Let's get vaccinated and live normally – says Professor Adam Krętowski, MD, PhD, Rector of the MUB. At the beginning of the new academic year, we are talking about the pandemic and the upcoming evaluation of the University. And we are planning to be learning more in real life than online.

Wojciech Więcko (WW): Will an unvaccinated student be able to participate in stationary or clinical classes at the hospital?

Professor Adam Krętowski, Rector of the Medical University of Bialystok: - If the Ministry of Health or the government will not impose restrictions, we as a University do not have the capability to restrict access to classes for the unvaccinated persons. I still believe that we can convince everyone who has not done it yet. After the vaccination campaign at the University, we know that almost 100 percent of our doctors or nurses, as well as senior students, those who have clinical classes in the hospital, have been vaccinated. So it turns out that the more medical knowledge you have, the closer you are to the patient, when you see up close what the consequences of this disease are, then you have no doubt that you need to get vaccinated.

On the other hand, we have data from the courses that don't have their classes in the hospital, or from the lower years of study, and they were not so impressive. I would like to point out that the data was obtained from a vaccination campaign run by the University. I do not know how the data presents now, when you can get vaccinated at any time and place. However, we will encourage to do this, and we will also ask for support from student organisations.

CORONAVIRUS

The University will not prepare its own regulations?

• No. We need to think about what to do when the unvaccinated persons come into contact with patients. How to organize it? We will certainly continue to wear masks, apply the principles of social distance and other principles of the sanitary regime. After all, it is the unvaccinated persons who are most vulnerable, but because of that they also put their loved ones at risk. I think we can convince reasonable people. Much can be achieved through direct conversations. Then it turns out that those so-called anti-vaxxers  are not like that. Their attitudes are based on completely different reasons. People have doubts, they have question marks. Of course, there will be those who will say "no, because no" – we will not convince them. However we cannot deny that COVID-19 vaccines work. Around the world 2.5 billion people has already been vaccinated . Yes, we have only been vaccinating for almost a year and we do not know what can happen in the long term. However, the results that the vaccines were supposed to achieve, i.e. reduction of mortality, hospitalizations, or severe complications, have already been achieved. We already know that the vaccinated are 10 times less likely to get sick than the unvaccinated. It is alleged that the vaccines have side effects. Yes, in a small percentage they have. So are other medications. Therefore, they should be further investigated and all results reported. However, comparing the benefits to the risks, there is no doubt that you should get vaccinated.

Do you not observe what is happening in the legal sense in France or Italy?

• I'm generally standing for getting back to normal as soon as possible. Those who are vaccinated are protected. Those who aren't vaccinated are taking the risk themselves. The vaccinated should not suffer the consequences of those who have not. Another lockdown? Already after those that were, each Polish person weighs about 6 kg more. And this is a risk factor for a bad course of COVID. We won't deal with this virus this year or next one. However, we cannot allow ourselves to stay at home for another five years.

The first time the lockdown was necessary, because we did not know in what danger we were and whether the health care system could cope. Now we have more experience, we know more and we should live as normal as possible. Yes, let's wear masks, keep our distance, preserve other restrictions. Let's get vaccinated. Anyone who can, consider getting a third dose. I'll get vaccinated. I work with the sick, and I got vaccinated at the end of December last year. Experts recommend a third dose as early as 6 months after vaccination. So I'm even a little late.

The Minister of Health Adam Niedzielski has been threatening with the local lockdowns in the country for a long time. Podlaskie is listed as an example where there are the least vaccinated people, so in principle we can be the first to be closed.

• If there is a top-down order, then at the University we will start online classes. We are ready for it. Students really liked online lectures. Moreover, some of the lecturers also like them. We have a teaching dispute. Some want to have more of such classes, while others opt for stationary classes. I'm on this other side. I believe that direct contact in the classroom, the opportunity to talk with the teacher, discuss with colleagues, is an additional value that builds the student as a future doctor, specialist. This is extremely important.

CLINICAL HOSPITALS

Will our clinical hospitals withstand the fourth wave of disease? Or else, will the people working there endure it?

