A high percentage of the ambulances assigned to public hospitals are down and almost out for the count, a probe of the institutions by the Sunday Observer has found.

Some officials say that up to 40 per cent, others cite 50 per cent, of the units are defective, meaning not only those that are in garages, but others that may be drivable, but stand a high risk of breaking down without warning due to lingering faults.

The situation is so bad that even Health Minister Ruddy Spencer has admitted to a chronic shortage, due mainly to mechanical challenges afflicting the units.

However, the senior political official revealed that he was advanced with plans to ease the pain on the system.

"Let's put things in perspective. We have between 14 and 18 ambulances in garages now. Four ambulances have been ready and the regions haven't picked them up yet, one of them cost $70,000 to repair," Spencer said.

"A few of them have to be written off, while others have to be repaired," he said.

However, one senior doctor who asked not to be identified said that the number of lame ambulances was far higher.

"It's much more than that, but the health ministry will not admit it because it will look too bad," the doctor said. "There needs to be a serious overhaul of the system. Ambulances are essential and should be treated as such."

The health ministry did not provide the Sunday Observer with the total number of ambulances in its fleet, but a tally based upon the responses from the various institutions put the figure at 41.

Among the institutions mainly affected are the University Hospital in the Corporate Area, St Ann's Bay Hospital in the North East region and the Cornwall Regional Hospital in the west.

The lack of a working ambulance at Jamaica's premier health facility, the University Hospital of the West Indies, has put the delivery of health care at the institution under threat.

The hospital has been without an ambulance of its own for a month, thus putting further stress on activities there and has added to already established woes, topped by the lack of a CT scan machine which went down earlier this year, was repaired and worked for a short time, before crashing again.

"We are struggling," Dr Trevor McCartney, the hospital's chief executive officer, told the Sunday Observer.

Workers at the hospital have long complained about the lack of key equipment, and the loss of the ambulance has added more pain to those who operate in the firing line of the health care system.

Bureaucratic bungling is said to be part of the symptom of the disease afflicting the institution, as the ambulance that it had up to a month ago was sent to a garage for what seemed to be an extended vacation, and efforts by hospital authorities to buy another have hit a snag.

"The hospital wants to purchase an ambulance, but we hear that the matter has to go through the Contractor General's Department for the procurement process to take shape. That process appears to be long and tedious," one worker said.

"The ambulance is used to transport patients who have need for admission but they cannot be accommodated at the institution," another worker offered. "The ambulance is also used to transfer patients to the KPH (Kingston Public Hospital). It is also used to take patients for investigations outside of the UHWI, which is not available, like CT scans. Not having a CT scanner and not having an ambulance is just crazy.

"Let us say a patient comes in with a head injury, we don't have a scan, so how are we going to know what is the pathology in the brain, unless we do a CT scan?" the worker complained.

"Let us say again, that I meet in an accident and I am unconscious, even if that is the only injury I have, one of the investigations is a CT scan. If I go to the premier hospital and there is none, you go to Andrews (Hospital), I can get a CT, even though they don't have specialists on call. Getting to Andrews is another matter, because the ambulance is not working. So what do we do?" the worker asked.

"Even if we at UHWI have qualified experts to deal with head injuries, their hands are tied until they can get a CT scan. It would then require us to get a private ambulance to go down to Andrews, which would delay the management by several precious minutes, if not hours. I cannot believe that the big university doesn't have an ambulance," the worker said.

Dr McCartney, in the meantime, is hopeful that repairs to the ambulance can be completed in short order.

"We have been using our utility vehicles to provide transportation for patients who need to access care at our institution, or who need to go elsewhere for treatment," he told the Sunday Observer.

"We have been in touch with our ambulance repair people and they have assured us that they are doing their best to speed up the process of repair," Dr McCartney said last week.

The story is not one of hope for the St Ann's Bay Hospital, where two of three ambulances are down.

Asked if the situation is adversely affecting the institution, senior medical officer Dr Nicole Dawkins said: "Most definitely. We have one working now and we are supposed to have three, plus a utility vehicle.

"The lone ambulance is serving as an ambulance and a utility vehicle. We have been given assurances from the Ministry of Health that things will improve, but nothing has happened yet," she said.

The St Ann's Bay Hospital was thrown into the spotlight weeks ago when a patient from St Mary accused the institution of not attending to her fractured ankle after she had made 17 trips to the facility.

She was later treated at the Kingston Public Hospital upon the intervention of Health Minister Spencer.

The Cornwall Regional, one of three Type A public hospitals in Jamaica — the others being Kingston Public and University hospitals — is also facing its share of challenges, due to the lack of all functioning ambulances.

There was no response to messages left for administrative officials at the hospital to comment on the matter, but a count by the Sunday Observer showed that the hospital had five ambulances in its fleet, but only two were functioning up to the end of last week.

The KPH, the all-maternity Victoria Jubilee Hospital (VJH) and the Bustamante Hospital for Children are all served by a central dispatch centre located at Bustamante Hospital in south east St Andrew.

