What does a paramedic do during a flood? Episode 74

Monika Rachtan
Hi Monika Rachtan, I would like to welcome you to another episode of Po Pierwsze Pacjent. We all saw what was happening in southern Poland just a few days ago. The scale of the devastation that affected this part of our country is huge, but before we saw the devastation, the work of rescuers, paramedics, firefighters of the various services that brought help to the Poles was very important. And today, my guest, but above all your guest, is Michał Chełstowski. Hi, a very warm welcome to you.

Michał Chełstowski
Hi, welcome as well.

Monika Rachtan
A paramedic who just returned from the flood-affected areas a few days ago. Before we even get into our conversation, you've probably noticed the new décor of our studio. We've tried to introduce a more homely, slightly lifestyle atmosphere. I hope you will like the new décor and that you will be watching us in such large numbers again in the new season of Po Pierwsze Pacjent (Patient First), but Michał, you have just returned from the flood-affected areas, from the Opole region to be exact. What was the saddest image you saw during this flood?

Michał Chełstowski
I think the element that is the saddest, but it is with any disaster, is how people need and are looking for that help and don't know who to turn to. As we started our operations in Ukraine, we had the opportunity to see at the border where people were fleeing, going across the border and were terrified of what was next. People were coming to them. They were saying here they can give food, here they can give food, and these people didn't believe that they can get this help for free. And I saw the same thing here on the activities as well.

Monika Rachtan
It really was the case that the Poles were asking if it was free or this water.

Michał Chełstowski
Ukrainians asked if in Ukraine Ukrainians asked if it was really free. But physically it happened, like I gave a bottle of water, I got from the ambulance, I gave a bottle of water and I got asked how much? How much for the water?

Monika Rachtan
All right, but the Poles, you say, also needed this help very badly. And in your opinion, was that help timely?

Michał Chełstowski
This is a very difficult question, because with disasters, not only in Poland, this aid will never be on time. You can minimise and you can prioritise. What should come first, what should come next, or what things can be done in advance, because it will be known, especially in the case of floods, that something will happen. And here the decision-making issue of the bodies that deal with this, whether at government level, provincial level or lower, can be delayed. Mostly because of our lack of experience in such things, we haven't had a real disaster for a dozen years or so, and so it's also been hard for us to prepare to get these plans in place quickly.

Monika Rachtan
Because I think that the very mayors, mayors of those towns and cities that were affected by the floods did not have this experience, because both the flood in 2010 and the flood in 1997, which we remember so well, were disasters that affected the people who governed the particular town or city. 25 years ago. It would be difficult for them to continue to govern that town. Even looking at how the system is set up in Poland. So it is difficult to say that someone could have been prepared, had super experience. But in my opinion, maybe there was a lack of some instructions, maybe the state should have prepared top-down, knowing the topography of the area in Poland, these local government officials for just such a clash, and that if someone new enters the system, a new mayor, a new commune leader, they should have such crisis management training, which would have been very useful a few weeks ago.

Michał Chełstowski
There is a nationwide plan when it comes to crisis management issues issued by the BBN, or the Office of National Security, which also obliges all levels and all governmental organisations to prepare for different types of disasters. And at this point in time, from the village head, to the mayor, to the district governor or the provincial office, these plans are made and it is physically resting on the shoulders of these people. The fact that disasters rarely happen and the fact that something is in writing. I am convinced that the organisation's communications instructions are too. They are there. And they are probably even good ones. It's just that, unfortunately, a lack of experience in implementing them can cause very big problems later on.

Monika Rachtan
So you want to tell me that they are in writing and that probably the procedure is that there has to be a signature, a date, a stamp, but in fact everybody says I don't take it seriously, it probably won't happen to me.

Michał Chełstowski
I can marvel at the fact that the document that BBN produces is a very simple document. It is written in very simple language. There is no legal jargon, because it has to be very accessible. Of course, how it is later implemented at various levels depends on who is making the decision at the time. It is often the case that in a small authority, the mayor at this point appoints one person from the administration to create plans and supervise these plans, and it depends independently on the competence of this person. This can then work differently. In addition, there is the issue of getting things done in advance. For example, to meet with the local TSO and say that if something were to happen, maybe they would give someone from themselves to communicate with them, so that there wouldn't be constant missed calls. These are the sort of things that often go beyond what we need normally. Well, because let's be honest, in most towns and cities, the fact that it rains more and a sewer manhole gets blown out by this onslaught of water is the biggest disaster of the year.