• People come first. The hospital as a building, or even the best equipment, does not work itself . We can't do this without our staff. That is why I always thank everyone: from doctors, to nurses, specialists in laboratories, to those who work in these lower positions. For the past year and a half, they've all worked really hard. And there are many signs that soon there will be so much work again. I have this sad reflection: it will be really hard, but I believe that we will cope. We have no choice. The role of our two clinical hospitals in the region is so great that if we can't do it, no one can.

You're sighing heavily.

• Recently, more often it is the case that when a problem arises, then everyone goes to clinical hospitals. Now we're talking about refugees. They'll come to us, to USK hospital, to the children's hospital. Previously, when we did not test COVID patients with PCR tests in Podlasie, all eyes turned to the University. We helped. When there were no COVID beds or COVID hospitals, we transformed our hospital at Żurawia Street for this purpose and in addition we even donated our sports hall. We helped again.

I am constantly making our decision makers aware of the role we play in our environment. We should be properly appreciated, rewarded, but also be given infrastructural support. We need to evolve. We have no oncology, we have dramatically devastated infectious diseases. In fact, we need to build a new infectious disease hospital in Dojlidy district.

Is there anything other than "thank you" appears in these conversations?

• We receive various promises, but the funds are withheld for now. But there are other ideas that I cannot understand. For example, to open new medical courses in training colleges. It seems to me that the author of such an idea has never been engaged in the training of medical staff. Soon we will discuss this at the meeting of rectors of medical universities.

It is much more logical, and at the same time cheaper, to invest in universities that are already doing this.

They have the experience, the staff, the infrastructure and often the reserves to teach more people. Let us improve the financial conditions of universities, encourage young people to stay in universities, and not create new medical universities from scratch. Where are they going to get the staff from? From already existing universities, because there are no other specialists. As a result, we will weaken the existing facilities. The new university is being built for years, and we guarantee increased student enrolment and the appropriate quality of education almost immediately.

HOSPITAL DEBTS

What are the financial issues of our clinical hospitals? They've both been in debt for a few years now. Admittedly these are not due obligations, as you often emphasise, but maybe 'not yet' should be added there. The next wave of pandemics is approaching, and therefore the risk of re-closing hospitals and non-implementation of the lump sum imposed by the National Health Fund. Is there a risk that the debts of hospitals will pull down the entire MUB?

- The pandemic has impeded the whole issue. There was a time when we couldn't admit patients, so we didn't make a lump sum. But the National Health Fund paid. However, it has not changed the fact that clinical hospitals are notoriously underfunded. People working there are dissatisfied with the salary, and the directors do not give them the expected rises or allowances. They're the only ones who don't have the money. Our hospitals generate higher costs than average district hospitals. We have highly specialized equipment and procedures, and to a large extent we are forced to work as a district hospital. We have a problem with the hospital emergency department at the clinical hospital.

In June - with a date of the end of September - we terminated the contract for its operation with the National Health Fund. We just can't keep working this way. During the duty the ER accepts approx. 600 patients. Sometimes we have to keep most of them in the hospital for treatment. Normally, we're overloaded, so when the next patients arrive, someone ends up in the corridor, or in a random clinic, because that's where the vacant place was. And in parallel there is an empty hospital e.g. MSWiA, or there are places in the city or provincial hospital.

In Białystok there are two Emergency Rooms, which work alternately (the second one is in the provincial hospital – editor's note). However, other hospitals do not want to cooperate with them. After all, we can diagnose a patient on our ER and possibly transport him to another hospital, according to its capabilities. A sick person won't be any better in our hallway. ER patients are pushing planned patients out of the hospital. We, by accepting patients through our ER are generating overpayments for which the National Health Fund will not pay us. The Fund is content, because it is all correct in the tables: patients are admitted and do they not have to pay for it. Is a good hospital director the one who takes in all the sick people, helps them, and at the same time indebts the hospital? It's a systemic error. We've been explaining it all along. Our last meeting with Minister Niedzielski was very promising. We were promised that there would be legislative changes in this regard. We do not see anything happening at the moment, but we also understand that there are more important issues at the moment.

So what happens to ER after September 30th?

