Fixing health: Remedying the terrible hospital situations
There are 24 public hospitals and 330 health centres and the University Hospital of the West Indies (funded by the regional governments) and 10 private hospitals. The public sector hospitals account for 5,000 hospital beds, for a population of 2.7 million.
Hospitals are classified as A, B and C, based on their bed capacities, coupled with the services offered.
The demography of the Jamaican population has changed since these hospitals were constructed. Some of these facilities have been constructed from as far back as 200 years ago with little or no upgrading.
The epidemiological profile of the population has also changed from the communicable diseases to non-communicable diseases (NCDs) (hypertension, diabetes, cancers) and trauma, whether from motor vehicle accidents, gunshot wounds or domestic violence.
ER TURNED INTO WARDS
With urbanisation in many of our rural towns, the bed capacities of these institutions can no longer manage the population which they serve.
For example, the Spanish Town Hospital has increased the services, while the bed capacity remains the same, with the exception of beds being placed in the passage and verandas being converted to a ward. This institution functions as a Type A hospital.
This is not unique to Spanish Town, as the May Pen Hospital and the Mandeville Regional Hospital are in a similar situation. The resultant being, patients are housed in the Emergency Rooms (ER) for up to one week before a bed becomes available on the admitting ward. Hence, the ERs are converted to wards, housing up to 33 patients. This is now a new phenomenon in many of our public hospitals.
This situation provides an additional strain on the nursing staff and the Directors of Nursing Services (DNS) in trying to staff these areas to ensure quality care is given despite the circumstances. This lends itself to frustration from the clients and sometimes volatile situations directed at the staff, which further complicates the process.
SERIOUS BED REVIEW NEEDED
The Ministry of Health needs to seriously review the bed capacities of these hospitals based on the population and the profile of the parishes these hospitals serve.
For instance, the parish of St. Ann was upgraded to being the largest parish. The hospital, however, was not upgraded, even though they have added specialist services, for example, orthopaedics.
The parish of St. Ann is also renowned for having some serious motor vehicle accidents. With this in mind, coupled with the NCDs, a High Dependency Unit (HDU) was added, which saw up to 120 patients being admitted for a 12-month period.
The patient load at most of our public hospitals, despite the classification of illnesses remains overwhelming for both the staff and patients. In most cases, persons who are seeking services at our public health facilities need proper assessment to determine the level of treatment necessary and sometimes there is need for admission.
There is no guarantee that the patient will get a bed when admission becomes necessary. It sometimes means sitting in a wheelchair or lying on a gurney for two to three days or weeks, or in the case of patients at the Black River Hospital, until a bed space become available.
As a nation, what can we do to remedy this situation that exists within our hospitals?
PENNY WISE AND POUND FOOLISH
We speak to ‘Primary Care Renewal’, but do we as a nation understand this concept? We hear of ‘Centres of Excellence’. Having erected these centres, what's next?
There is dire need for the education of our people on the use of the health centres, all 330, and not just these centres. The key to the success of primary care renewal is education.
Education on the NCDs (hypertension, diabetes) and the use of our health centres, inclusive of the types and the services offered, needs to be clear.
The Type 1 Health Centre should be upgraded to include more services, with an increase in the services based on the population which they serve. This will result in off-loading of the patients from the hospitals.
Another factor that needs much consideration and thought process is the utilisation of our Family Nurse Practitioners (FNP) in follow up care after discharge from hospitals. This would significantly reduce the re-admission of patients to hospital. This is supported by a study conducted by McFarlane et. al., where re-admission to hospital saw a significant reduction following intervention by these FNP due to follow-up at home of these patients. This intervention facilitated compliance with medication and appointments.
As a country, we sometimes have the resources but under-utilisation of the resources compromise patient care, that is, being penny wise and pound foolish. Our FNPs are highly trained and skilled in delivering care, however, they are suppressed in carrying out the duties that they are so ably trained to do.
The government of the day needs to look seriously at the changing demography and the epidemiological profile of the population and the resources that are available to deliver quality care to the populace.
Our nurses are innovative and nation builders. As a country, we may need to adapt some systems with some adjustment from some of our developed countries. There needs to be greater involvement of the hospital social workers and non-governmental organisations in the management of our in-patients. The social worker would assist in the reduction of the number of patients who are social cases, and who in some cases occupy hospital beds needed for ill patients.
There is greater need for collaboration between the Ministry of Health and all stakeholders, in examining the logistics in ensuring that everyone in this country has access to care-effective and cost-effective health care.
There is urgent need for speedy solutions to the health problems in Jamaica land we love.