Michał Chełstowski
So in thinking about it, no one prepares for what happens once every dozen or so years.

Monika Rachtan
That's right, because a lot of complaints and shortcomings are directed at this level of government. However, when I watched the statements of mayors on television, I always had the feeling that we have fallen a little short. We have fallen short at this more local level. Because I think that when you were in Kłodzko as a tourist.

Michał Chełstowski
Once upon a time, a long time ago.

Monika Rachtan
When you walk through the Old Town in Kłodzko and you see this river and you know the scenario from 97 and from 2010, the first thing I would do, if I were the mayor of this town, is to educate myself on what I can do if there is a flood, because it is not a question of if it will happen, but when it will happen. And these people cannot be resettled. I mean you can, but it has to be some kind of nationwide action by these people. You can't just say listen, stop living here, because there's a big risk of flooding, because these people probably have nowhere else to move to, so you have to put such plans in place and prepare for it so that later on you don't have to resent everyone one by one that something has failed, but I think you have to think about what I, as a city leader, could do more.

Michał Chełstowski
I think the big challenge is that as it is now for the next year, for the next two years it will be a very big topic of preparation. But in five years' time, in 10 years' time, when nothing is happening.

Monika Rachtan
We will forget again.

Michał Chełstowski
We will forget again, which is normal and natural. And of course, at this point it is in the duty of the people who have been elected to various offices to maintain this despite the fact that this subject is unpleasant, despite the fact that this subject requires a lot of money as well. But in Poland we also have this very strange culture of accusing and looking for someone to blame. And when I had the opportunity to talk in the Opolskie Voivodeship Office, I suggested that they should already be preparing something like this, which is called lessons learned, that is, that all the people who had some decision-making power and had some resources which they had put in place within this voivodeship should meet for a moderated conversation, where everyone would say not about what was wonderful, but what happened.

Monika Rachtan
Successful, True.

Michał Chełstowski
About what went wrong, what went wrong, but not as an accusation, but as a way of not making those mistakes again in the future. I have been to such conferences several times, including on the issue of Ukraine. And these are the kind of moments where, of course, some people are just talking about what worked out wonderfully and defending themselves, but, for example, non-governmental organisations are saying very clearly what where they made a mistake, how much it cost, how it could have been fixed. Because it's only by being honest about what went wrong that we can make these plans differently in the future. Because at the end of the day, at some point, they're just going to be plans that have to be put into action later, so without taking that lesson from what you did, there's no way to avoid those problems. And we were already doing a briefing while we were still there, and by the time we got back we had a meeting with the different organisations we were working with and we were clear about where we had made mistakes, how we could fix them.

Michał Chełstowski
And even today I had the opportunity with one organisation to talk about it and we have whole plans and projects on how to fix it in the future to make it go better.

Monika Rachtan
And tell me, how did these local communities react to these proposals of yours, which you had already made while you were in Opole?

Michał Chełstowski
As an international medical team, we have certain guidelines that we have to follow very clearly. We, for example, do not have the option to just go and start helping. We have to properly have permission from the local authorities to go. So even before we left, I had conversations with a dozen or so local authorities in various locations. All of them that were affected by the disaster, because I needed information, a simple email to come and help. And at that point we could already dispose of it. And these people often didn't know that there were additional opportunities to help at all. The moment we arrived and gave various possibilities under the title of whether it was a field hospital or ambulances, because we have quite a wide range of activities, and they didn't know what to do with us. Luckily we had experience in that how to bite it and who to coordinate with to get to where there is the greatest need for help. But at that point everyone thinks of the fire brigade, everyone thinks of the WOPR. And all of a sudden ambulances arrive and say We don't need anything, what should we do? And all of a sudden people were coming to ask if they could, because for example they got slightly injured, what to do next? And we provided help in that moment. We also often hauled water after people, because we also knew that there were short-term and long-term needs of these people.

