The Ministry of Health (MoH) has stated its disapproval with the view that government spending on several new medical institutions around the country may be a case of unnecessary and questionable expenditure, and is being done at the expense of health workers.
In a release yesterday, the MoH, interpreted the Stabroek News editorial of Thursday, January 11, as a rejection of the government’s investment in improving the physical and technological infrastructure of the hospital network, saying that it was “disappointing.”
The editorial focussed on two medical facilities, the New Amsterdam General Hospital (NAH), and the Suddie Public Hospital and put forth the argument (in the case of the NAH) that while “there is dire need for modern, affordable, and satisfactory healthcare in Guyana, which includes buildings with the necessary facilities,” there is already a New Amsterdam Hospital which was opened as a brand new institution in February 2005. And to support the argument, it was noted that “universally, hospitals are built to last at least 30 years before requiring renovations.”
Regarding the Suddie Public Hospital, the editorial reminded that in September 2021, President Ali had turned the sod for the construction of a $2 billion, multi-specialty, 250-bed hospital at Suddie, in Region Two, which was said to be slated for completion last year. This, it pointed out, was despite the fact that in 2018, the Granger administration had spent $40.9 million building a new operation theatre at the existing Suddie Public Hospital.
The editorial then went on to observe that when one does the math, a “ton of money” is being spent on hospital buildings and that questions need to be asked and answered, because “something just doesn’t add up.” It contended that when one talks to the people or just looks at what is provided, “there does not appear to be any concomitant improvement in healthcare.” It added, “Of course, one reason is that insufficient attention is being paid to the needs and working conditions of medical workers, specifically nurses, but also attendants, cleaners and others on the lower rungs of the ladder whose services are essential to keeping hospital doors open. If things don’t change in this area, everything being touted above apart from squandering money is purely an exercise in futility.”
In response to these assertions, the MoH chose to respond to the infrastructure criticism as one issue, and the working conditions of medical workers as another.
It began by examining the Editorial’s query of the need to build a new hospital in New Amsterdam and stated that the government’s plan to build a new hospital in New Amsterdam was announced early in 2023. Funding was secured and government signed a contract with a “renowned” Austrian company, VAMED, in the last quarter of 2023. Further, the land has been cleared and handed over to VAMED while first drafts of the preliminary design of the new 24,000 square meter hospital complex have been completed and the MoH and VAMED are presently engaged in completing the design.
The release went on to describe the facility. It stated that the 230- bed Level-5 hospital will have five operating theatres (OR), including a dedicated C-Section OR, and a dedicated laparoscopy OR. There will be a catheterization laboratory for cardiac interventions such as stenting and angiograms. In addition, there will be a dedicated endoscopy room, a 12-bed ICU (Intensive Care Unit) and an 11-space NICU (Neo-Natal Intensive Care Unit). The hospital will have an advanced imaging diagnostic center with a 1.5 Tesla MRI, a dual 128 slice CT, digital C-Arms and X-Rays, an Echocardiogram.
Transformation
The argument was made that as a result of the economic transformation taking place in Region Six, the government has recognised the need for a Level-5 hospital in the region. It pointed out that the present Level-4 New Amsterdam Hospital, with three ORs, has proven inadequate for the existing staff. Presently, most of the surgical staff are limited in performing surgery because of a shortage of OR time and because the ORs are not appropriate for the complex surgeries the staff has capacity for. Further, although there is a team of surgeons with laparoscopic skills, the present OR limits the application of laparoscopy and complex orthopedic and neurosurgery presently cannot be done at the NAH.
The release also pointed out other treatment limitations faced by the institution. It noted that while there is a competent cardiologist at the hospital, she is limited by the lack of diagnostic capacity and interventional treatment options. While there is now dialysis, the 11-chair facility is inadequate. Chemotherapy is limited by space. Obstetrics and gynecology options are also limited. The laboratory and imaging diagnostic capacities restrict clinical options and it is impossible to extend these areas, without relocation into additional buildings. While there is now a NICU, it is limited to 4 spaces. The ICU is only a 3-bed ICU. The present NAH out-patient area and facilities, the ER, the pharmacy area are outdated, uncomfortable and cannot sustain the present volume of patients. Overall, the hospital has 134 beds. It added, “There are other myriad limitations to expand clinical services with the present physical and technological infrastructure.”
Further, the MEP (Mechanical, Electrical and Plumbing) design of the present facility does not permit easy and affordable transformation of the facility to permit the practice of new clinical services and to permit a more comfortable environment.
Original
The original plan of the President Irfaan Ali’s administration, the release continued, was to upgrade the existing facility as part of the present $US97 million IDB loan. But an assessment of work to be done to upgrade the facility to address the MEP design inadequacies, the transformation from a Level-4 to a Level-5 facility, and to cater for an expanded menu of clinical interventions and the increased number of patients, revealed that a new hospital had to be constructed.
