KPH overwhelmed by deluge of walk-in patients
BY DONNA HUSSEY-WHYTE Sunday Observer staff reporter firstname.lastname@example.org
I had learnt from my last hospital visit that if I arrived in the afternoon, chances are I would get through no earlier than if I went before daybreak. So, in my continuous quest to get the 411 on the public health care system, I arrived at Kingston Public Hospital (KPH) at 12:20 pm.
Two men directed me to park across the street from the hospital in an area labelled 'visitors' parking' but with the word 'visitors' struck through. I wondered at the time if it was a deliberate ploy by the scruffy-looking men who took up position at the entrance to the otherwise unsecure lot and demanded money upon your exit. It was most disheartening. How can you have a public hospital where visitors are required to pay?
From the looks of the men one could easily conclude that they did not work for any official organisation, neither the hospital nor the Kingston and St Andrew Corporation (KSAC). Later checks revealed that the KSAC was not responsible for the parcel of land and thus did not regulate parking there.
Once on the hospital compound, I sought directions from one of the security guards and was directed through a large door leading to the Accident and Emergency (A&E) department. I was given number 115, but fortunately a large number of the patients who had arrived before me had already been seen by the triage doctor where I was expected to go first. Only 21 persons were ahead of me.
I sat on the back bench, moving up as persons were called in by the doctor.
The first thing that struck me about the room was how unhygienic it appeared, especially for a health institution. Cobweb lined the ceiling, seemingly from years of neglect; the walls desperately needed painting; the rusty, broken cooler sitting at the back of the room had seen better days; the entire room had a look of abandonment.
More than the look, however, was the smell that permeated from the waiting area as I entered. It reminded me of the stench from a pit latrine from my days as a child visiting the country. So strong was the odour that I immediately felt nauseous. I noticed though, that after about an hour or so the wave of nausea disappeared, apparently because my nostrils had grown accustomed to the offensive smell.
Soon, as is ususally the case when I sit on dirty surfaces, my bottom began to itch. It was an indication that the benches, along which there is a constant dragging of derrieres, were perhaps not properly cleaned, if at all.
One young woman, who didn't appear to be in her right mind, began to curse just about anyone she could think of on top of her voice. Using strings of indecent words, she threatened persons, promising to shoot them and declaring who were "frigging lunatic" and should be taken to Bellevue.
It was a welcome distraction as it took our minds off everything else.
She grabbed the sympathy of many, especially since she seemed to be in her late teens. A security guard came over and forcibly told her to be quiet or she would be removed. She did not respond, but continued her tirade at the top of her lungs. Not knowing what to do, the guard left. Fifteen minutes later, another came over and tried coaxing her into silence. This, too, failed and eventually they had to allow her to see the doctor before her turn.
At 2:15 pm, I saw the nurse who did the vitals. I was advised to do a urine sample, but there were no containers in which to leave the sample. She wrote the words 'no containers' on the slip of paper I was given and told me to wait outside the room until someone returned with a container. No one came.
Having seen the nurse and done my vitals, I had to sit on another set of benches and wait to see the doctor. He had left the room sometime after 1:00 pm, so there was now a build-up of patients waiting to be attended to.
During his absence, no other doctor took over, but it was a situation I had got accustomed to from visiting other public hospitals. When a nurse or doctor went missing, no one else took over, forcing patients to endure long waits that could have easily been avoided.
"Then, they don't know seh when one person gone another fi take over? Dem don't have nuh b...t sense. Look how long people haffi wait!" one man said hissing his teeth. Others joined in.
"From you come a dem place yah, you have to just make up you mind to stay all day," an elderly woman said.
At 3:16 pm, the doctor had still not returned.
Two women had fallen asleep on one of the benches at the back, others sat grumbling, and others still, sat patiently awaiting his return.
I was hungry. Sitting down for over an hour with nothing to do and not knowing what was happening was very tiring. No one came out to explain why there was such a lengthy delay and how long persons would have to wait.
I decided, therefore, to drive back to my office on Beechwood Avenue, less than 10 minutes away. There I had lunch, spoke with my editor about the inactivity at the hospital, completed a story I had started days before, then headed back.
When I got back it was 4:30 pm.
Some of the persons I had left there had left, but it wasn't because they were seen by the doctor, I was told.
"Some people just get fed up and leave," the man who was one number ahead of me explained when I enquired. The fact that he and others with numbers ahead of mine were still there meant I had missed nothing. He explained that the doctor had not long ago returned and had resumed seeing patients.
At 5:40 pm, I was called in to see the triage doctor. He looked at the form the nurse had given me and sent me back to do the urine test. He advised me to return to him as soon as it was completed.
I asked a nurse in the room for a container and was handed one. The restroom was a short distance away and so the trip to and from, though embarrassing, was not as psychologically painful as they were in previously visited institution.
When I went back to the doctor, after the nurse had tested my urine, he told me my condition — concocted symptoms of a very heavy period, nausea and severe headaches — was not serious enough to be seen by the hospital and that I should instead visit the health centre.