Monika Rachtan
That is to say, it was also not just such strictly medical assistance, such as providing just health or life-saving assistance, but also the kind of assistance that was most needed there at that moment and that other services could also provide. But you simply committed your equipment and your resources. So that there were more people there providing real help.

Michał Chełstowski
You have to be flexible with any action, and the moment you have your plans they mostly go like paper, they stay somewhere and you have to implement them on the basis of some of your guidelines. But there was also a time when we had a lot of resources in one place, because that's how we were ordered by the provincial office, so, for example, we put our teams on the boats, which didn't go to the call, but to be closer, if the need was there. Well, and at that point carrying bottles of water or carrying a boat, I don't know what to call it. Delivering, delivering water and food can mean that, for example, an elderly person who suffers from dehydration because they don't have this drinking water will not need our help. So also this kind of prevention. Therefore, this humanitarian aid, which we also do, is an integral part of medical aid.

Monika Rachtan
And tell me if it happened that you actually had to provide the kind of medical assistance that determined whether or not someone would survive this disaster.

Michał Chełstowski
It is difficult to say, because we were there. If we hadn't been there, it is possible that there would have been another team or ambulance service that could have provided that help. So it is hard to say. We have provided emergency medical treatment on many occasions to people who were directly or indirectly affected by the floods. I think to a long-term degree yes, but whether it was medical issues or our support as part of the experience is hard to judge.

Monika Rachtan
And tell me, how do you assess the evacuation of the Nisa hospital?

Michał Chełstowski
Unfortunately, due to the fact that we were waiting for an official request for help, we arrived at the very end of this evacuation, but I have a lot of friends who worked on it, and luckily it was also very much a coordination initiative, a bottom-up initiative, so the people who worked there, the people from the ambulance service, while waiting for certain decisions, were already carrying out these actions, and this is always the case, everywhere. At the moment, a movement is slowly beginning in Poland to create the function of a coordinator of unaffiliated voluntary work, that is, people arrive, because everyone wants to help, people arrive with things, with clothes, with food, and you have to coordinate somehow, because they are already there, they have a lot of things and a lot of willingness, and leaving them on their own can hinder more than help. Chaos, right? Exactly. And at the moment like there are people who say ok, since you've come, since it's your ambulance from a private company and you're available, get that person, get them there. And that's grassroots and that's indispensable with anything like this, that such people have that opportunity to make decisions.

Monika Rachtan
I would like to return to the hospital in Nysa, because I have a huge heartache when I hear that modern CT scanners or MRI scanners have been destroyed, and in fact it is not that the hospital has lost them, it is all of us who have lost them, the residents of these towns, small towns. Although Nysa is quite a big city, it also brings together patients from other neighbouring towns. And now I wonder if things could have been done better. Because in my first thought I said to myself while watching the news, who does an MRI on the ground floor at all. But then I thought to myself hmm, old hospital, old building. All in all, you could probably only bring them in on the ground floor and there wasn't some kind of option that we would do a lab on the fourth floor, like there is in some institute that was built three years ago. So, on the one hand, these resources, which were there, had to be used in some way, but on the other hand, if there was information that something bad could happen, wasn't it time to secure this medical equipment in a proper way, to transport it away?

Monika Rachtan
What is done in general? What is the procedure in such a situation?

Michał Chełstowski
First and foremost, MRI is the ideal example, because it is important to remember that practically always. The site and location of an MRI must be planned in advance before the building is built, because it requires very suitable structures all around, for the reason that any magnetic field can disturb its operation, so it is often impossible to simply do it in another place, as you said. In addition to that, there is the question of cost optimisation at a time when we are thinking not just about this one location, but we are thinking about the whole province, and sometimes, sometimes. Is it worth focusing on preparing 80% things, but more broadly than 95% things, for the reason that the latter 15% can consume several times more money, so it is impossible to prepare for everything. At the moment, the hospital has been very badly damaged. We had the opportunity to spend a few days just in Nisa as part of the transport of patients from the military hospital that had been set up there.

Monika Rachtan
Have we taken care of these patients?

