Patients dying

Junior doctors say shortage of equipment resulting in deaths

BY KIMONE FRANCIS
Senior staff reporter
francisk@jamaicaobserver.com

Friday, August 16, 2019

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A significant shortage of equipment at several of the island's public health facilities has resulted in deaths, junior doctors have stated.

The doctors, who have been speaking with the Jamaica Observer on condition of anonymity since May, suggested that patients' lives could have been saved if vital equipment had been available.

“I was on medicine at KPH (Kingston Public Hospital) and a patient was transferred from Linstead [Hospital]. He had a CT (computed tomography) scan of the brain that showed that he had a haemorrhagic stroke and they sent him to KPH because Linstead obviously doesn't have neurosurgery. For some reason, I don't know how, he ended up on the medical ward instead of the neurosurgery ward,” the doctor disclosed.

The doctor said the neurosurgery ward was consulted, but doctors there were reportedly unable to perform surgery without a magnetic resonance imaging (MRI) scan of the patient's brain.

“Now KPH doesn't have an MRI machine, so he had to go to UHWI (University Hospital of the West Indies) for that, and there was a fee... So that took a few days for the family to [raise the funds] and then when they did pay, KPH only had one ambulance so that took a few more days for them to actually book the ambulance for him to go [to UHWI]. So five days after admission, when it was time for him to actually be transported to UHWI for the MRI, he died,” the doctor shared.

A haemorrhagic stroke happens when a blood vessel breaks and bleeds into the brain. Within minutes, brain cells begin to die.

According to the doctor, had the equipment been available at KPH, the patient could still be alive.

“If we had an MRI machine actually available two days earlier, he would have got the MRI and would be able to do the brain surgery. I don't think he would have died,” the doctor theorised.

“These things happen all the time. We lose patients because we lack the necessary resources — it's a known thing,” the doctor added.

Similarly, another doctor confirmed that there is a shortage of equipment at the hospital, which is the largest multidisciplinary hospital in the Government health service as well as the largest trauma centre in the public hospital system.

“I can't pinpoint a name, but for example, the neurosurgery [department] has no microscope. I'm not sure if one has been procured, but patients with brain tumours will die waiting for surgery due to a lack of a microscope,” the doctor stressed.

A microscope is an instrument that produces enlarged images of small objects, allowing the observer a close view of minute structures at a scale convenient for examination and analysis.

“A lot of the things we need, we don't have,” a third doctor told the Observer.

“I could say patients die every week because we don't have the equipment or relevant staff. You work, for example, at KPH or Spanish Town [Hospital], those hospitals see a lot of trauma — average maybe three gunshot wound cases in a night. You know, all three of them are emergency cases. There's only one surgical team on call; that surgical team might not have enough staff. They sometimes have three interns, two medical officers, and the consultant, and depending on the experience of the medical officers they may or may not be able to do two emergency surgeries at the same time and hope that the third person doesn't die. Sometimes, they may have to choose which patient needs surgery more than the others, even though the three cases are emergencies,” the doctor shared.

“And then again, a lot of the things we need, we just don't have. A patient may come and need urgent dialysis; they can't get it. They need an urgent investigation; they can't get it. My colleague had a patient in a car accident who had significant head trauma and needed a CT scan — we were working at Spanish Town Hospital at the time — the radiology CT machine was down, the X-ray machine wasn't working, all these things were down and the patient suffered,” the doctor continued.

He mentioned, too, a case involving a maternity patient at Spanish Town Hospital who died while awaiting an emergency Caesarean section.

“You had three to four emergency C-sections backed up. A patient ended up having uterine rupture, and died because of that. In that case, it wasn't equipment; we didn't have enough staff. We didn't have enough operating theatres as well,” said the doctor.

Uterine rupture is a spontaneous tearing of the uterus that may result in the foetus being expelled into the peritoneal cavity.

“Spanish Town Hospital has three operating groups — you have orthopaedics, general surgery, and you have obstetrics. Each of them, at nights, may have multiple cases that they may have to carry to the operating theatre, so they have to be competing for the theatres. I can tell you, I've worked at several [hospitals],” the doctor expressed.

“It is fine for the minister to put elevators in hospitals and all, but there are things that need to be prioritised, like doctors not being able to run tests to properly diagnose patients; things like doctors not having simple things such as tubes for blood samples. Those are immediate issues that we need him to address. We need him to be practical and stop the grandstanding,” said the doctor.


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