczenia ran?
Na pewno. Zaczynamy wdrażać metody zdalnej opieki nad raną trudno gojącą się za pośrednictwem smartfonu i komputera, takie jak wideokonferencje, e-konsultacje. Ponadto mamy coraz więcej aplikacji dedykowanych leczeniu ran, za pośrednictwem których pielęgniarki i lekarze mogą nie tylko aktualizować i poszerzać wiedzę na temat najnowszych rozwiązań i zaleceń w leczeniu ran, ale też uzyskać poradę lub konsultację od innych specjalistów. To kolejna bardzo istotna platforma wymiany doświadczeń.
Jedno jest pewne – w dobie koronawirusa nie możemy zapominać o pacjentach z ranami trudno gojącymi się. Wraz z interdyscyplinarnym gronem ekspertów SNLR dołożymy starań, by bez względu na okoliczności – bez ustanku leczyć i przekazywać swoją wiedzę dalej.
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