Michał Chełstowski
And we used to drive them, for example, to Opole or to Brzeg, where it is an hour one way. And because suddenly the multispeciality hospital is non-functional, so of course these long-term consequences for patients will be very serious. But it's not just the hospitals, because the hospital of course is such a big element that we think about, but let's also remember the pharmacies, let's remember all the outpatient clinics that have also been damaged in various cities. And all of a sudden those people, especially the elderly, who have illnesses and need that doctor, have lost access to that and in the long term it could be more problematic than that one hospital.

Monika Rachtan
I will return to this Nysa and to this hospital. Tell me, what was the mood among the patients who were evacuated? Were these people afraid? Were these people suffering, or did they feel that they were in good hands?

Michał Chełstowski
As a foundation, we have a very specific code of ethics when it comes to issues of working with patients. We have experience with patients who have lost everything. Two years in Ukraine have given us a lot of experience with this, so compared to what you can often unfortunately find in the emergency room or in the hospital with us, there is no possibility that we will not be at eye level with the patient at the first contact, that we will not introduce ourselves with a smile and say who we are. So we have a very strong focus on making these patients as comfortable as possible. It practically never happens to us because of this that the patient has additional fear. Rather, we try to reassure him or her, because a reassured patient who is at the worst point in his or her life also requires less medication at that point. And by virtue of the fact that we were mostly involved in transporting either intensive or mass transport of patients in ambulances, we spent 8 hours at a time with them and suddenly it turns out that we were able, for example, by giving the patient coffee, to reduce this need for morphine twice.

Monika Rachtan
I now think that this meeting between the public and private sectors, and the private sector is often unnecessarily burdened with some negative emotions by us Poles, shows that this cooperation can in fact work well and that the private sector is not a threat to the public health service, but that, once again, it is necessary to manage wisely, to use these resources wisely and to be open to working together.

Michał Chełstowski
This I can say a little bit from the other side, because, of course, with us practically all of them, because we now have more than 70 people, are volunteers, that is, they don't take any money at the moment from what they do, and there is a lot of this work, and I also call it a fight against professional burnout. We have people coming to us who have several years of experience, they're really experts, but they're on that borderline of whether or not to leave this job in the hospital or in the emergency room. And by coming to us, they meet other people who also want to. And thanks to that, in a way, we also impose certain standards, which are completely different than in a normal, systemic solution, and then they come back to work and implement these principles at work. And this we have already heard many times from various employers, because I also have contact with the employers of these people often, that suddenly such a person wants to implement the principles of safe infusion, which was never implemented in the hospital. And the very fact that these people feel that as a paramedic or as a doctor or as a nurse they can do well, then later on in this job, which has been monotonous for 20 or 15 years, they can also go back to that.

Monika Rachtan
We have hosted doctors on our programme many times who have told us about this professional burnout and we even had Sebastian Goncerz from the Residents' Agreement with us, who just spoke about the fact that doctors experience professional burnout already during their studies. And I think it is similar for paramedics. It is similar for nurses. It is similar for laboratory diagnosticians. Tell me if the fact that you could work, that you could work in just the kind of project that people want to work in. Because we have talked about the fact that you started out as a volunteer. Does that make you look at this job of a medical professional in a completely different way?

Michał Chełstowski
Before I started my first volunteering at the end of 19, I never imagined in my life how it was possible to work for no money, for free, and often paying extra still. And now, in retrospect, I can't imagine how this volunteering can't be an essential part of life. I am a leader of a medical team, an international team, but I also volunteer for WOŚP. I go to Poland Rock once, once a year for a week, just working with patients, because this volunteering is wonderful and until you try it, it's hard to even talk about how much energy it can give. At the moment, especially in Poland, we have such a strong pursuit of certain ideals, the goals of volunteering.

Monika Rachtan
Also among medics. And this is something that probably needs to be talked about openly.

Michał Chełstowski
But also with stability. And at this point, this volunteering can allow you to take that step back. This volunteering doesn't have to be medical. There are very many different forms of volunteering, whether it's social volunteering, with people in crisis of homelessness, with older people, with veterans. There are actually a lot of these volunteering activities and all the people who have already started it and got into it. Whether it's by accident or whether it was some sort of goal of theirs. From what I have noticed they are always happy.

