Staff, drug shortages among issues at GPHC – Basic level of patient care remains unaffected
GINA, GUYANA, Wednesday, May 03, 2017
The Parliamentary Sectoral Committee on Social Services (PSCSS), based on a visit to the Georgetown Public Hospital Corporation (GPHC) has discovered that medical staff and drug shortages are some of the core issues that prevail at the healthcare facility.
However, Minister within the Ministry of Public Health, Dr. Karen Cummings said that these issues do not affect the level of healthcare offered.
The visit to GPHC by the PSCSS was one of a number of scheduled visits to public health facilities as mandated by the committee’s administrative functions. The visit was to examine the operational procedures which members of the public follow when accessing emergency health care, and to observe the conditions under which patients receive care.
Minister Cummings explained that, “we do have some shortages of course, but it’s not affecting the quality of care that doctors and nurses are giving to the patients. So, of course we know where the challenges are, where the gaps are, and we have made efforts and continue to make efforts to address those.”
The committee led by its chairperson, Dr. Vindhya Persaud, visited key departments of the GPHC, interacting with staff and patients. These departments include the Accident and Emergency (A&E), Paediatric, the Surgical Out Patient (SOPD), Maternity, Cardiac Intensive Care Unit (CICU) and the medical laboratory.
Dr. Persaud said that these visits are aimed at ensuring that better quality healthcare is offered to persons. “The various visits that we would have done were to find out where we can have recommendations, not only from top level management, but also from persons within the system who use the system so that these recommendations can be compiled in a report and taken to parliament, debated if necessary and acted on.”
Head of the A&E unit, Dr. Zulfikar Bux, guided the committee through the department stressing the need for additional nurses and doctors to efficiently cater to the number of patients treated on a daily basis. Additionally, Dr. Bux noted that there is also not sufficient
accommodation to house the large number of patients seeking care at the unit.
“The most important challenge for us is the overcrowding. As it stands at most points during the week, we would have more patients than we have beds available. We have a system in place, in terms of an overcrowding plan that works very well, but it is still affecting efficiency, but sometimes you have effectiveness and we would have more patients from referrals, we cannot reject referrals,” Dr. Bux explained.
The unit has a required capacity of 30 doctors to function efficiently, but for a number of reasons, Bux said the department is short and is only being run with 16 doctors managing the large number of patients on a daily basis.
Dr. Bux added that the unit has an 18-bed capacity but treats approximately 60 – 100 patients at any given time. He also added that the unit has a relatively stable nurse to patient ratio of five patients to one nurse; however there is need for more nurses in the department. He further explained that 19 nurses are undergoing specialisation training to boost the level of care provided at the unit.
Surgical Out Patient Department
The SOPD caters to outpatients requiring same day surgery. This department is one of the most efficiently run departments in the GPHC with a small number of patients requiring healthcare on a daily basis. Dr David Samaroo, acting Director of Medical and Professional Services at the GPHC recommended that the only issue in the department is the limited space that has been made available for doctors to function.
“In these areas, we have enough doctors, what we are short of here is that we do not have enough rooms for the doctors to work in,” Dr. Samaroo added. On this note, Orthopaedic Surgeon, Dr. Anthony Jeffery advocated for a specialised healthcare facility which will offset the number of patients flocking the GPHC for various levels of healthcare.
Dr. Jeffery also said that periphery hospitals must be equipped to provide an adequate level of healthcare which will remove the burden of overcrowding at the GPHC. “We can’t be referring patients from hospitals that have the facilities, sending the patients to Georgetown, once we can fix that I think we can fix the problem, the overload of the Georgetown Hospital the answer is the periphery (needs to be upgraded).”
At the pharmacy, the committee found that the hospital recording, managing and procurement for drugs need to be computerised. This will prevent continuous drug shortages currently experienced by the major referral hospital.
Acting Pharmacy Manager, Yvonne Bullen told members of the committee that reorder levels for drugs are set for three months. The drug procurement department of the GPHC is usually informed on a timely basis of shortages and reorder levels.
“We procure based on the need, we look at the consumption pattern. Sometimes if we are out, we would have to look at that and take that into consideration in determining the amount of each drug that is needed. Procurement would place orders and check to see if the drug is available. When we inform procurement of shortages we would follow up,” Bullen noted.
Director of Finance, Ronald Charles also told members of the PSCSS that the procurement process in itself affects the timely delivery of drugs to the hospital. “We would normally send requests to the various suppliers, and we have four major suppliers and we get the response from them and based on the price we would normally send it to the tender board so we can get the approval, but this is just to cover the immediate needs.”
Shortages at the pharmacy, according to staff have not prevailed for more than three weeks to one month. Drugs that have been ordered would usually arrive late resulting in a subsequent drug shortage.
The paediatric unit also has an issue of staff shortage. Dr. Marissa Seepersaud, Paediatric Surgeon noted that generally the paediatric unit benefits from donor and volunteer agencies contributing to efficient paediatric care.
“There are issues with shortages of staff especially in the sub specialties; we have people who are really interested but maybe because they are not exposed yet to some of the specialties. In terms of the nursing staff there are a few shortages,” Dr. Seepersaud said.
She however, added that the hospital’s administration is responsive to the needs of the unit whenever the request is submitted.
Dr. Pheona Mohamed – Rambarran told the visiting committee that GPHC serves most of the regional and district hospitals, as well as some health facilities in Region Four with clinical testing.
“All of our basic testing is done here; we would receive samples from GPHC, along with patients outside of GPHC because we are the referral hospital. We process the regional hospital samples especially for chemistry, and we would process samples from all of the health centres in Region Four.”
Dr Vindhya Persaud recommended an electronic system to be implemented for the transferring and transmitting of test results. This, she said, will allow for a more timely diagnosis by doctors, and other professionals depending on the results from the medical laboratory.
This department does not record the need for additional staff since they are well equipped to handle the magnitude of testing services offered.
The maternity unit is currently catering for referral patients, as well as those from Region Four. Sister Denise Marks, Senior Midwife said that there is the need for a separate facility to either cater to the referral patients or those of Region Four only.
Minister Cummings said that works are currently underway to upgrade the CC Nicholson Hospital on the East Coast Demerara to cater to these needs. Meanwhile Sister Marks stressed the need for more midwives.
“We need more Midwives, we have 51 and 102 is needed, that is my total. We have one school of nursing and we only train midwives twice a year,” Marks added. The maternity unit is faced with other constraints. Marks said that it would be beneficial to the care offered by the unit, if support services to the maternity unit are centrally housed in the department instead of sending patients to various departments of the hospital to access it.
The Sectoral Committee on Social Services has thus far visited the New Amsterdam Regional Hospital, Diamond Diagnostic Centre and the Linden Hospital complex. A number of scheduled visits are expected for hinterland hospitals and others along the coast. Recommendations and all other information gathered from these visits will be compiled in a report and presented to the National Assembly for swift consideration and action.
Sectoral Committees, in the exercise of their responsibilities, have the power to examine all policies and administration for each sector to determine whether the execution of Government policy is in consonance with the principle of good governance and in the best interest of the nation.
By: Delica Haynes