The maternity ward of the Centre hospitalier du Nord (CHDN) in Ettelbruck has been closed since Monday. A few patients are still present on the premises, but as they leave, medical care will indeed cease. The crux of the problem lies in a lack of specialised medical staff, and is not really new. But administrators hope the closure will only be temporary, as ways are being explored to reopen the ward as soon as possible.
Closing the maternity ward is not a trivial decision for the CHDN. We can imagine that it was taken because there was no alternative?
Paul Wirtgen: The problem of medical staffing is an old one, but has become perhaps more acute with the increasing specialisation of professions. For a maternity hospital like ours, the law stipulates that we must have an obstetrician-gynaecologist, an anaesthetist and a paediatrician available for emergencies. For the first two, there is no problem, because one of them is always available. For the paediatrician, it is different, because they are not always on the spot and do not always live near the hospital. Moreover, the paediatrician who has to be present must be able to do neonatal resuscitation. Not all paediatricians have this specialisation in neonatology. And recruiting them is very complicated, because a structure like the CHDN does not have the critical mass to open a neonatology department. This is not our goal.
Why, when this problem has been around for a long time, did you have to take a sudden and radical decision to close the department?
"We are no longer able to comply with the law. The situation was already tense with regard to the paediatricians. One of them has just retired, another is ill... There are only two left. This is not sustainable.
The solution will undoubtedly be to strengthen the CHL's neonatology department and to redefine a collaboration agreement with it.
An insufficient number of doctors, professions that are becoming increasingly specialised, difficult recruitment, the impossibility of creating a neonatology service in Ettelbruck... What solutions are being considered? Is one to have a reinforced collaboration with the neonatology department of the Kannerklinik in Luxembourg?
The Kannerklinik's neonatology department does indeed have a neonatology emergency service, which we sometimes call upon when necessary. The problem is that this service cannot always move very quickly with only one doctor on call at the CHL, because he may be called upon in Luxembourg City. The solution that we have been working on for weeks, with the ministry, is therefore to increase the budget of this neonatology emergency service, to have two doctors on call, by hiring them. This is easier in Luxembourg than in Ettelbruck, for reasons already mentioned such as the number of deliveries. So, yes, the solution will probably be to strengthen the neonatology department at the CHL and to redefine a collaboration agreement with it.
How soon could this be put in place?
We hope to finalise this collaboration agreement within a few weeks.
Couldn't the intensive care anaesthetists at the CHDN have taken over the role of the paediatricians?
No, they are the ones who raised the question: what about our responsibility if we also take care of the child, when, according to the law, we are there for the mother? It is normal for doctors to want clarification. The 2018 law may have to change, but that will take time. And in particular to specify who does what, and who can do it, until the ambulance arrives, for example. In the meantime, we need to find solutions for the care of newborns.
I think that in Luxembourg, and particularly in the Ministry of Health, there is unanimity in saying that we need four maternity units: two in Luxembourg, one in the South and one in the North.
The situation will also revive another old debate: while the CHL has a neonatology service, should not all the obstetrics services be centralised in one place, in Luxembourg City?
Centralise or be close to the people? This is indeed an old debate, which comes up from time to time, just like other subjects related to hospital planning. I think that in Luxembourg, and in particular at the ministry of health, there is unanimity in saying that we need four maternity units: two in Luxembourg, one in the South and one in the North.
Patients from the CHDN will be directed to Luxembourg City. Do your colleagues have the capacity to absorb this extra workload?
The decision to close the CHDN maternity unit was not taken on a whim, but has been discussed for several weeks with all parties. So it was not a surprise. We had contacted our counterparts in Luxembourg beforehand, who assured us that they could take care of our patients. The interviews that take place with the midwives one month before the end of the pregnancy, the pre-anaesthesia consultations, etc. continued to take place, and the mothers-to-be have all the information they need about the end of their pregnancy. Our priority has always been their health and that of the future newborn.
But some patients found out that their maternity hospital was closing via the media, which is still annoying and a cause for concern?
It's true, and we're sorry about that. Doctors have notified their patients, we were also supposed to do so on Monday during the day and officially communicate the temporary closure on Monday evening. We had to move faster, because the media got wind of the information and echoed it, as did some MPs. We were caught off guard.