It’s a typical weekend at Finnish hospital, and ambulances and police cars usher inebriated people with injuries through the door. Nurses and doctors might be heard to mutter about the "unnecessary" work, but all patients must of course be treated equally.
Most mortality associated with alcohol use in Finland is the result of head injuries: falling on stairs, bicycles, or while walking along - sometimes getting into a fight.
Neurosurgeon Ville Leinonen from the Kuopio University Hospital in Central Finland would like to correct a misconception. He says inebriated people that come to hospital with head injuries need not be major consumer of alcohol. Sometimes they are normal 9-to-5 office workers who have drunk their recommended weekly alcohol ration in one go and taken a spill.
"Then they come to us with spilled brains," he says.
He says that while bones can mend, a hole in the head cannot be cured. Brain injuries can have life-long effects in terms of a person's ability to focus and retain memories. Some are forever-after plagued by fatigue or a change in their personality.
Stop alcohol abuse in its tracks
Leinonen says Finland has danced around its alcohol problem for too long. That's why he's done mincing his words. He wishes medical staff could intervene and stop alcohol abuse in its tracks already during the care of the first injury, but for people who don't want to be helped, it's like "pouring water in a well".
"On the one extreme we have people who think they are so healthy that they don't believe they have an alcohol problem. On the other, there are those who are in such rough shape that they don't care anymore," he says.
This is why he says he is flat against any attempts to loosen Finland's famously strict alcohol regulation. He says it is clear that making it easier for people to get their hands on alcoholic products would contradict national health objectives.
"The sin tax will never be high enough to cover all of the added expenses that alcohol creates," he says.
Sometimes a question of life or death
Hospital staff frustration with drunken patients who have hurt themselves only grows acute when things get busy. Each new patient that comes through the doors makes it more likely that they will be forced to prioritize.
"At worst, we have to decide who to keep alive," says nurse Kari Karttunen.
Sometimes the ambulance or police car drops a patient at the hospital whose only complaint is serious drunkenness. They aren't hurt, they haven't lost consciousness, but they are very intoxicated; so much so that they can't manage on their own.
Nurse Ari Kinnunen says that at the Kuopio University Hospital patients like this are first asked to sit for a blood test and general health check. Then they are directed to a bed.
"So first we assess how drunk they are and then we let them sleep it off. They wake up in the morning with a hangover and go home," he says.
Expensive bed for the night
Kinnunen agrees with many of his colleagues that this is wrong for many reasons. First, because of the care prioritization problems it sometimes causes, but also because of the cost.
Taking care of drunks in a specialized facility for hospital care is one of the most expensive ways the problem can be handled. Each person who arrives drunk at emergency services and sits for basic tests before passing out for the night could mean a 225- to 425-euro expense for the municipality.
Sleeping off a bender in a community jail would be a cheaper alternative, but the police don't believe it is their responsibility to provide a bed to peaceful drunks. The police are also not trained in medical care, and between 6 and 21 people have died in police holding facilities every year in Finland in the last decade.
Workers exposed to regular violence
Safety is another consideration. Starting a few years ago, the Kuopio University Hospital employed the services of a security firm around the clock, one guard during the day and two at night.
Sometimes patients that seem calm can become unexpectedly aggressive, especially if they are under the influence of alcohol or have a mental illness. If a security guard can't get there in time, medical professionals occasionally pay the price.
"It's dangerous to work here sometimes. We are often the target of yelling and slapping. If people did things like this in a bank, the guards would grab them by the scruff of their neck and throw them out the door," says nurse Kari Naukkarinen.
A solution at hand?
The city of Kouvola in south-eastern Finland is trying a different approach. They opened a detoxification centre in 2011 to serve as the primary care centre for people under the influence of alcohol. A night at the facility has a cost of about 200 euros, depending on the situation. The staff at the centre is trained in the care of alcohol-related matters and has consciously chosen to work there. It is also a much safer alternative for the customers than a night at the police station.
"Only one person has died in police custody in Kouvola since we started," says Antti Immonen, director of the A-Clinic Foundation-funded centre.