- Talks are ongoing (the interview was conducted on September 21 – editor's note). When terminating the contract, we informed the voivode about this fact. As a nationwide hospital, we have no obligation to have the ER. They say procedures are best priced here. And paradoxically, our ER in 2020 brought 4.5 million zlotys in losses. This year it will be approximately 7 million zlotys of losses. From a management point of view, it's best to close it and open the Casualty Ward. This means for us that we only accept the planned patients from the clinics, and if we don't have space, we don't put the patient in the corridor. We'll be back to normal in a moment. People will not be overworked, patients will not complain, because they will be well cared for.

Why are residents now choosing district hospitals over us? Because we have to work hard. And yet residents, as young doctors, where will they learn better than here? It is in our hospital that we have the most medical cases and they are the most valuable educationally. This has huge consequences on many levels. And what will students learn when we can only act on an ad hoc basis to treat acute conditions? Not only these cases are in the programmes of many specialties.

Something has to change. Recently I talked about this with two deputy ministers of health, or the director of the National Health Fund. They know that these changes are necessary. There is a lack of someone to deal with this phenomenon on a national scale, there is a lack of such an organisation of the health care system that takes into account the needs of the patient. The National Health Fund sees everything from the level of the state of finances, and in life this is not all about that. These are the arrearages of many years, and the pandemic has only highlighted it.

UNIVERSITY

In January 2022, an evaluation of the University in accordance with the new rules should finally take place. Admittedly, there is not much left from the original Jarosław Gowin's reform of education, but nevertheless this assessment will be made. Are you waiting calmly, or is there anxiety?

- The rules have changed so much, that it's hard to predict the end result. Evaluation is mainly based on the assessment of scientific results, i.e. publications, patents, implementations, or obtained grants. Comparing the indicators from five years ago, when we were receiving the A category, now we have improved significantly in all aspects. We have more indexed publications with higher ratios. The total Impact Factor of the whole university is growing strongly. We have increased the number

of the obtained grants, although it seems that we still have reserves here. We submit a lot of applications, but the success rate could be higher. The University owns two commercial companies: LOM, which is the operator of the PET/MRi hybrid, and the new one - Genomika Polska (www.GenomikaPolska.pl), which deals with genome sequencing and data analysis. It was created under a territorial contract, so we can earn from our research. We already have our first orders.

Theoretically, we should sleep peacefully. The problem is that the evaluation criteria have changed a lot and there are completely new scoring mechanisms. So what if the old rules say you're good, when the new rules say you're not. As medical universities, we were included in the group of scientific institutes of the PAN. That's a little unfair. We, in addition to scientific and research activities, are dealing with teaching and also we treat patients. They only deal with science.  And the pandemic has caused many of our scientists to focus primarily on treating people. They didn't write the publication, they just took extra shifts at the hospital to put together the schedules. Our rating will be derived from what the best individual in the whole group will achieve. If we fall behind from it by more than 20 percent, then we will not achieve the A category. This will be equal to lower grants for the University. I can't even imagine it. The pandemic has shown that the MUB is needed in our region, not only for the purposes of education or research, but also for treating people and saving the health care system.

That is why I sensify all scientists to remember about their publications and to make statements about their inclusion into the University achievements, because it is not automatic. Then it will be visible in their own assessment.

INVESTMENTS

MUB is now one big construction site. The money from the territorial contract (more than 150 million zlotys – editor's note) was well used.

• There have never been so many investments in the history of this University realised at the same time. Right now everything is going well, but times in construction are difficult. As we know, prices are going crazy.

We experienced this over two years ago, during the extension of the infectious diseases hospital with the E1 building (today it is a COVID hospital – editor's note). The company that made the investment went bankrupt. In the new tender, it turned out that the costs have doubled in comparison to the cost estimate. The Ministry of Health didn't want to give us any money at the time. We've been given an ultimatum, Either we end building or we take out a loan to finish it. We felt it was a necessary facility and we took a risk with the loan. When the pandemic broke out, it turned out we were right. If we stopped the extension, there would be no more COVID beds for patients.

I'm glad we were able to make use of the opportunities we had. We're about to open the psychiatry, especially child psychiatry, which didn't exist. We have a world-class scientific infrastructure, one of the best in Poland.

