BILLIONS IN BLOOD
Untold financial, psychological cost from violent injuries continue to bleed hospitals, taxpayers
As Jamaicans came to terms with the first case of the novel coronavirus in March 2020, the Kingston Public Hospital’s (KPH) Accident and Emergency Unit – one of the busiest in the country – had up to that time seen 212 gunshot wound victims and 116...
As Jamaicans came to terms with the first case of the novel coronavirus in March 2020, the Kingston Public Hospital’s (KPH) Accident and Emergency Unit – one of the busiest in the country – had up to that time seen 212 gunshot wound victims and 116 persons stabbed in violent attacks since that year started.
By the end of December – when 302 people had died from the COVID-19 virus and after multiple curfews and lockdowns imposed by the Government to curtail the spread – 604 more gunshot victims and 336 more stab victims had been rushed into A&E of the island’s largest trauma hospital.
Fast-forward to 2021. As KPH, like almost all other public hospitals across the island, overflow up to 30 per cent of their capacities from COVID-19 intake, more than 250 gunshot victims and 75 stab victims have so far added more stress to doctors and nurses charged with offering critical care to victims, and janitors mopping up trails of blood left behind by them in the capital city.
The year-on-year increase in gunshot injuries does not even complete the picture, with more than 413 persons injured from motor vehicle accidents since January, and an additional 1,981 persons rushed into KPH’s A&E after motor vehicle collisions last year.
These often unnamed victims make up the ‘others shot and injured’ in police reports on shootings incidents, the lucky few who escaped the island’s bloody tally of 1,301 homicides last year or who have so far remained above ground after attacks that have left close to 400 others dead since January. These from scores of stabbing attacks and a reported 1,280 shooting incidents last year; and more than 352 shooting incidents since 2021, according to police records.
Still, some are not so lucky, dying hours or even days after receiving intensive care.
Burning through resources
Yet, their ordeals bring unending financial and emotional challenges for themselves and their families, the country, and the hospital staff. Woes that cut deeper as the COVID-19 crisis gobbles up oxygen and other physical and human resources at under-pressure public facilities.
Comprising gangbangers and innocent Jamaicans alike, these victims use up well-needed bandages, syringes, beds, and medication, and burn hours into irreplaceable human resources.
They consume operating theatre time and, with COVID-19, have pushed more than 400 persons awaiting elective surgeries on to the back burner, at home and frustrated. This, while taxpayers bear the cost of their ‘free’ medical treatment at institutions like KPH and the Spanish Town and Cornwall Regional hospitals – all located in Jamaica’s most gang-infested police divisions.
“A gunshot wound that goes in and out, hitting no organ, you would apply the regular dressing to it and more than likely the person can be told to go home and get a referral to come back to a clinic. That is if it is in and out and it is very superficial,” explained A&E Nurse Charmaine O’Reilly, who, along with KPH CEO Burknell Stewart, bemoaned the impact of COVID-19 on the facility three weeks ago.
“In that case, you may not use a lot of supplies, but at the same time, a wound can be superficial but it bleeds a lot, or it could bleed a lot but with compression, you can stop the bleeding. Everything is relative and so you can’t really put a cost when talking about treatment,” relayed the nurse, whose years of working in A&E have seen her sifting through truckloads of dead and injured persons during the 2010 west Kingston incursion in which more than 70 were killed.
“You have to be very careful when you talk about wounds because someone might be very critical and they don’t bleed a lot ... . There are several variables. It depends on the location of the wound as well. So everything is relative,” she told The Sunday Gleaner, highlighting the wide spectrum on which gunshot, stab, and chop victims may fall.
“I’ve seen persons with gunshot wounds to the head where the gunshot went through and through and the person was just dressed up and sent home. I’ve also seen persons with a gunshot wound to the head and it takes all the different disciplines based on the trajectory of the bullet. You have the neurosurgeon involved, ENT doctors involved, you have the facial auxiliary doctors involved,” she said, adding that some victims of violent crimes, especially those with multiple gunshot wounds, require long-term treatment and intensive care.
$400,000 a day, 2,000 victims a year
In 2017, then National Security Minister Robert Montague said crime costs Jamaican taxpayers roughly $68 billion per year, quoting World Bank statistics. It costs approximately $400,000 per day to keep a gunshot victim in intensive care, he said, emphasising that Jamaica sees approximately 2,000 gunshot victims per year. With that money, he argued, “We could build some 30 hospitals, furnish them, and staff them.”
That same year, the Mona Geoinformatics Institute and the Violence Prevention Alliance, in a cost-of-care study, indicated that Jamaica spent an estimated $12.6 billion in 2014 to deliver direct and indirect healthcare to persons admitted islandwide with injuries sustained from 25,000 violent-related cases, 13,000 road crashes and 500 cases of attempted suicide.
At the time, findings from the study prompted the call for ‘Type B’ Trauma Units in public hospitals from Professor Trevor McCartney, deputy dean in the Faculty of Medical Sciences at The University of the West Indies, Mona.
“We have to be able to address the issues to understand that not only is it an increased workload on the [hospital] staff, increased emotional stress [and] increased utilisation of resources, but, more importantly, because their injuries require the use of ICUs, persons who have serious illnesses would be unable to readily access their care,” McCartney argued.
Last week, one private medical practitioner explained that treating gunshot wounds can be quite costly, a realisation made more vivid if treatment is examined through the scope of private healthcare.
“To deal with certain gunshot wounds, you need what is called a trauma series,” explained the doctor, who has also worked in the public hospitals. “We’re talking about multiple X-rays to locate bullets and damage. These can cost around $20,000 each. Abdominal and irregular chest CAT scans can also cost $20,000 each, and an ultrasound to rule out blood vessel injuries is about $10,000. These are the basics. Individual patients may require other procedures,” he continued, adding that disability and long-term treatment also add to lifetime expenses.
In the meantime, O’Reilly highlighted another set of costs involved with treating patients of violent trauma – that of the psychological impact on hospital staff, who no amount of training can fully prepare for the A&E front line.
“We don’t look at what it does to the security guard who first sees this injured or dead person, the porter who has to go out there for the body,” she frowned. “[Nobody sees] what it does to the janitor who has to go out there and clean up all that blood. We can’t send bloody persons to X-ray, so who looks at what it does to the nurse who is doing the mopping up, and the doctors?” she asked.
“It is costing the country financially, but it is also costing us psychologically because it is like a revolving door. Today can be a lovely day with no cases, but remember you saw the trauma last week or last year, or in 2010, May, when the trucks came in with the persons from Tivoli [Gardens] and we had both men who were alive and dead man in there,” said O’Reilly.
“There are persons who you would normally care for in A&E – the asthmatics and so on – and you identify [dead] patients who you would have seen and treated before ... . No amount of training can prepare staff members for that, and remember we all deal with trauma differently,” she continued, noting that counselling is offered to staff upon request.
Last week, one female doctor, after years of working in A&E, told The Sunday Gleaner: “I think I’m desensitised to victims with gunshot wounds. Only injured children move me at this point.”