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| Sunday, 7 December 2003 |
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Features |  |
| News Business Features Editorial
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Anuradhapura General Hospital : a hell-hole by Shanika Sriyananda Poor farmers, bitten by venomous snakes, and patients admitted with serious head injuries, are transferred to Colombo. But the six-hour journey from Anuradhapura to Colombo is often fatal to these patients. Lack of staff and essential medical equipment have made this hospital, Sri Lanka's third major hospital to cancel all routine operations. The poor villagers in the North Central province, who can ill-afford private medical care are compelled to wait patiently for years now wonder whether it is only death that will bring them relief. The AGH, which comes under the North Central Provincial Council and was given top priority during the North East conflict is in a complete state of neglect now. Consultants in every unit lament the lack of even basic facilities, but the authorities have been turning a deaf ear and 'blind eye' to the pleas, often passing the buck to someone else. The blame for much of AGH's state of neglect has been attributed to political interference and the tug of war between the government and the North Central Provincial Council, which has been going on for a while. The victims of this have been and will continue to be patients who can ill afford private medical care. The situation has forced 13 of the 22 specialists consultants to seek transfers to other hospitals where they hope to provide better medical care to needy patients. The AGH has over 1384 beds and over 1,500 patients seek medical treatment daily. It is the only major hospital for the poor people in Dambulla, Jaffna, Kilinochchi, Mannar, Vauniya, Puttalam, Polonnaruwa and certain areas of the Kurunegala district. But, those who are in the 'waiting lists' for routine operations are being turned away due to poor facilities and unhygienic conditions in theatres and also due to shortage of staff for post medical care. "We are doing only emergency operations" confirmed Dr. Lakshman Gamlath, AGH Director, attributing the current state of the hospital to poor financial allocation to upgrade the facilities. He also said he was the only hospital director in the country without any power even to buy low cost equipment. "I have to go to the Provincial Health Department always begging for money", he said. "Shortage of nurses is also a major problem. The hospital needs 550 nurses, but we have only 350" he said pointing out they were also short of clerks, pharmacists, physio-therapists and accountants. According to hospital sources, the annual financial allocation for the AGH is only one fourth of what's allocated to other district hospitals. The AGH needs over Rs. 100 million to purchase new equipment to re-commence routine operations. The new building, opened by the President last year, where there is no equipment and beds, is only a 'show piece', today, sources said. Consultants who have been given wards in the new building mere forced to use wards and theatres in the old buildings, owing to lack of facilities in the new building. Some consultants, who do not have wards or theatres to carry out their treatment, have been idling for months. Fulfilling a long felt need, Dr. Prasanna Gunasena, Consultant Neurologist was appointed to the AGH on October 1 to set up the first ever Neuro Surgery Unit. But, today he is compelled to spend his time 'doing nothing' due non-availability of CT scanners, a ward and a theatre to commence work. "Neuro Surgery is a vital requirement as there are no facilities for that kind of surgery from Jaffna to Colombo and Kandy. I was appointed to develop this neglected area of treatment, but I cannot start my work because of poor facilities", said Dr. Gunasena, who is planning to get a transfer to a hospital where he can make use of his talent to help poor patients. "The problem is poor co-ordination between the NCPC and the Central Government. On the other hand, the Provincial Council also cannot allocate a huge sum of money to purchase state-of-art equipment by cutting down the allocations to other vital areas such as maternity health and nutrition", he said. "The President through a gazette notification ordered that the Anuradhapura, Badulla and Kegalle hospitals be handed over to the central government. Dr. Gunasena questions why the AGH was also not handed over to the government in a similar manner. Meanwhile, medical officers alleged that laundry, dietary service, Security and building construction, and repairing have been given to private contractors by the NCPC. " Though the Council claims that it does not have money to provide facilities for the hospital, payments to the contractors have been made on time. On the other hand, these contracts have been given at higher rates violating tender procedures. But, they have not done a good job. Water is leaking from the newly tiled floors and even from walls in theatres and wards. It is a wastage of public money", they charged. The medical officers say that the government should declare the AGH as