Those eventful visits to KPH, Spanish Town Hospital

Sunday Observer reporter details drama, pain and agony

BY KIMBERLEY HIBBERT Sunday Observer staff reporter hibbertk@jamaicaobserver.com

Saturday, January 03, 2015

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WHEELCHAIR-BOUND Peter is no different from any other citizen, but on December 22, last year, while awaiting treatment
at Kingston Public Hospital (KPH), he experienced discrimination.

Around 6:46 pm, Peter felt the need to use the restroom and asked for assistance from the porter on duty by the screening nurse. But, the porter didn't assist him.

"Weh you waan go ina the bathroom fa? You no have pee pee bag on you?" the porter said, obviously annoyed.

Peter in his defence tried to justify his reason and said: "It block up [the bag was filled to capacity] Please I'm asking you to assist me."

The porter, then opened the door for Peter, then walked away from his post and outside of the accident and emergency building. When Peter was through and wanted to return to the waiting area he had to call from behind the bathroom door, and a patient who witnessed the incident walked to his assistance.

Despite horror stories and countless reviews of the public health system in Jamaica, patients still face the brunt of a sick system.

On the same day, I journeyed to the KPH armed with a referral letter and entered the accident and emergency department seeking treatment for what the letter suggested was appendicitis.

The letter read: "Please see the above named patient who has been complaining of lower abdominal pain and vomiting x 1/7. She has
no chronic illnesses. On examination her vital signs were normal and she was found to be well looking but
in painful distress. She was found to have lower abdominal pain with guarding and rebound. She is diagnosed as appendicitis and is referred for further management. Thank you."

This was approximately 5:30 pm. I saw a nurse and the regular routine checks were done. But, when I was told to pass urine in the bathroom my fears were soon realised as there was no tissue paper or soap in sight. When I inquired, I was told to "drip dry" and asked if I didn't have wipes or hand sanitiser.

Waiting to see the triage doctor was the next round. Although I waited for roughly 15 to 20 minutes, a few patients made conversation and told of their experiences.

One man shared his ordeal about receiving health care.

"The fuss mistake mi mek was to come out or mek dem release mi and mi no get better, 'cause now a problem fi get look after," he said.

"The last time mi come here mi wait so till dung deh so lock up (point of entry), up deh so lock up, man come in a bawl out woii, blood a leak from people, and all a wi sit down out here waiting. A pure foolishness go on down here so," he said.

The young man, while complaining of not having something to eat, a loss of appetite, and being affected by the air conditioning, however, commended the efficiency of the doctors on the wards.

"Anytime you fi get injection dem ever deh pan time, but some a dem, you just have to shake your head," he said with reference to the way some staff members have dealt with him.

By this time I saw the triage doctor, was registered and sat waiting to be called to the emergency room. The stories continued, and Yvette was another patient who felt as if she was being bypassed or ignored.

"ie deh ya from one o'clock and all now me cyaa see a doctor, and if I'm here and walk outside and my name is called, they're going to say I'm not here," she said.

"About four time in here full and everybody gone lef mi, I didn't know I was to see the screening doctor and then register. I sat here, no one told me anything or what to do. Mi just siddung here," Yvette recounted.

A roving nurse who overheard her conversation intervened on her behalf.

"Yuh sure you've been here this long? I will check to see if you were registered and if your name is around there [emergency room]," the nurse said.

Shortly after, the nurse returned and informed Yvette that she was to proceed to the emergency room. In approximately 45 minutes she was seen being transported in a wheelchair by a porter to the ward.

While I waited, a number of incidents unfolded, which included fights and even the receptionist and security guard assuming the role of doctors -- giving advice on medication to a man.

The man, whose name is unknown, had returned to the hospital with a relative who was treated earlier in the day and released. He returned out of concern for the relative, whom he said was not responding to the medication.

The receptionist said: "You think the medication is magic? You have to give it time to work."

The security officer, on the other hand, said: "Sometime me wonder weh some a dem people yah tek KPH for. The man come with the woman this morning and expect miracle already."

But the man, in a bid to justify why he brought her back said: "She not lying down and when I try to lift her on the bed her body got heavy and changed colour and she left here in good health."

The security retorted, "She leave here a sick person." However, the triage doctor took a second look and sent her to the emergency room.

The saying the devil finds work for idle hands was proved while waiting. This time a man, and a woman he referred to as his "babymother" got into a quarrel over a missing $1,000 note. In the woman's defence, another patient openly scolded the man for how he addressed his babymother, but when the truth was spoken, the babymother turned against her defender saying "she should mind her own business". A fight ensued, which saw nurses and the triage doctor running from their posts to the entrance of the accident and emergency department to get a first-hand look. Unfortunately, I never witnessed it, as I was summoned to the emergency room.

At approximately 7:12 pm I saw a Dr Henry (woman), who examined me. But while waiting, other doctors were in a frenzy as they had admitted a patient who needed to do an ECG. But, they received no response via telephone from the department, which closed at 9:00 pm.

After I was examined and told to sit and wait for a blood test, I realised that there were not enough seats for everyone who was in the emergency room. I counted six people standing and I soon joined them as the roving nurse asked me to stand and allow an elderly man to sit.