Monika Rachtan
And tell me, what was the scale of the damage during the floods, in these areas just in southern Poland? When you arrived in Nysa, the water had subsided. What did you see.

Michał Chełstowski
Worldwide, more than one third of the world's population has been affected by various floods, and depending on what kind of flood it is, we have also had the opportunity to see this. At the moment in Poland there are different kinds of damage, because there is flooding, which can be quick and sudden, in other words a river swells, a bridge is destroyed, buildings collapse, but there can also be long-term flooding of an entire city at a depth of one and a half metres, and it is hard to say which is worse.

Monika Rachtan
In Poland, we have been dealing with both in recent weeks.

Michał Chełstowski
That's exactly right. What was, what was fortunate for us in this whole disaster was that very few people died in this flood. In fact, everyone reckoned it was going to be much worse, but fortunately it eased in those final moments. The long-term consequences have eased. There was a lot of talk about the fact that the European Commission's Copernicus early warning system had made predictions about what the short- and long-term consequences would be in terms of this disaster. Fortunately, the most optimistic ones, the most optimistic scenario, won out, and as a result I think we are now seeing mostly destruction of property rather than health and life. The bridge destroyed in Głuchołazy will be a serious problem for at least two years. Road between Opole and Brzeg. The new road with new bridges will have to be made entirely from scratch. That's why it has been washed out from underneath. And these are the kind of long-term infrastructure elements that will have to be repaired. But there are also these private dramas of people. We were at a bakery where the owner of the bakery swam with us to see if his life's work had been destroyed. Unfortunately it was destroyed in full.

Monika Rachtan
So were you able to get there freely? Did you actually travel part of the way in ambulances, in cars, and did you have to travel part of the way already in boats because you couldn't get to certain places?

Michał Chełstowski
We pay a lot of attention to safety issues. We are in the business of rescue, emergency medical services, so where it is not possible to drive in, we do not drive in. We stood in a safe place designated by the fire brigade, and then we communicated directly to the fire brigade. On boats, whether on amphibious vehicles or fire engines. Already to the patients and victims themselves.

Monika Rachtan
What feelings did you see in the eyes of this man who sailed with you, to see if his life's work still existed?

Michał Chełstowski
There was a lot of horror at the thought of what would happen in the future, but then a lot of happiness, for the reason that he entered this bakery. It turned out that the storeroom, which was on the first floor, was all gone. He had a bunch of sweets in there and long term stuff like that, so suddenly we had a whole boat loaded with what he'd managed to salvage and he spent an hour and a half with us afterwards distributing it to people who had stayed there at home. So all of a sudden it was out of that horror of what was going to happen next. I saw a lot of happiness that he was able to help others who were also affected.

Monika Rachtan
Well, that's right, but these long-term effects that you mentioned are the effects that these people will face. Often these are often small businesses that support not only the person who works there directly, but also the whole family. When a house is flooded, a job that supports a whole family is flooded. I guess it's hard to think that somehow it will be there in a while, that these next months, years. Winter is coming, that you will have to somehow survive. There has been a lot of talk in the media about the need for psychological help there. The one now and the long-term one. Have you also noticed that these people might need such help, that they will need it?

Michał Chełstowski
That people will need psychological help is certain. And the moment we go to the disaster area, we have at least one intervention psychologist with us for the patients, but also for us. At that point, a lot of organisations, whether private or non-governmental, that deal with psychological help are already on the ground and working there. In fact, I have been in contact with one of them, which has sent, I think, 9 intervention psychologists to help, precisely in the Opole and Lower Silesia voivodeships, directly people who have lost everything and need to come to terms with it at the end, so that they can move on and start rebuilding what they have lost. Because unfortunately, as a society, we will never be able to help everyone on the same level so that they can return to normality. Unfortunately it's going to be a lot of hard work for those people affected.

Monika Rachtan
You said that it is not only the people affected by the disaster who need this psychological help, but that you also benefit from it. What do you feel in such a place, apart from the fact that you feel motivated to help, because you know that this is the most important thing when you go to help these people. But how do you feel when you get home and sit down at the table with your family? What do you feel then?

