The state-owned Kingston Public Hospital (KPH).
MEDICAL doctors yesterday blamed the lack of resources for the poor health care received by citizens at the nation’s public hospitals.
The doctors, who all requested anonymity, were responding to yesterday Sunday Observer story which exposed the conditions under which doctors have to work at the Kingston Public Hospital (KPH) and Spanish Town Hospital as well as the poor treatment received by patients, mostly poor Jamaicans.
One surgeon at the KPH told the Jamaica Observer on a number of occasions surgeries have had to be cancelled or postponed because of a shortage of equipment and the malfunctioning of others.
“The elevator is always a problem, as it hardly ever works. The issue gets worse when you have to tell a patient ‘I’m sorry, I can’t do your surgery again because the elevator isn’t working’,” the surgeon said.
In June last year elective surgeries were cancelled at the KPH because of repairs being carried out on one of the main elevators at the hospital, according to the surgeon. He said that, to date, the elevator does not function properly.
“A man is required to be posted in the elevator at all times to get you to the floor the surgery is being done. That’s not a functioning elevator if someone has to be posted in it to allow it to go up and come down,” the surgeon said.
He said that only emergency surgeries can be done because of the risks patients face when the elevator doesn’t work.
“When the elevator doesn’t work and the patient doesn’t get to do the surgery, it can result in death. Sometimes patients are moved manually up and downstairs, which is a major risk because if you drop the patient no one will understand and look at it and say you were trying to help a situation. Plus, no one is covered by insurance if they drop a patient,” the doctor lamented.
“Because of this, you will find that people who have hernias unfortunately have their surgeries cancelled and only cancer cases are dealt with because they are considered urgent,” he added.
In addition to the malfunctioning elevator, there is insufficient supply of medication, surgery gowns, and surgery equipment, while the list of patients awaiting surgeries grows.
“There are no antibiotics and patients have to be asked to buy their own and take to the hospital. The gowns are not appropriate for surgery as the plastic aprons do not cover anything,” said the surgeon. “Once I went into surgery, and when I was finished, the blood from the patient soaked right through the apron onto my skin and that’s a risk to ourselves right there. But we put ourselves at risk for them to get their surgeries done…,” he said.
The surgeon mentioned, too, that there was only one functioning ultrasound machine for the entire KPH, which means if a patient needed to do an ultrasound they might be required to wait several days.
“The health care might be free, but it becomes costly when a patient is waiting for several days for one test. They have to be given clean linen, meals and medication, which is an expense,” the doctor said.
He added: “There’s one CT machine, and when it’s up it’s great, but when it’s down it’s a big backlog of persons waiting to be tested. It even gets to the point where you have to bargain to get your patient in first to be tested.”
The surgeon described the conditions as depressing and told the Observer that doctors on a number of occasions have to bring surgery equipment from their private practice.
“From a human point of view, I feel very bad. This is something that affects mainly poor people. I would not want my relatives to got through this, so I pay for private care. But some just can’t afford it. Emotionally it takes a toll on the doctors to the point where they now have to withdraw themselves from the situation to not be affected. It’s not easy when 90 per cent of your patients are affected by the cost of free health care and end up dying,” the KPH surgeon said.
At the University Hospital of the West Indies (UHWI), the situation is not much better.
“There are no purple top tubes which are used to check your blood count. There are no branulas used to insert the IV drip. There is no prednisone — an anti inflammatory drug — so if anyone comes in with an allergic reaction, asthma or auto immune disease there’s nothing that can be done here [at the UHWI]. Also there’s no lidocaine, which is used as an anesthesia so anyone who needs to get stitches will feel the pain and this is a huge issue as the doctors have to reschedule many procedures,” the doctor said.
“There is no barium enema (a special X-ray of the large intestine), so if you have abnormal bleeding from your rectum you can’t check to determine if it’s cancer or something serious causing the bleeding,” one doctor said.
He also said the X-ray machine has been without film so patients have to be sent to KPH or elsewhere to do their X-ray.
The doctor added: “There is also an ultrasound problem, so you have people here waiting for an ultrasound and can’t get a date.”
In addition, he pointed to a shortage of toilet tissue, hand towels and bedlinen, which pose a problem when admitting patients.
At the Mandeville Regional Hospital, a doctor said basic supplies are often out of stock.
“I think either the Government has no money or the hospitals aren’t getting what they’re supposed to get, because basic things like hand towels and tubes for basic blood tests are hardly or never here. The [Accident and Emergency] Department has none, and we have to put off something as simple as a complete blood test because there are no tubes,” the doctor said. He added that, for the last two months, there have been problems with the ECG machine.
The hospital also faces a staffing issue, which the doctor explained is a major risk.
“…There is one nurse in the department, and you can’t run an A&E Department with one nurse. Ideally three to four should be there,” the doctor said. He said also that, because of the shortage of beds on the wards after surgery, some patients are housed in the A&E Department, while are sometimes placed in a reclining chair, which the doctor said is a further risk to their health.
Last night, acting permanent secretary in the Ministry of Health, Dr Kevin Harvey said the complaints were alarming, and an investigation would be conducted in an attempt to alleviate much of the problems the doctors face.
“I was not aware that there were a shortage of tubes at specific hospitals, and I will personally have to investigate that. While specific hospitals might be out of items, the country is not out of items. If these problems are made known in a timely manner we can move to have the hospitals supplied,” Harvey said.
However, he mentioned that at times there are problems regarding ordering the supplies at the regional level, but once the ministry is made aware they are willing to address the complaints and discuss them with the doctors.
With regards to the UHWI, Harvey explained that this hospital is managed differently from the rest of the health services.
“It is still a fee-charging facility and it has its own management. Where shortages there are concerned, while we will assist where we can, it is really managed by the UHWI management board and structure that exists there,” he said.
The ministry, he said, was aware of the elevator problem at the KPH and was in the process of having it fixed, but said it would take some time to finalise.
“Our plants are old and have suffered from a lack of maintenance over decades. To keep them up and running is a challenge,” Dr Harvey said.
He added that the primary care and health services system is in need of an upgradem to manage the number of patients and health care distribution.
“Hospitals are having to deal with too many patients. When the health services were built a few decades ago the population was roughly 1.8 million. Now the population is 2.8 million, which indicates a massive shift and also a larger migration of people to urban areas,” he said.
“Forty-seven per cent of the population lives in the South East Regional area, which is St Catherine, Kingston and St Andrew, and St Thomas. If we intend to provide good health care, there needs to be an overall restructuring to match the shift and deal with issues of overcrowding as the doctors and health care workers are dealing with more than they can handle because of the population shift,” Harvey said.