Garth Rattray | Chronic paucity of hospital beds

Some memories are so stark and so painful that, no matter how much time has passed, they never go away. Several decades ago, Janet (not her real name) came to see me urgently. She was experiencing the most severe headache that she had ever had in her life. I sent her to the University Hospital of the West Indies (UHWI) Casualty Department.

She was diagnosed with a bleed from a brain aneurysm. She was a wonderful human being in her mid-30s and the mother of two little boys. In those days, I could visit her on the ward, and she expressed her deep concern that ‘they’ were going to let her die from the aneurysm, just like a good friend of hers had within the past year. Incidentally, that friend of hers also saw me as her family physician.

All the necessary parameters were satisfactory for the neurosurgical team to fix her life-threatening problem, but the ICU was understaffed, so no beds were available at that time.

I consoled Janet and assured her that I had total confidence in the hospital and that they would never allow her to die because they could handle this. However, the delay was inordinate, Janet languished on the ward, re-bled and died. You can only imagine my distress and grief. For the want of a staffed bed, that wonderful human being suffered and died.

Not long ago, one morning, I received a call from a gentleman who saw me as his physician. He had a visiting friend who went to one of our private emergency rooms with abdominal pain. He was in urgent need of surgical intervention. However, except for the Kingston Public Hospital (KPH), all the hospitals within the Kingston and St Andrew Metropolitan Area (KSAMA) were at capacity.

I called a surgical colleague who, literally, presented himself at the Tony Thwaites Wing and, as soon as a patient was discharged, he admitted the gentleman and operated on him.

Shortage of hospital beds is nothing new; it has been going on for many decades, and that troubles me greatly. Back in those days, I genuinely believed that, by now, hospitals would have increased their bed capacity to facilitate far more admissions. I was very wrong. There is ongoing hospital construction and upgrading, but the KSAMA, which has about 673,000 citizens (24 per cent of our total population), is in urgent need of inpatient beds, equipment and staffing.

I recall my days at the UHWI when, having seen patients in Casualty - they now have an Accident and Emergency (A&E) Department, if there were no available beds for admission, patients were stabilised and transported to KPH. There came a time when the KPH administration pushed back because that facility was inundated with admissions from everywhere. They felt like a ‘dumping ground’.

Interestingly, the UHWI mission is to “provide teaching, research and quality healthcare” in that order, whereas the mission of the KPH is to “provide high-quality preventive, curative, diagnostic, emergency and rehabilitative care to all. Provide opportunities for training, clinical experience and research for health professionals” in that order. Nonetheless, despite the stated order of their mission, UHWI prioritises healthcare.

CHRONIC SHORTAGES

The UHWI A&E Department has had to improvise and create what I call an intermediary ward for patients who need admission when there are no beds available on the regular wards.

The chronic shortage of beds within the KSAMA is bad enough, but it severely impacts ICU beds. A metropolis the size of KSAMA should have approximately 280 ICU beds; we have nothing near that number. As was already pointed out, sometimes the physical beds are available but specialist staffing is not.

Another problem is the beds occupied by ‘social cases’ – patients who should go home but have been abandoned by relatives or have no home to go to. Then there is an increasing number of chronic non-communicable diseases that require inpatient care. As our population ages, this number grows.

KPH has been a stalwart of healthcare for many decades. However, from before I worked there in 1981 to the present time, it has suffered from resource constraints. Because that facility accepts all patients, it also has infrastructure problems and severe overcrowding in the clinics and on the wards. The hospital is so overwhelmed that clinic and most emergency patients experience extremely long waiting times. This is exacerbated by the number of unnecessary motor vehicle crashes, gun, knife and blunt-force trauma cases that flood the emergency department and commandeer operating theatres and inpatient beds.

Both the UHWI and KPH are infamous for having to give extremely long clinic and follow-up dates. I have had several patients who died only because they were given ridiculous clinic dates and could not afford private investigations or care. Other patients whom I know die on the wards because they cannot afford some outside investigations or the hardware needed for their operations.

Sometimes patients assist other patients because of a lack of adequate care on the wards. The sanitary facilities are of serious concern. Equipment tends to break down and take a long time to be repaired. Patients sometimes have to source medications because they are not available in the pharmacies. The medical staff are usually under pressure, and that can lead to a reduction in efficiency and the abandonment of bedside manners.

The sad and scary refrain, “no beds are available”, is not uncommon. The government is working towards increasing inpatient beds. Until then, emergencies suffer in chairs, and people are dying unnecessarily. We must do better, fast.

Garth Rattray is a medical doctor with a family practice, and author of ‘The Long and Short of Thick and Thin’. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com.