Concerning the Editorial’s contention that the present NAH which was commissioned in 2005, (only twenty years ago) with the implication that there was no need to build a new hospital as the government had invested much resources in the present hospital as well as the fact the Granger government had invested a considerable sum in 2018 to construct a new maternity wing, the MoH pointed out that initially, the Granger government had invested almost $200 million to construct a new ob-gyn building to include three new ORs and new maternity wards. By August 2020 when President Ali was sworn in more than $300 million was expended. Construction was incomplete and the new government was stuck with a poorly-designed incomplete building that it had to invest more money into in order to make it useable. Basically, outside of a questionable foundation, the building was only walls and the OR area was poorly designed and would have been difficult to operationalise without extensive modifications. Outside of having supporting pillars badly positioned in the middle of each of the OR rooms, there was no provision for separation of clean and dirty spaces. “Clearly, while the building can be re-purposed, for example, to serve as regular wards, it is inappropriate for the purpose it was constructed for. It is one more of the many infrastructure investments made by the then APNU+AFC Government that constitute bad governance and malfeasance.”
The MoH then moved to the Editorial’s mention of the $41 million investment made by the present government in 2021-2022 to establish a 15-bed Infectious Disease Unit. An investment, it argued, that was sorely needed at the time as the COVID-19 pandemic was raging. It was further argued that it would have been “reckless” not to invest in a facility to house the increasing number of very ill-people who were infected with COVID-19 in that period. The release then accused the APNU+AFC of not catering for COVID-19 in Region Six or anywhere in Guyana. Further, it made the claim that in Region Six, the APNU+AFC merely utilised a rented house to locate COVID-19 patients and that there was no ventilator-supported ICU and no life-saving equipment to support clinical care for patients, prompting the remark that “The negligence during the March to August 2020 period was genuinely a criminal act.”
The release observed that the Editorial had queried the need for the construction of a modern hospital in Region 2, citing the Granger administration’s investment of $41 million for the construction of a new OR at Suddie Hospital and had this to say. In its haste to criticize investments in health [the Editorial]… failed to mention that the so-called new OR was never completed, never purposed for an OR, was leaking and never designed to function as an OR.
“In fact, the Frank Anthony-led MoH has invested to remove the deficiencies and convert the space into a new NICU, the first time Suddie will have an equipped and functioning NICU, commissioned by the Minister on January 12, 2024.”
The MoH noted that several other regions were deserving of upgraded facilities. According to the release, the people of regions Five and Six deserve a Level-5 hospital. The people of Region Two deserve a new Regional Hospital in the Anna Regina area to add to the facility at Suddie. In addition to the six regional (Level 4) hospitals being constructed in Lima (Region Two), De Kinderen (Region Three), Diamond and Enmore (Region Four), Bath (Region Five) and Number 75 (Region Six), construction will soon begin for new hospitals in Bartica, Lethem, Moruka, Kato and Kamarang. The six regional hospitals are due to be commissioned between December 2024 and March 2025. Lethem, Kato, Moruka, Kamarang, and Bartica, are due to be completed before the end of 2025 and first half of 2026. Other hospitals, such as Mahdia, West Demerara, Kwakwani, and Linden, are also in the plans for upgrading and reconstruction.
The release assured that all the aforementioned hospitals will be properly equipped with fully functional operating rooms, fully equipped critical-care departments such as ICUs and NICUs, fully-equipped laboratories, fully equipped radiology departments, with all six regional hospitals, Lethem and Bartica, equipped with CTs. All these hospitals will have telemedicine and digital health technology, and to support the modernisation and improved standard, a fully deployed, first-world electronic medical health record system will be in place by first quarter of 2025.
It said that with more than 300 specialist doctors now working in the public health sector, ensuring that more complicated medicine can be practiced, all hospitals require upgrading. It explained that for the first time, with regard to specialized doctors, it is possible to genuinely meet the standards for Level 4 facilities. Level 4 facilities should be capable of high-quality critical care for ICU, NICU, SICU (surgical intensive care unit), and PICU (pediatric intensive care unit). ERs with trauma-care capacity is now possible, in terms of critical-care doctors. However, it noted that none of the existing hospitals were designed to support fully functional Level 4 or 5 hospitals and while New Amsterdam was only commissioned in 2005, its design was based on hospitals more suited for Level 3. Meanwhile, Suddie is about 100 years old and cannot serve as a fully functional Level 4 facility, housing a CT and with dedicated ORs for certain surgical interventions.
As such, the MoH pointed out, all Level 4 hospitals require an MEP design that is far more advanced than the present MEP capacity in existing hospitals, and it listed the shortcomings. 1) None of the hospitals have HVAC system. 2) The electrical system cannot support modern medicine equipment and technology. 3) The plumbing system cannot support the Infection Prevention and Control needs of a Level 4 or Level 5 hospital. 5) None of the existing hospitals, even with rehabilitation and extension can support the addition of the technology and services required for Level 4 and 5 facilities.
Further, prior to 2015, the resources available did not permit an “aggressive movement” to upgrade physical and technology infrastructure. However, now that more resources are available, Guyana is moving rapidly to ensure a hospital infrastructure that permits the country to genuinely operationalise Level 4 and Level 5 hospitals. As such the MoH outlined it plans for the necessary upgrades. Twelve hospitals are already funded for reconstruction, with all of them either in design stages or construction has already begun. Other hospitals such as fully operationalizing Level 4 at the Linden Hospital by upgrading both the physical and technological infrastructure are in the works. A new GPH is being discussed and a new West Demerara hospital as well as upgraded hospitals in Kwakwani and Mahdia are also on the agenda. A new pathology laboratory is being operationalised and should be commissioned in February, 2024. Two new Allied Health Schools will begin construction in a few weeks.