the second National Hospital as it caters to a large number of patients and covers a large area of the Central, North and East provinces. Paediatric Unit In the Paediatric Unit, two or three children share a bed and some even sleep under the beds. There are only a few nurses to care for the children. Dr. Dayananda Bandara, Consultant Paediatrician said that over 50 children below the age of 12, who were victims of snake bites, septicaemia and renal failure die due to poor ICU facilities. " We have two ICUs - One for children and other for neonatal babies. Every day, 30-40 children, mainly from Kandy, Trincomalee, Batticaloa, Ampara, Chilaw, Puttalam, Dambulla and Jaffna, Vavuniya, Killinochchi are admitted to the children's section", he said. Looking after the babies is a serious problem at the Paediatric section due to a shortage of nurses. " There are over 45 babies in one ward and the existing nursing cardre cannot provide better care for these babies. Unlike adults, babies need special attention and care. One nurse in the ICU has to look after three babies and it is an extremely difficult task", Dr. Bandara said. Over 15 premature babies die every month due to septicaemia and renal failure, according to Dr. Bandara. However, the new ventilator installed at the Unit three-months ago helped to bring down the death rate. "However, due to poor facilities at the Unit, 10 babies still die on a monthly basis", he added. Owing to shortage of beds, two infants share one bed. " As these infants, sometimes suffering from different illnesses, share the same bed, they are vulnerable to infections", he said. Dr. Bandara stressed the need to have a separate unit for children suffering from Thalassaemia, as the victims keep on increasing. There are over 200 Thalasemic patients registered with the AGH. These children need assistance to buy thalassaemia pumps, which cost Rs. 25,000 each. " Of the total thalasemics only 20 have pumps. Without this equipment their survival is difficult", he said. The Paediatric ICU also needs a Blood gas analyzer, Cardiac monitor, Pulse Oxy metre, 10 Syringe pumps (Rs. 50,000 each) and five incubators ( Rs. 500,000 each). Medical Unit Meanwhile Dr. Wasantha Dissanayake, Consultant Physician said a separate unit was needed to treat victims of renal failure, as the number seeking treatment had increased by 26 per cent during the last few years. " A recent research has found that the renal failure rate is high in Mannar, Padaviya, Rajanganaya and Thanthirimale. There is significant evidences that identified floride in water and unlimited use of insecticide, as the main reason for this increase", he said. "I have been requesting a separate unit for treatment of renal failure from the North Central Province for the last four years. A properly functioning Medical Intensive Care Unit is essential to treat victims of snake bites and insecticide poisoning, as they run the risk of getting pneumonia and various diseases due to infections in the theatres. " Majority of them die, not because of snake bites or poisoning, but because they get infected with pneumonia and other infections", he pointed out. Patients who flock to the AGH suffer from lack of bed facilities in wards. Infants, youth, expectant mothers and adults are forced to share beds in small congested wards. Some are even forced to sleep on the floor or under the beds. Dr. Dissanayake, alleged that more often than not the seriously ill patients transferred to Colombo National Hospital (CNH) for better medical care die enroute due to delayed treatment. " It takes more than six hours to reach Colombo and by that time the patient has left this world", he said. According to hospital sources, the only air condition unit, which is an essential facility to make the MICU germ free is not functioning. " Windows are opened and flies and dust enter the MICU easily. Water leaks from the floor and tiles and the room is full of fungus. Three ventilators and monitors are out of order. The unit has only four beds and providing proper nursing care is a major problem. One surgical ICU is under repair and the theatres are malfunctioning", they claimed. Orthopaedic unit: Dr. Dilshan Munidasa, Consultant Orthopaedic Surgeon, shares the surgical ward as there is no proper Orthopaedic wards. A ward has been given to him from the new building, but due to lack of nurses and bed capacity, he cannot continue his work. " I need a highly sophisticated 'Lamanaflora theatre', recommended by the other countries. But at the moment I am doing the operations in the common theatres. The infection rate is high here. Four to five patients are being transferred to Colombo daily and it is unavoidable due to the prevailing poor conditions at the hospital", he said. Performing of spinal cord and joint surgeries have come to a standstill and those who need surgery are given only oral medicine as a temporary measure. " We have been trained to do modern surgery, but we cannot help the poor patients due to these short comings. Most of them who need cannot afford Rs. 75,000 to 200,000 for a surgery at a private hospital. They are suffering", Dr. Munidasa added. Dr. Munidasa, who needs 20 well trained physiotherapists, is