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Mandeville hospital overwhelmed

BY DONNA HUSSEY-WHYTE Sunday Observer staff reporter husseyd@jamaicaobserver.com

Sunday, October 02, 2011    

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In the second of the Sunday Observer's series of undercover visits to hospitals across the country, we go inside the Mandeville Regional Hospital in Manchester.

Tempers flared in the chaotic patients' waiting room at the Mandeville hospital during a recent visit by the Sunday Observer, as angry patients, many of whom said they had been waiting for over four hours to be attended to, gave up trying to control their tempers and spat expletives.

"Mi a slide (move down on the bench) too long and can't reach nowhere! Dis a *&%$#@! foolishness," one woman shouted, uncaring of the sick child in her arms.

The mother of a two-year-old joined in the heated venting. She said her child had been brought to the facility three times in two weeks for the same condition, and despite purchasing medications every single time, for a combined cost of $5,800, her child was still constipated. In her mind, the doctors at the hospital had not done enough.

"Dem not even seh run test pon him to see what wrong!" she argued vehemently, grabbing the attention of all in the room. "Look from when the pickney cyah pass him stool and dem not even as much as look in him. No examination! All dem do is look in him eye and tell him fi open him mouth. Looking in him eye and mouth can tell you why smaddy cyah pass dem stool?" she asked rhetorically.

This outburst of anger and frustration belied the smooth start to the day as I set out to discover first-hand why there were so many complaints about long waiting times for patients seeking medical attention at this facility.

Before entering the gates of the Mandeville hospital, where I would spend the day undercover as a walk-in patient, I decided on an address in the parish which would help eliminate questions as to why I was seeking medical care at a hospital so far away from my home in St Catherine.

Satisfied that I could pass as a resident of the parish, I went inside, using signs to guide me to the casualty department where I expected to be seen by a doctor.

It was 9:35 am.

I asked the person behind the information desk where to go from there and was directed to a nurse's aid wearing a pink and white uniform who was manning a door. She directed me to four sets of benches, instructing me to sit at the very end and 'slide' up as persons were called from the first row of benches into a triage room. I was the 39th person in line.

The triage room — where patients' cases are prioritised based on how urgently they needed medical attention — was occupied by a nurse who would screen patients to determine the order in which they would be seen by a doctor.

There were four stages of triage (the determination of priorities for action in a medical emergency. The order was clearly labelled on the door leading to the room. The nurse would test a patient's vitals then hand them a piece of paper with a number written on it.

One could be designated either Priority 1 — emergency patients; Priority 2 — urgent patients; Priority 3 — minor/semi-urgent; or Priority 4 — non-urgent cases.

Another sign on the wall warned, 'patients are seen according to the seriousness of their illness and not on a first-come-first-serve basis'.

At 12:05 pm, 14 persons were still ahead of me. A sense of restlessness pervaded the room and disgruntled patients started voicing their concerns at what, for some, had already been a three-hour wait.

The nurse's aid, who was in and out of the room, heard the whining and explained that emergency cases were being attended to in-between seeing those patients sitting on the benches, resulting in the delay. This quieted the grumbling for a little while.

Compounding their irritation over having to wait so long was the fact that some patients, who had already visited the institution the day before and had blood tests, ultra-sound tests, and X-rays done, had to again sit on the benches, results in hand, in order to see a doctor once again. They complained that this was unfair, as it meant spending two days at the hospital sitting and waiting.

"We already see the doctor and him give you paper to do test," one woman said. "So now that you come collect the result you shouldn't have to wait again, they should have a doctor that you could take the results to when you collect it instead of joining line again."

Amidst the frustrated patients, a 20-something year-old woman complained of severe headaches and dizziness and had to rest her head on her friend's shoulder. She said she had been chopped in the head and had to be rushed to the hospital four days before. She was treated and given a referral by the doctor to have an X-ray done as it was suspected that her skull had been cracked as a result of the blow.

She returned with results in hand that Wednesday when the Sunday Observer was there, but still had to endure long hours in the waiting room before she could get a chance to have a follow-up visit with a doctor.

Another woman said she had a pain in her chest that wouldn't go away. She had visited the hospital the day before and had now returned to pick up the results of an ultrasound. Her fidgeting and intermittent groaning suggested she was in severe pain. She repeatedly expressed her desire to remove her bra, which she felt was making the pain even worse. She, too, had to wait.

Another mother declared that her baby had appendicitis and had started vomiting. Her baby had, in fact, vomited after eating fruits earlier in the day, prompting a hospital orderly to bring out a mop, but still she was forced to wait to be seen.