Spanish Town General Hospital was slightly different, as for the most part the conditions were the same and even worse.

I arrived there on January 2, at approximately 11:15 am, but this time I went to the casualty section -- with no referral letter. The receptionist took my name and I sat and waited to be screened. To be screened was not the problem, however, as I complained of having abdominal pains I was coded 'blue' -- not urgent -- and told to register.

Dr Alfred Dawes, president of the Jamaica Medical Doctors Association, explained that when patients are screened, they are assigned one of three codes depending on how life threatening or serious their injuries or symptoms are.

"The codes are red, green and blue. The reds are usually seen right away and are given to persons who were in serious accidents, experience trauma, wounds, head injuries, chest pain, stroke, stab to the belly, chest or neck. These and also the abdominal area are high priority areas," he said.

"The green codes usually go for vague abdominal pains, gastritis, and appendicitis. The blues are for common illnesses such as cough and cold, rash, STIs and back pains," Dawes said.

Concerning me being given code blue for abdominal pains were concerned, Dawes explained that it's risky to wait, but new research has shown that persons presented with appendicitis do not have to be sent to the operating room immediately, and a delay of up to 24 hours will not significantly affect the outcome.

While trying to figure out where I should register I became confused as I didn't know where the registration area was. When I asked the security officer to whom I was directed, her response was "gwaan dung deh so go wait". This was when I realised that I had to join a queue and wait while one person did the registration, as opposed to my experience at KPH where I walked up to the window and was registered in a short period of time.

One woman, whose child had an asthma attack in the morning at about 7:00 am, had a bad experience with the same security. After 'stealing' time from work to attend to the child, she went up to the security asking if the child could bypass a few patients waiting and get registered as she had to return to work.

The security responded: "No bring you mouth to me, go and sit and wait like everyone else. Mi no ina no long argument with no patient, sit and wait with the child."

But, the mother tried explaining her situation and said: "A thief mi thief off a work an come cause me hear dem [her children] down here." However, the security would not be moved and said: "A true you waa go weh mek you a say that. If you were a good mother you would sit down with the child."

At this point the mother walked away but the security still argued.

"The pickney have asthma and if the pickney dead pan her she couldn't even bury her. No bada come ramp wid me, because mi nah no sense when me ready [indicating she had the potential to be vile]. Here is a waiting place, when you come here you wait. If she was a good mother she siddung and keep her ass quiet and wait."

However, with more pleading the mother was allowed to register the child and leave.

It was after I had been registered, had my vitals checked, and was examined, that the strain the hospital faced came to the fore. Like KPH, however there was no tissue or soap in the bathroom. Unlike KPH, I was seen immediately as the doctor peered above her glasses and decided to just examine me since I was already in the emergency room. Also, whereas I did the pregnancy test at KPH for no cost, I had to purchase the kit for $300 at Spanish Town. I was also required to pay $5,000 for an ultrasound examination to determine if I was indeed having appendicitis, which raises questions on the issue of free health care. I did not do the
ultrasound exam.

While in the examination room waiting on the doctor I realised she was taking more than the average time to come to me. However, she explained that it was because of a lack of equipment.

"I'm sorry for the wait, I'm trying to examine you, but I don't have the equipment," she said. She continued, -- seemingly to herself -- "How can I work without equipment? I can't understand how an emergency room has no speculum [a medical tool used to dilate an orifice for examination]," she said.

Another doctor who was on duty at the time also complained "We can't even do an ECG exam, many times we buy the equipment needed for surgery and certain other medical examinations, yet when anything goes wrong we are the first ones to blame. No one sees that the system is really broken."

The 2013 to 2014 net total budget for the Ministry of Health is $32,166,828 billion. Of that figure, the South East Regional Health Authority received $200 million for building and equipment and $9,657,027 billion for the delivery of health services. Of the net total budget, $1,987,400 billion was allocated to the maintenance and upgrade of health facilities. It was broken down so that the health services and improvement programme would receive $1,633,000 billion, while $290,400 million would go to the purchasing of medical equipment. There was a slot for repairs to the Bellevue Hospital, but no funds were allocated for that.

After I was examined I opted to sign myself out and leave the hospital to seek treatment elsewhere. But, when leaving some patients still complained of having to wait too long.

When asked what could contribute to the long wait some patients experienced, Dawes said that the waiting time often increases because of staffing or patients overestimating the seriousness of their symptoms.

"Some shifts are worse than others, where doctors operate with 25 per cent of the staff complement. Anything can happen and people can call in sick. Sometimes there's only one nurse working when you're suppose to have two or four," he said.

"On the other hand, some things that patients come to the hospital with can be treated at a clinic, but patients think they get better treatment at the hospital versus the clinic and will come to the hospital with a flu or a urinary tract infection and end up waiting for hours," Dawes explained.

He further appealed to patients to understand the codes and be patient as the emergency staff tries to see a significant number of patients in time, despite the staff shortage.

With regard to poor customer service that patients may receive, he said an ethics conference will be held on January 18 to address the issue and reinforce the need for health care workers to display attributes of good customer service.

 


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