There was no sign anywhere that indicated what conditions could or could not be seen at the hospital. Patients therefore had to spend over six hours going through the process before finally being told that they could not be seen at the institution.
Chief Executive Officer at KPH Godfrey Boyd said persons first need to realise that the institution is the major referral hospital for Jamaica and the English-speaking Caribbean having approximately 60 per cent of medical cases in Jamaica.
"This is the major referral hospital for Jamaica and the English-speaking Caribbean. It's not just Kingston and St Andrew, it's not just a downtown hospital. So this is the end point for a lot of the other hospitals," Boyd explained. "This is where other doctors send their patients, both from the public and private institutions. On any given day, we have over 3,000 outpatients. On any given day! And an average of 505 inpatients and that can increase significantly, and we don't turn away patients. The waiting may be affected by the number of patients we do have, unfortunately, but we are not going to turn you away."
The CEO said that if the number of those who accompany the sick to hospital is added to the 3,000, an average of 4,500 persons pass through its halls each day.
"When you are in Accident and Emergency and you have to be moving back and forth because persons came in from an accident and another with gunshot wounds, a next person based on domestic violence has been stabbed up, etc and you have to be moving fairly quickly, but you have to be as thorough as possible to try to save a life or loss of limb... it is hard," said Boyd.
But, he said, some outpatients could be spared the long wait if they sought treatment at the health centres rather than visit the hospital for sundry ailments.
"We do have a high level of persons who really should go to the health centres. In our Accident and Emergency, we have to respond to those categories that are for life. That's why it is the Accident and Emergency. Some persons come to the hospital because you know, you hear 'hospital' so persons think that well, this is a one-stop shop for everything, but the primary care is set up to deal with the primary care issues, things that are not considered life and death. The hospital is specifically for the emergency and accident care," he said.
He said having a sign at the hospital indicating what cases are not seen would be unfair to patients as sometimes a symptom may mean something more serious than what it is thought to be, thus they have to see the triage doctor whose assessment would then determine whether or not the situation warrants further check-up at the hospital or if it is safe for the person to then go to the health centre.
"Just putting up a sign and saying to you 'if you have a cough or cold, go to the health centre', you might miss somebody who is having a serious bronchial problem and this could result in them dying. It is not as easy as it looks. Part of the policy of the Ministry of Health and the South East (Regional Health Authority) is that there has been documentation, there has been information disseminated to the public asking them to go to the primary care centres, but if truth be told, a lot of persons still don't do that."
While not detailing how many doctors and nurses were assigned to the hospital, Boyd said in total there were over 2,000 staff employed directly and indirectly at the institution.
"Globally, I don't think there is any health system in the world that has enough nurses and doctors to take care of all the persons who visit their health institutions. I don't think there will ever be any health system that would have as many as they would want," he said. "I don't think anywhere in the world you would have the type of staff numbers that you would ever want."
Addressing the parking issue, Boyd said with the high-level traffic it has from employees and visitors, it would not be possible to accommodate everybody on the compound. He said, however, that there were plans to convert part of the property in front of the hospital into a proper parking lot.
"We certainly have a vision to make part of the lot into a parking area. In general, the population grows and people are living longer and as far as living longer goes, it means that the seeking of medical services will be (extended). One of the strategies of the South East (Regional Health Authority) is that we constantly review the system and look at how we can improve services that are offered to the public," he said. "Sixty per cent of my day is spent trying to figure out, 'how do we improve this', 'What do we need to do and what are the different alternatives?'," the CEO said.
In terms of doctors and nurses sometimes missing from the triage room, he said they are sometimes called away to perform life-saving procedures.
"In A&E we have a lot of cases, especially those that take up time, such as those having to do with gunshots, stabbing, some violence, whether be it at home or from criminality etc. And if you understand the nature of an accident and emergency situation, when you have a life to save versus a common cough or cold or ache or pain, whether it's arthritic pains etc, then you are going to go to try to save that life," Boyd explained.
"So it is also hard for the staff members and for the hospital to try to balance and I think a lot of times persons don't understand that, and I can understand from a singular patient's point of view whether it's a cough or cold you would want to think that you are the most important person who exists. But there are also others who their lives are threatened. And therefore, they have to be attended to first."
He says as a result of the many trauma cases his staff sees daily, they too become emotionally stressed and have to be given in-house counselling. Nonetheless, they often make sacrifices to meet the needs of patients.
"The staff members do try their best and their stress level is always high because with a patient who is in pain, sometimes the emotional competence and capability goes out the door and it poses a challenge sometimes when the staff member tries to deal with these patients. And when you are in an area like Accident and Emergency, where you are seeing all of this trauma, as persons call it, the blood and the gore aspect of things, it does take its toll. I have had staff members who have been beaten up and spit on and had their lives threatened. So sometimes people don't understand what we go through," the KPH CEO said.