Following severe criticism of conditions at the Skeldon Hospital, the Ministry of Health (MOH) yesterday said it is working to place more nurses at the facility with two additional doctors placed at the location as of Friday.
The ministry’s response came eight days after a scathing letter from Jan Khan about conditions at the hospital and a September 25th editorial in Stabroek News.
Weeks earlier, on September 7th , the Regional Democratic Council of Region Six was informed that there was a shortage of doctors, nurses and even medication at the Skeldon Public Hospital.
Khan in a letter of September 22 to Stabroek News said, “My sister was a bed-ridden critical-care patient at this hospital and my siblings and I visited her for one week at the end of July to the beginning August 2023. She would eventually die at this institution on August 23rd, For the sake of the downtrodden in Skeldon, I believe it is my responsibility to bring the following issues to the attention of the public in the hope of prompt and effective resolution.”
Pointing out that the Skeldon Hospital has been an essential healthcare institution serving the residents of the region for many years, Khan said that the current state of the hospital is nothing short of “deplorable, and the deteriorating conditions are causing immense suffering and endangering the lives of the patients who depend on its services.”
According to the letter writer, some of the issues they witnessed and experienced include a shortage of doctors and nurses, poor doctor communication/attitude, atrocious patient care, no dignity for patients, poor sanitation, lack of proper patient conveyance, lack of equipment and supplies, lack of potable water and fear of victimization.
The Ministry of Health in the release yesterday said that in the case of the staffing at Skeldon Hospital, the Region 6 Health Department and the Ministry of Health have been on record admitting that staff improvement is a priority for this hospital explaining that in August 2020, the Skeldon Hospital had three doctors assigned, covering the hospital and nine health centres, including Orealla and Siparuta. There are presently seven doctors assigned to the Skeldon Hospital, including two Cuban doctors and five Guyanese GMOs.
However, it added, that “as of September 29, two additional doctors have been assigned to the Skeldon Hospital. In addition, a doctor has been assigned for resident duty in Orealla and Siparuta. The improvement in staffing have resulted in an increase in patient load from 17,800 in 2020 to 29,000 in 2022 and estimated to surpass 30,000 in 2023. The ER department is estimated to see more than 12,000 in 2023, the highest number ever. From zero ultrasound in 2020, the hospital now performs almost 3,000 ultrasound per year. From less than 100,000 prescription filled in 2020, the hospital filled almost 116,000 prescriptions in 2022.”
The MOH is working with the Regional Health Officer of Region 6 and with the hospital management to ensure better rostering of doctors, the release added.
“It is no secret that Skeldon Hospital is affected by the overall nursing shortage in Guyana, a challenge that every country appears to be enduring at this time. The 25 nurses that are assigned to the Skeldon Hospital needs to be increased and the MOH is presently addressing this matter. This matter is compounded by no-notice absenteeism, a problem we are trying to solve.”
Meanwhile, in terms of medication and medical supplies, according to the statement the hospital’s reporting and the MOH’s monitoring show that the hospital maintains an availability rate of between 85 and 95%.
Furthermore, they said that reports from all hospitals show a rate of availability of 82% (Pakera Hospital) to 99% (Mahdia Hospital). “While we have to strive for 100% every time, the situation has improved dramatically from August 2020 when the hospital maintained an availability rate of less than 35%.”
In the September 25th editorial in Stabroek News, the case of a young woman who had recently faced disrespect and mistreatment at the Georgetown Public Hospital (GPH) – the country’s main public health facility was referred to. In her own words, published in the weekly “Women’s Chronicles” column in the Sunday Stabroek, the young woman related the harrowing circumstances she endured in late August when she was admitted for what should have been a routine laparoscopic procedure to remove ovarian cysts.
The editorial added, that “Among the questionable care decisions was the hospital switching at the last moment from a minimally invasive to an open procedure. In the main, the behaviour of the nurses in the maternity surgical ward ranged from dismissive to callous.
The young woman opined: “… I believe that a lot of patients’ deaths are not caused by the procedures they undergo but rather by the lack of proper aftercare from the nurses in charge. While I understand that wages may not be attractive, nurses have taken an oath to care for patients…”
“This is but one of the testimonies of the heartless and unprofessional treatment meted out to patients. Also to be navigated by patients are the unsanitary and understaffed facilities, misdiagnosis and incorrect application of potent medicines”, the editorial said.
Not a pleasant one
Furthermore, the editorial pointed out that on September 7th, APNU councillor Shurla Scott at the statutory meeting of the Region Six Council, stated that her first-hand experience at the Skeldon Hospital was not a pleasant one after she visited a patient at the hospital.
“The first thing I noticed is that there was no medical supervision there in the night at Skeldon Hospital… I remember standing here enquiring about Skeldon Hospital as it relates to staffing and this council was informed that there was enough staffing at Skeldon Hospital especially with the doctors”, she related.
Scott said, that she was present at the hospital for four days for visiting hours, “And I saw two Guyanese doctors for those four days consecutively and two Cuban doctors… The very patient was prepped to be transferred because there was no supervision.”
According to Scott, there was also a recommendation in the patient’s chart to have an ultrasound done but it was day four and this had still not been carried out.