At 1:55 pm I was finally next in line to enter the triage room. Someone stepped out and I stepped in, only to be informed by the nurse that I would have to wait a while longer as she had not had a break since she got to work that morning and would now be taking one.

I returned to my still-warm spot on the bench. Five minutes later she could be seen exiting the hospital, handbag over her shoulder.

I prepared to see the nurse that would now take over, but it wasn't until 3:15 that another nurse called me in -- over two hours after the departure of the first.

All this time patients were simply sitting and waiting without anyone to attend to them.

"So because dem gone fi lunch we haffi just sit down and wait? The woman beside me asked. "That can't right. So what happen to the next nurse who suppose to take over?"

Some persons, tired of sitting on the hard benches took the opportunity to lay down, lean on friends or put their heads in laps.

After being seen by the nurse I was given triage priority 3 -- minor or semi-urgent then sent to register. I headed for the registration section.

Despite being the only one on the bench waiting to be registered, I sat for 10 minutes before being acknowledged and called to the window by one of three persons behind the glass window.

At exactly 4:00 pm, my name was called over the intercom to be seen by the doctor. After explaining my 'condition' to her, I was given a referral to do an ultra sound and a blood test.

I was told, however, that the ultrasound department was now closed and I would have to return the following morning between the hours of 8:30 am and 10:00 pm to make an appointment for the earliest date. I would also need to return the following day to do the blood test.

I left the hospital at 4:10 pm, some 6 1/2 hours after I got there.

Alwyn Miller, CEO of the hospital, contacted for comment, said the lengthy wait time for patients to be seen by medical personnel is not unique to the Mandeville Hospital, however, it can be reduced if persons with non-urgent cases seek treatment at the health centre.

"Many of the persons who are seen there (hospital) really should be seen in the health centre, (that is) cases that do not classify as emergency for the Accident and Emergency department (A&E). Because ideally the A&E department is for accident cases, gunshot wounds and other such cases. But persons tend to see the hospital as a one-stop place. Hence we have the triage system where persons are screened to determine the order of seriousness in which they should be seen."

Miller said given the limited resources the hospital has to work with, the staff complement is just four medical officers (doctors) working from 8:00 am to 4:00 pm; four, from 4:00 pm to midnight; two, from midnight to 8:00 am and one that overlaps shifts between 12:00 midday and 8:00 pm.

"In going forward we hope to increase officers on the morning shift by one, but we have to look at the human resources and the financial efficiencies," Miller said. "As we go along we want to see how best we can improve on our system."

He explained that each doctor spends an average of 10 to 25 minutes with one patient, depending on their medical condition, with all four doctors combined seeing between 16 to 20 patients per hour.

"When you look at 200 patients, it will take some time to factor in. And while those patients are being seen, if an emergency comes in we have to pull two or three doctors away to see that patient to save a life," he explained.

While unable to say what the specific problem was on the day of the Sunday Observer's visit that caused patients to wait so many hours before being seen by the triage nurse, and why there had been a one hour and 20 minute wait before another nurse took over the shift, Miller said usually there were two triage officers working at one time who are specially trained for the task. Therefore, if one falls ill, or is absent for any reason, only one is left to carry out the tasks. There were times however, when a medical officer would be asked to work in this area.

In an effort to help the process run smoother, Miller said a system was recently introduced at the hospital where persons are sent to move through the crowd to identify those whose health may be deteriorating during the wait. These persons are then ushered into the A&E department.

As for the long waiting period for persons returning with diagnostic test results, Miller said these reviews are done by doctors in the A&E department, so a similar procedure has to be followed.

"When persons return, they have to be registered again because the doctor would want to see the patients docket and make further entries. The docket contains the patient's medical history and the entry from the diagnosis would have to be done."

He said however, the hospital is constantly trying to evaluate and improve. Among these improvements are the introduction of a medical consultant in the A&E department to help speed up diagnoses.

A kidney dialysis treatment facility opened in January and serves a number of persons needing renal treatment, and means they no longer need to visit Kingston, Montego Bay and Spanish Town for this life-saving procedure. Additionally, the Optomology department is rated as one of the best in Jamaica, said the hospital CEO.

A new hospital wing 'Block J' is being built and is expected to be completed by December this year. This will see additional rooms with 20 medical beds for patients needing hospitalisation. Presently there is a shortage of beds with only 30 on the wards.

A nursery is also being built to accommodate 15 additional cots, the hospital presently only has 10.

But while the hospital is trying to play its part in improving services at the institution, Miller said he is appealing to persons with minor ailments such as rashes, cold, minor aches and pains, etc, to seek help at the health centre.

"Persons with those ailments really need to go to the health centre for primary care. That would reduce the number of persons coming to the A&E department and add to the efficiency of the hospital," Miller said.

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