Michał Chełstowski
The moment you are a medic, you are unfortunately directly exposed to a great deal of work-related emotions. Because sometimes it's a person you don't feel any emotion towards. Sometimes it is a child who may die or worse and that is always taken home. Hence, this help given right away or the possibility of this help is extremely important. At this point it can be an intervention psychologist, but also a properly structured team and those relationships within the team.

Monika Rachtan
You also support each other.

Michał Chełstowski
This is the basis. And at this point I don't see any other option. Like any team member who can go to their supervisor. So in our case it's leaders under the title I need a break, I'd like to have a chat. This is a situation where I saw that something happened, where I could have done things differently, because without this, without this reflection, without this support, we can also make very dangerous and also dangerous decisions. Under the title you can see that a person needs help, and we will run there without thinking and put our lives or team members in danger. So this psychological support is important not only so that these people don't have problems returning home later, but also so that they don't put themselves or team members in this danger.

Monika Rachtan
And is the phenomenon of post-traumatic stress disorder also evident among you?

Michał Chełstowski
While working in Ukraine. Much, much excitement came to us. We had 18 months of such very active activities. We took two and a half thousand patients out of Ukraine and among these patients we saw people who are very close to us. Sometimes someone became friends and this causes development later on. In which direction we had psychological help. We had reports from the psychologist all the time on an ongoing basis. It's not who is walking, it's how we can help the team to deal with it. A lot of people unfortunately gave up because it was too intense in terms of the emotional issue, because here there is more than just the issue of going to war, where missiles are falling and there are troops in the streets and the family is worried. The family is often angry because of the fact that someone is acting in this way, but also because you see directly the harm that these people have suffered and you want more, you want more and unfortunately there is a limit in most. How much can be helped.

Monika Rachtan
And can you say that your colleagues actually experienced post-traumatic stress disorder and that they had to stop doing their work because of it? Did they have to use such support, not only from a psychologist, but perhaps also from a psychiatrist?

Michał Chełstowski
I have seen this happen many times. Often the acute people who join us as volunteers are people who have already experienced this, and have left their jobs for a year or two years and are afraid to go back to work in the system, generally called the health system. They go to us because they feel it's a safer environment where they'll also have other support in all of this. But yes, I have seen that in most of the medics I work with.

Monika Rachtan
How does this manifest itself? Tell me if it's actually the case that as well as there being some anxiety, withdrawal, there's also this tendency to not always make good decisions.

Michał Chełstowski
But equally it's a matter of sometimes someone can have a lot of aggression in them and suddenly a calm person, a refuge of calmness suddenly has aggression. You can see that they get a lot of stress or they start working more and more, more and more. I know medics who work 400 hours a month because they are suddenly afraid to go home. They're afraid to talk about it with their family, with their friends and they work more because it's easy there, there's a clear task.

Monika Rachtan
If we can go back to the Ukraine issues. A fortnight ago here on this couch, we had a guest who talked to us about preparing medics to help in the event of an armed conflict and we also talked about battlefield medicine, but we also talked about helping civilians. Tell me, do you, having spent 18 months in Ukraine, do you have such experiences that you can share with Polish medics? And can you actually say that if an armed conflict happened in our country, you are ready to help civilians.

Michał Chełstowski
I think when it comes to the issue of a potential war, whether it occurs or not, everyone is in some way ready to give that help. And it's no longer just about medics, it's about everyone, because at the end of the day, everyone is willing to give help. And as far as the specific issues of what we have learned from Ukraine are concerned, there are things that are also implemented in international standards. The World Health Organisation standards are now being finalised, and we are collaborating on them. And where are the principles that we introduced because we had the need. The standards are coming in, which means, for example, when we were picking up patients from hospital, we usually only brought out the name and date of birth, nothing else. We didn't know if the patient was on a ventilator, if the patient was walking and had an amputated arm. We didn't know anything. So we introduced, for example, in-hospital segregation. That is to say, when we entered a hospital, we verified the condition of the patients, the issue of analgesic treatment depending on the location can be very different, so we took such measures already directly and still in the hospital, before we took that patient de facto. Poland is well prepared compared to most countries in the European Union, because at home we always say, with our children, that there will be a war one day.