The centre has three units in its fleet, two assigned to KPH/VJH and the other to Bustamante.

However, they also service health centres within the Corporate Area and also operate as utility units to take samples for testing in Kingston and St Andrew and Portmore.

Among the concerns of the president of the Jamaica Medical Doctors Association, Dr Shane Alexis, is the question of prioritising in a critical situation.

"When there is one ambulance and three critically ill patients, how do you prioritise? Valuable time can be lost by the time the decision is made," Dr Alexis argued.

"There is no clear way of prioritising cases, and it comes down to someone making the decision who is not qualified to do so, like a driver for example. There is an inherent problem in how the regions are structured," Dr Alexis said.

Chief executive officer of Mandeville General Hospital Alwyn Miller said that the facility's emergency vehicles were operating at around 50 per cent capacity.

"We have two ambulances in our fleet, one of which is in good working order, and the other is being sorted out in the garage... it requires some parts," he said.

"We are able to manage with the two when they are functioning, and where we require assistance, our sister hospitals lend us. That's standard procedure," Miller said.

At the Port Antonio Hospital, one of two vehicles used as ambulances is down.

"We have a Mercedes Benz and a Hiace bus," said Dr Wendy Allen Davis, the hospital's senior medical officer.

"The Hiace bus is in the garage, but the Benz is working. However, don't be fooled by the name Benz, as it doesn't always run like one. There are times when we need to have both working concurrently," Dr Allen Davis said.

"The shortage of ambulances is an islandwide problem, and it seems to be more chronic in this region. We have to do a lot of juggling and borrowing from each other to make things work," she added.

One hospital which supports the St Ann's Bay and Port Antonio is the Type B facility, in Annotto Bay, which, for now, has both ambulances functioning.

"My two are up and working," said the hospital's chief executive Arlene Mighty. "If my two are not enough, there is an agreement between institutions that if they are able to help, they will do so.

"I have been self-sufficient for the past couple of months... thank the Lord," Mighty said, citing the cost of using private ambulances when necessary, as a deterrent.

"I use private ambulances occasionally, especially when our ambulances are down, but it is very expensive. It affects your bottom line. You can pay between $25,000 and $30,000 for a trip from Annotto Bay to Kingston. They don't come cheap, and they come with their own staff, including driver and paramedics," said Mighty.

Annotto Bay is approximately 34 miles from Kingston.

One institution that seems to be working out reasonably well is the May Pen Hospital, which has three of four ambulances functioning.

"May Pen has four ambulances, one of which is out for servicing," said the hospital's CEO Nadia Nunes Howe.

Interestingly, there is an ambulance parked at the Princess Margaret Hospital in Morant Bay, St Thomas, which has not been used in over three years because of a lack of documents.

Charity organisation Food For the Poor gave the hospital the vehicle as a gift years ago.

Apart from the documentation that is needed, the vehicle also requires a special stretcher that it can accommodate.

The hospital itself has one working ambulance.

Member of parliament for Eastern St Thomas in which the Princess Margaret is located, and Opposition spokesman on health Dr Fenton Ferguson bemoaned the situation, saying that the sector could not tolerate such waste.

"The ambulance is just there parked up and being used for storage of stuff," he said.

"Overall, the ambulance service islandwide is in shambles, and is a further manifestation of a failing system. It is part of a stubbornness of this administration to review the policy that major stakeholders have said is not working. They have almost recklessly continued to proceed on a path that is going nowhere," Dr Ferguson said.

Spencer said that the situation with the non-functioning ambulance at Princess Margaret was being addressed.

"The matter was discussed as recent as today," Spencer told the Sunday Observer last Thursday. They (hospital officials) told me and the PS (permanent secretary) that they are awaiting something from the National Works Agency to move the process and we will then determine what we do with it."

Dr Alexis, whose organisation has been strident in bringing to public attention the ills of the health sector, underscored the importance of ambulances in the system.

"The ambulances are almost like the drivers of the hospital," he explained. "Ambulances are not only used to transport patients, but various things, including blood products. "Even when CT scan machines are down, it is an ambulance that has to take patients to private hospitals."

Spencer said that tenders are anticipated for the procurement of new ambulances.

"We have asked people to put in tenders for ambulances as we are going to buy between 20-odd and 30 new vehicles, as soon as the paperwork is ready," he said.

"We are going to buy a mixture of ambulances this time, ambulances of all kinds, including some to transport or accompany diplomats when they arrive here.

"We have looked at all ambulances and we are looking to get money to have them repaired," Spencer added. "We have sent out quotes and we expect to have the process started by January of next year.

"I know that there are shortages, like St Ann for example, and I had to borrow one for that hospital from another area, but we are trying," Spencer said.

The starting price for an ambulance that is partially equipped ranges from a low of US$22,463, excluding applicable taxes like import duties, to over US$50,000, based upon listings posted by suppliers overseas.

Government, for example, would find it more appealing and attractive to buy ambulances in bulk, as the unit cost would drop significantly and there would likely be a waiver of import duties at the receiving end, leaving the purchaser to stand the CIF or cost, insurance and freight expenses.