The lone Hiiumaa gynaecologist quits

2011. aasta mais olid Kärdla haigla uuendatud sünnitusosakonna avamisel Merike Tingase kõrval haigla juhatuse esimees, peaarst Gennadi Aavik ning Kärdla haigla sõprade ja toetajate esindajana USA saatkonnast kolonelleitnant Robert R. Williams.

PHOTO: Helja Kaptein / Hiiu Leht

Come September, the Isle of Hiiumaa will be missing a permanent on-location practising gynaecologist, with outlook looming of no births possible at Kärdla Hospital. 

«I’m exhausted, the nerves can’t take it anymore – tired of having to decide on my own,» said Kärdla Hospital’s only local gynaecologist Merike Tingas, asked about the decision to depart before official pension age.  

If Ms Tingas goes, Hiiumaa will have no gynaecologist left living and working permanently on the island. After graduating from University of Tartu in 1979 and dispatched to Hiiumaa, Ms Tingas has laboured as the island’s only «on-location» gynaecologist these past 21 years. There used to be two. But then the island was much more populous and births at least thrice what’s left. 

Last year, 53 babies were born at Kärdla Hospital’s freshly renovated obstetrics department. Mostly, they were born to locals, with a few occasions of premature births by ladies from mainland.

As Ms Tingas set to work on the island, 36 years ago, the place averaged 150 births a year – minimum. The peak was 1991 – 235 babies brought forth in the year.

After that, sharp has been the drop. Mere 43 some years, and the new constant around 50. «The work is for one gynaecologist,» observes Ms Tingas. Regarding the volume, that is.

Alert 24/7

What actually wore Ms Tingas out is the constant state of alert – round the clock, every day of the year. In case of births or emergency situations. «This week has been serene for me, another doctor is working,» rejoiced Ms Tingas. Once a month, for four-five days at a time, Ena Volmer comes to Kärdla. She’s been around for 21 years – randomly for starters, the last seven-eight years it’s been stable.

On the island, Ms Volmer is performing routine surgeries. Some are such as are usually the job of Estonia’s major medical centres. But the lady, engaged at various hospitals on mainland, is unwilling to settle on the island for good.

There are the others who come around to help. During their vacations, lots of doctors like to spend some quiet weeks on the summertime Hiiumaa. Indeed, some weeks come with no birth and emergency surgeries at all.

These past years, doctors from Tallinn and Tartu have also come for week-ends, twice a month. Then, Ms Tingas has been able to plan family events of do the occasional trip to native Rapla.

This is life on an island, and no-one is complaining. It’s just that there comes a moment when the strength runs out. To the offer to perhaps be coming around as replacement to others, Ms Tingas says a resounding «no!»

Seven hospitals sending help

Yesterday, chairman of Kärdla Hospital board Gennadi Aavik and Hiiu County governor Riho Rahuoja were to Tallinn, for discussions at social ministry regarding the situation starting September. Attempts to find a new on-island gynaecologist have remained fruitless.

«We agreed that North Estonia Medical Centre (PERH) and Kärdla Hospital will make the calculations how many extra costs would have to be covered so that a doctor from mainland could constantly be on location,» said Mr Rahuoja.

«That will be travel and accommodation, extra money for being on duty, which will be bigger than for being on home-alert,» explained the county governor. Preliminary reckoning says Kärdla Hospital may be needing extra €70,000 – €100,000 a year. An extra €100,000 has been allotted to the hospital even this year – PERH project manager Meelis Roosimäe says doctors go to Kärdla from seven mainland hospital, of these several from PERH.

Mr Roosimäe feels confident that in cooperation with West and East Tallinn Central Hospitals they’ll be able to keep quality work going in Hiiumaa till a permanent island-doctor is found. «Even if it takes a while,» he vowed.

Social ministry hastened to add they’d not for sake Hiiumaa either. «Within a month we will discuss the issue with ministry of finance so as to keep the service going locally, while naturally having to consider the local regional specifics,» said the ministry via communications chief Malle Aleksius.

The Faroe Rest

Mr Rahuoja the county governor said they had agreed that all kinds of alternatives will be sought for the scheme starting 2016 – even obstetrical care on mainland.

«While we have six good midwives working, able to cover the 24/7 watch, obstetrical care can be secured on the island,» he added. «Keeping the obstetrics department going is not limited to midwives and doctor alone. It includes blood bank and anaesthesiologist.»

Doctors fresh from university are not hoped to show up, and Mr Rahuoja says this would not be good for them anyway, practice-wise, as the cases are few. «We expect the experienced ones,» he explained.

Ms Tingas works till September, including a vacation split in two. Today, she is doing a planned Caesarean. In the beginning of August, four more local ladies come to give birth. The emergencies? One never knows. But before the doing-nothing era dawns, Ms Tingas up and goes to holiday on Faroe Islands. A dream long harboured.