Michał Chełstowski
Yes, this is true. And if the Polish government now said it would allocate 10% of GDP to the military from tomorrow, most of the public would say why so late? So at least from this perspective we are thinking about it at all. There has been much, much work for years in terms of the question of preparing medics for this. Will it be successful? We can see that in Ukraine.

Monika Rachtan
Better not to check.

Michał Chełstowski
It is better not to check. But Ukraine has also shown that you can implement certain solutions very quickly and learn from mistakes. Only these mistakes also need to be admitted and told what really doesn't work. That is.

Monika Rachtan
As we talked about at the beginning in the case of the floods. And to come back to this topic. Different ministries are now working on different plans and solutions. The Ministry of Health, the ministries that are going to deal with the reconstruction Ministry of Climate. Tell me, if you were to give five pieces of advice to Prime Minister Tusk, what would you tell him? Because you've been on the ground, because you've brought aid, because you have international experience and you've seen a lot, you have a lot of experience. We are after that one experience, so I assume you have more. 5 tips for Donald Tusk.

Michał Chełstowski
I think speaking as advice to Donald Tusk is quite a specific concept. I think it's more advice to people who are in a position to make decisions, because.

Monika Rachtan
But you know the Prime Minister at the end of the day is going to have to pat it all down, so to speak. And I think that he today just needs that kind of support and the voice of different specialists, people who just know what they're doing, to be able to verify all this multitude of information that will eventually come to him. Because at the end of the day it will be time to make decisions and to prepare these standards for what is going to happen probably in a few years' time. That's why I think from all sides the advice just for the Prime Minister is very good. Because my impression is that I'm convinced that you're an expert at what you do, so I think you can speak up.

Michał Chełstowski
I specialise in a very narrow field when it comes to crisis management, because I deal with this, this acute phase, that is, where action has to be taken quickly. Here, some of the decisions that were taken by the Polish government were correct and some were not correct. And I think that accepting outside help in such a situation of flooding that hit us is one of the things that was a bit lacking. There were teams from all over Europe, but also from outside Europe, who were willing to help, who did not come in the end.

Michał Chełstowski
Unfortunately yes, because in Poland we have always been afraid to say hey, I need help. We are not only talking about the level of the state, but also at smaller levels, because it means that we admit that we cannot cope. But with any disaster, this is also the definition of a disaster in general, where our forces and resources are insufficient, whether in terms of direct action, coordination or communication. The World Health Organisation has this special unit, it's called the Emergency Medical Coordination Cell, which is a unit that, with experts who, like for example I was in Cairo for a few months at the moment, as part of the operations in Gaza we go into the country to help coordinate these external resources, because we know the standards, we know the ways of communication. So it's not just a question of these resources coming in, but proper coordination. And that can be done. It's just that sometimes you have to dare to admit that you can't and that you need that support.

Monika Rachtan
I already have some advice for people who will be dealing with next years plan. And tell me, what can I, as a grey person or Monika Rachtan, do more to prepare for the next flood? You know, I live in Wrocław, it's difficult for my house to get flooded, but I think that many people who watch this programme live in floodplains and we in Lower Silesia have partly defended ourselves in the Wrocław area, but it would be enough for another dike to fail and we would also have a disaster in big cities. So what? A first aid kit, some sort of survival bag? What should I do?

Michał Chełstowski
There are two things that I think everyone can always do, whether they are in a high-risk area or not. First of all, listening to the messages. Because people were getting text messages, they were getting messages very quickly that there was flooding and they decided not to worry about it as much as they should. And sometimes it's worth leaving when something hasn't happened yet and, at most, coming back after a few days, focusing on your health and your life and your family's life, rather than on property like your flat, because, at the end of the day, your flat and other such things can be rebuilt, but your own health often cannot. And the second is what you said, which is this escape bag. We in the organisation have such a thing that when we go on a trip, we always have to carry a rucksack with us, where we have medicines with us for a fortnight, and we have our basic toiletries. Plus a water filtration system, such a handy one, basic food, but also documents. So the moment you have to leave you take such a rucksack and you have everything you need, the essentials.

