Living in their shoes

Dr. Lionel Varela came to Geisinger-Lewistown Hospital as part of the Hospital Rural Residency Program, but the arrival of the COVID-19 pandemic changed those plans.

LEWISTOWN — Back in July 2018 when Dr. Lionel Varela joined the newly accredited Geisinger-Lewistown Hospital Rural Residency Program it was like any other residency you would expect at a hospital in rural America. That is until the COVID-19 pandemic swept into the region.

Varela, who was born in California, raised in Arizona and spent time in Mexico before moving to Yonkers, New York, was among the first group of four residents to be selected to the hospital’s 3-year program. According to Varela a typical residency program consists of two types of structures — one is patient practice where doctors can apply what they learned in medical school and gain hands on training and experience treating patients and the other is the didactic side of the program which sees residents further their training with lectures and textbooks to comprehend disease thoroughly.

Around February of 2020 when the COVID-19 pandemic made its way into the Pennsylvania, Varela and his colleagues saw the residency program make a shift.

“It was affected. Definitely everything was turned upside down,” Varela said, “There was a lot of uncertainty. A lot of changes very rapidly.”

He and the other residents were told that things at the hospital would have to change, including their residences, because of the national emergency.

One of the first tasks asked of the residents was to fill the tents which were constructed outside the hospital’s emergency department to help service patients and help slow the spread of the pandemic. Varela said the purpose of the tents changed a lot during the course of the pandemic. Initially the tents were in place as a place to pre-screen for the COVID-19 virus. The pre-screening safety measure was in place to avoid infected people from going into the emergency department and exposing them to the elderly or people with chronic conditions.

The tents later switched to a place where patients infected with the COVID-19 virus could be treated without having to go into the hospital. Then the tents were changed again to go back to their original intent to screen patients. But that wasn’t the last transformation the COVID unit outside the ER would see.

Eventually, Varela said, the COVID unit was rebuilt so that the tent would be a more structured place and mainly used to see patients during the second peak of the pandemic. Varela said the residents along with the ER nursing staff were the originators of the COVID unit. They were the providers for the patients and were precepted by the emergency department doctors that were inside the hospitals.

“Throughout the whole year, it’s been a very long year, but there has been variations of how we help,” Varela said.

At one point the residents helped with the clinic out of the Family Practice Center in Mifflintown to see a lot of chronic patients through telemedicine — or a doctor visit via teleconference or video chat. With spikes in positive cases in November and December, Varela said the residents were called back to help serve patients in the emergency department. Eventually Geisinger-Lewistown Hospital was filled to capacity and the residents were asked to work in the inpatient setting as well as the COVID unit.

Things changed again when the COVID-19 vaccines were approved and began to be distributed. Varela said the unit in Mifflintown was one of the lucky ones as they were able to distribute the vaccines.

Varela said he and his colleagues have been helping weekends to administer up to 300 to 400 vaccines a day. Varela said he felt honored to be able to help people in need and especially with the whole country being in such terrible times with the pandemic.

“It had its good moments when we started seeing that our protocols started to make more sense and add more structure,” Varela said. “We understood more about the vaccine and were able to manage it. I saw patients get out of the ICU (intensive care unit). I saw patients starting to get out of the COVID units and actually make it through the pandemic with the advances in medicine as we understood it a little bit more.”

After he finishes his residency in June, Varela said he and his family plan to remain in Mifflin County.


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