She said that on enquiring with the sister in charge at the hospital she was told that she was “frustrated because nothing is being done, all of the reports that is coming from Skeldon to the region is falling on deaf ears…Shortages of staff, nurses, shortages of doctors, medication… And …that very patient was expected to have medication at 6 am, I was there, and the patient received her medication until 9 am… because I intervened that patient was transferred.”
Scott said although the patient was prepped and awaiting transfer this was done only four hours later despite the ambulance being present at the institution.
“When I enquired why, I was told the doctor was on lunch, I was told the doctor has to eat, of course I agree with that but this is one doctor that has been working since the morning… I was told that the Cuban doctors have limited medical functioning because there are certain things they can’t do… They can’t send charts, they can’t write up X, they can’t do Y”, she said.
Scott said that she was finally able to meet with the doctor responsible for the patient around 2:30 pm. He “was literally walking around with a resignation so I proceeded to speak to the doctor as well, it was the very thing I received from the sister in charge… Nurses are not around, no nurses in the night, ten-day (part-time) workers are supervising wards, there is one nurse running the emergency female and the male wards, that is the reality on the ground”, she told the chair of the council.
The editorial added, that the horror stories continued this time at the West Demerara Regional Hospital (WDRH). Five-year-old Jai-Devi Gurdyal passed away after allegedly being administered an overdose of asthma medication. “Her mother spoke of the crude and humiliating manner in which she was treated even as her child lay mortally ill. This case requires an immediate investigation to determine whether there was malpractice here and the matter should be taken up by the Medical Council of Guyana.”
Drastically
In responding to the editorial, however, the Ministry of Health in the release yesterday said that the health sector’s performance has drastically improved over the last three years, however, it conceded that there are some areas of concern that still plague the sector and the Ministry is making earnest efforts to address these.
According to the statement, a number of sweeping statements condemning care overall in the health sector were made in the Stabroek News in an editorial on September 25 and the ministry “unequivocally rejects this notion.”
The statement said: “One of the repeated statements made in the editorial is that whenever complaints are made about alleged poor and inappropriate treatment in public sector hospitals, the Ministry of Health or other relevant health authorities completely ignore these complaints and repeatedly fail to respond. This is not accurate. While making this charge of non-responsiveness, the same editorial also opined that `the authorities are quite good at convening investigations’. Indeed, in every instance, the MOH and/or other relevant public health sector authorities investigate the cases. As far as possible, findings are made known to the public. Every case is investigated. Stabroek News is unfair in concluding that the authorities are guilty of `waiting the public out in the hope that the affected families settle or simply give up’”.
Hotline
According to the Ministry, one of the challenges the sector has been addressing over the years is the institutionalization of patient-friendly services. “While significant improvement has been achieved, the sector continues to be challenged by inappropriate behaviour by a small number of staff members. For this reason, the MOH and the government have established a hotline which became operational in April 2023. The number is 227 4357. Since the inception of this national hotline, there have been 77 complaints, with 65 addressed and 12 pending. Similarly, the GPHC has several hotlines for complaints which operate 24 hours and complaints are immediately sent to the CEO, the Director of Medical and Professional Services and the Director of Nursing for action. The numbers at the GPHC are 226-6249, 227-8210, 227-8241, 227-8245 (Extension 1148) and 701-4742 (What’s App). We urge that persons utilize these numbers to let us know of problems they encounter in the health sector. In addition, the GPHC has an office by the entrance painted bright orange for in-person complaints concerns”, the ministry release said.
It said that while it would see some complaints in social media and sometimes in the printed media, “none of these ever has been the subject of a call to the hotline. The Minister of Health has instructed that a monthly report on hotline complaints and actions taken must be made public as of November 2023.”
Touching on the incident reported at the West Demerara Hospital with the asthmatic child, the Ministry said that it has been investigated by a high-level team and the Chief Medical Officer’s report has been presented to the Minister. “This report, like others, will be released to the public as soon as the Ministry has reviewed it. The WDRH had issued a statement of clarification immediately after the complaints were made.” No statement was ever issued by the WDRH to Stabroek News or the family on the case in question.
Furthermore, the ministry said that it should be noted that in spite of continued challenges improvement have been made.
“Medicine and medical supplies have improved from 32% availability in 2020 to 90% presently. Referrals from WDRH has reduced by 87% over the referrals from 2020. Since the beginning of 2023, the WDRH has been playing a positive role in assisting GPHC to manage critical care babies, given the heavy load that GPHC presently carries. Often the NICU at GPHC cannot accommodate additional critical care babies since the NICU is more than 100% occupied. Presently, the WDRH manages between 20 and 30 critical care neonates per month. WDRH has been ably assisting to take off the load from GPHC”, the ministry release said.
Shortcomings
In the meanwhile, recognizing a number of shortcomings at the West Demerara Hospital, changes are being made to address the concerns, the ministry noted adding that a number of practices that affect quality at the hospital have been discontinued.
“The incident referred to at the GPHC was the subject of a public statement by the GPHC.A thorough investigation is being conducted and the report will be made public. In the meantime, closer monitoring is being implemented to patient-friendly service is experienced by all patients and their families.”
It was stressed that while the Ministry stands by its statement that services have significantly improved, “the MOH concedes that it has concerns about poor attitudes of a small number of staff members. The MOH concedes that there is vast room for improvement in communication and steps have been taken to improve how we communicate with patients and their families. Our goal is to provide a patient-friendly service across the health sector. The MOH has prioritized patient and family experience in the sector for improvement.”