Michał Chełstowski
On a number of occasions we have encountered people who have been moved from their homes to these places, to schools, to TSOs, who, for example, have not had access to their medication or thought to take it. And medication is such a fairly important thing.

Monika Rachtan
I think that such a lack of responsibility on our part. But is it that we can't think in an emergency situation like this, or is it just that it is difficult for the elderly to come up with such an idea in the first place and that this responsibility is on us, the children, to take care of these people.

Michał Chełstowski
There are a lot of projects in Poland, and unfortunately they are quite quiet, where volunteers, for example, go to elderly people and prepare such cards, so, for example, the ambulance comes, because someone has called and suddenly on the door or in some visible place there is a card with the data of the person who lives in this flat, with the medicines he or she takes, who to call, in what situation. This is the kind of card that can be prepared as a family for an elderly person or a person who has another disability, which makes it very easy. If an elderly person flees for some reason or goes away, it is still the responsibility of the family or social assistance to remember to take these medicines. I think that here, as Poland, we do not have disasters, but in places that are more experienced, even poorer, but more experienced. These people know exactly what they need to take with them because they have to do it several times a year. In our country it happens once every dozen years or so, so I think that's not going to change and I don't think it's going to change either.

Michał Chełstowski
Simply put.

Monika Rachtan
You said that many people did not want to leave their homes, that they did not decide to evacuate the moment these announcements came. But we also saw that, in spite of everything, in the face of such a huge tragedy, there were looters who looted the property of people who had actually lost everything. People were very afraid of that. What did they say in the Opole region? When you asked yourself why you didn't leave your house, was this problem of theft actually that important?

Michał Chełstowski
Here I can speak from a slightly different point of view. There are very tough rules for every international team in terms of how to prepare, because you have to be self-reliant, but also in terms of safety. And every medical team, international team has to have, for example, a fence, lights around the fence and a person on duty to keep an eye on things, because even in these worst situations all over the world there are people who want to use that.

Monika Rachtan
So there goes that readiness again.

Michał Chełstowski
But she is. It's the same things all over the world, so it's no surprise that there are such people. But fortunately here the police have been very clear in apprehending such people and I know that now the proceedings are very fast and that there is zero mercy, which is very correct. And because the moment someone benefits from someone else's suffering, these consequences should always be checked properly, of course, but also these actions should be very strong.

Monika Rachtan
I think we are in no doubt that we were not adequately prepared for the disaster that befell the southern part of our country in particular. On the other hand, we know that we can now, that we now have the time to prepare solutions. I think what Michael said is very important, that we trust the services, because the services are there, they are training. They obviously need to be corrected, to improve their performance, but they are there and they are worth trusting because they are working for all of us, for our good. And I think that this is the message that we would like to leave our viewers with, so that they follow what we are told by those who manage us. But on the other hand, I also thought of another thing, that these activities in the flooded areas will continue for a very long time and will require discipline both from the people who come to help, but also from the inhabitants. And this is probably also worth mentioning here.

Michał Chełstowski
There are organised volunteers and volunteer coordinators already in every village that has been affected by the disaster. So going on your own, without knowing where you are going, can cause more problems than good. And in Głuchołazy, for example. The access road, the only access road to the village, was fully jammed by people who wanted to come and help and the emergency services, including us. We couldn't get there quickly because of the fact that a lot of people rushed to get help, so you often have to hold off on the official announcement of what's needed, how to deliver it and try to support the whole system, because it's never us, it's society, so we have to work together as a society.

Monika Rachtan
And I would like to appeal to you that Lower Silesia is still waiting for tourists, including the Opole region. Many areas which were flooded are now passable, and they lead to beautiful attractions in Lower Silesia. As someone who lives in Lower Silesia, I warmly invite you to visit these places. And today my guest, but above all your guest, was Michał Chełstowski. Thank you very much for our conversation.

Michał Chełstowski
Thank you also.

Monika Rachtan
And I invite you to subscribe to my channel.