Is something going on in the subject of the planned didactic centre under the courtyard of the Branicki Palace?

• We have our first success because we got conditional approval from the heritage conservationist to begin archaeological research on the site. Now we begin to look for funds for this purpose. If everything is successful, then maybe in the spring we will be able to start these works. We are bound by a number of restrictions, because if we find something, we basically immediately stop the work and the archaeologists enter. It's extremely exciting, because it's a chance to learn about an unknown history

of Bialystok. After all, it was at the Palace, and before the Wiesiołowski's Court, that the most important things in our city took place. The area under the courtyard has never been explored.

However, we care that this is not research only for research. We want to have a guarantee to be able to realize the target investment in this place (multifunctional auditorium for approx. one thousand people with the option of transforming it into an exhibition or congress centre – editor's note). Thanks to it, we will finally gain much-needed space for the education of students. We want to raise funds for construction from the education of medical personnel development plan, which is included in the National Reconstruction Plan.

Is anything new appeared in the University's investment plans?

• We are thinking of building an oncology hospital on the territory of the hospital in Dojlidy. The whole new building. We have several units that are strong in certain oncological areas: ovarian cancer, lung cancer, gastrointestinal tumours and others. It will be much better to join forces, to add the scientific University's potential to it, and to build a comprehensive unit dealing with the entire spectrum of cancers. There would arise a cancer surgery, radiotherapy and university immunotherapy, where patients would have access to modern therapies. It's extremely important to our future. We have already prepared a paper for the ministry on this subject.

The question about the Bialystok Oncology Centre is about to arise? Although our colleagues at the BOC are doing a great job, unfortunately, they have more and more oncological patients. During the pandemic, oncological diagnosis was delayed, and this transferred into more severe conditions of patients. Therefore, there is simply a need for the university oncology supported by scientific research, or increased training of specialists in many fields of oncology. There's a lack of them. Unfortunately, the prospects are bleak, there will be a lot of work for BOC and for us.

Oncology in the 1950s was systematically removed from universities. And its development is based mainly on scientific research. BOC is located in the city centre, where there is no way to expand, there is not enough space to do so. We need new diagnostics, like Gamma Knife therapy to fight brain tumours. The topic is sensitive for local decision-makers, who would prefer to develop only their own hospitals (BOC is managed by the Marshal's office – editor's note), but perhaps they do not yet understand that without university oncology we lose the opportunity to participate in scientific progress in this field. We're going to fight for it and we're going to talk about it loudly. If necessary, with our own funds, we will take them to the best cancer hospitals in the world: Harvard or Oxford. Just to show you how it's supposed to work. We have a preliminary project for the University's Oncology Centre. The budget of dreams is 500 million zlotys, but for 300 million zlotys it would be possible to build key units in the project, so that patients would immediately feel the availability of new types of benefits. This hospital is my greatest dream.

STUDENTS

And what about dreams more mundane: a university sports hall and a new multi-purpose field near the dormitory in the park?

• I don't have any positive news here. We have transferred the hall to a temporary hospital and it will definitely not be available to us this year, or maybe until the middle of next year. I'm sure it's going to be renovated after that, so it's hard to predict. The voivode have promised funds for these works.  As for the pitch, although we chose a contractor, this one kept postponing the start date and eventually withdrew because the prices of materials went up too much. We need to announce a new tender. Even if these costs have somehow increased very much, the University will add to this field and it will come into existence. Outdoor sport, even during pandemics, is highly recommended.

Is there any news waiting for students in the new academic year?

• The first message I give every year is that they have to learn a lot and work hard. And the second one - equally important - almost all exams will be held on a stationary basis. Even if sanitary restrictions will be imposed during the exam session. At the university we have enough teaching rooms and we are able to carry out the exam for more than 200 people at the same time, with keeping the sanitary regime or the necessary distance. No more online exams, which apparently weren't always written on their own. We will not give up when it comes to the enforcement of knowledge. As future patients, we want to have really well-educated doctors, nurses and representatives of other medical professions.

Of course, we also encourage students who have not yet been vaccinated to get vaccinated, then they will feel safer. I

Interview: Wojciech Więcko