also forced to carry out physiotherapy duties due to the shortage of physiotherapists. Post operative patients are also not looked after well due to shortage of nurses. Orthopaedic surgeries, which need highly sophisticated theatres- bone fixation, fixation of long bone of lower limb, joint surgeries, all compound fractures, and soft tissue surgery - have been postponed. Only emergency operations are being done. The Unit lacks Fixation sets, Arthroscobe, bone holders and sets for spinal surgery. Maternity Section: Over 1,000 babies born in the maternity section of the AGH. Though special attention has not been given to the section, the annual birth rate is close to that recorded at the Castle Street Maternity Hospital Colombo. Dr. Wimalasiri Abeykoon, Consultant Obsctrician and Gynaecologist claimed that they do not even have needles and paper for the CTG machine, the only such machine available at the unit to monitor the heart beats of new born babies. " Most of the time, this machine is out of order. We need at least six machines if we are to take care of new born babies", he said. He also claimed that the supply of paper to record the heart beat was always delayed and often poor patients are asked to bring needles from outside. Drugs are in short supply and two months ago most of the patients had been asked to purchase drugs from outside. The section, where over 1,500 patients seek treatment monthly lacks anaesthetic machines, theatre tables and suture material. According to Dr. Abeykoon, caesarian operations increased during the last few years due to lack of facilities. "We cannot take a chance and when there is a threat, we do a caesarean operation", he said adding that only emergency operations are being performed and removal of womb, removal of lumps and laporascopic operations, have been postponed. Due to lack of facilities, six mothers with their new born babies were forced to lie in the same bed and some on the dirty floor under beds. Surgical Ward: The surgical wards, where over 10,000 people get admitted for emergency surgical traumas due to road accidents, occupational accidents, falls, elephant attacks, trap gun injuries and acute abdominal emergency surgery. "Due to lack of facilities at the AGH, over 70 per cent patients with serious head injuries transferred to Colombo die on their way to Colombo. I cannot do such serious surgery due to lack of a CT scanner", Dr. Mahinda Gunasekara said. "Surgical wards need a clean environment as they tend to carry infections easily due to germs in the wards. But we are compelled to keep our patients in very unclean conditions", he said. According to Dr. Gunasekara, there are not enough beds, no sanitary facilities and proper washing facilities. " The patients have bath in common taps in the hospital garden", he claimed. The male, female and children's wards in the surgical section are in a very dilapidated state, he claimed. Dr. Gunasekara said that out of the 12 major hospitals, the third hospital - the AGH - lagged far behind and was treated poorly by the authorities. It also does not have teaching facilities, though post graduates are being trained. He also said that need of the hour is to get the hospital under the central government and to develop it as a big hospital. There are over 4000 in the waiting list for surgery and some surgeries have been postponed 10 to 15 times due to shortage of nurses and equipment. According to Dr. Gunasekara, the NCPC is full of unqualified 'experts' who are not aware of the required facilities of the health sector to have the hospital functioning smoothly. However, the Government Medical Officers Association had decided to take strong trade union action if the authorities fail to intervene and remedy the ills that have brought this important hospital to a standstill. ********* A high official of the Ministry of Health, Nutrition and Welfare said that they were 'helpless' as the AGH functions under the North Central Provincial Council, but admitted that the Ministry could help by giving more medical staff. "The fault is with the Chief Minister, who likes to keep the hospital under his 'custody'. If he listened to the President, who ordered that the hospital be handed over to the Central Government two years back, these problems would not have arisen", he claimed. According to him, priority will be given to the AGH when there is an emergency requirement and the drugs are purchased by the Council. There are hundreds of NGOs and philanthropists, who help poor people, but according to AGH doctors these NGOs are ignorant of the plight of these poor patients, especially the children. " The children's wards are good for animals. They are filthy and filled with files, the walls have not been colour washed for years and beds have torn linen. It is not a pleasant environment for kids, especially sick children", Dr. Mahanama Gunasekara, Consultant General Surgeon said. "There are no toys or nice pictures hanging on the walls in my Paediatric surgical ward to please children, who had undergone surgery. They bear the pain with great courage and a majority of these poor babies do not know the joy of playing with a doll or a toy car and never seen such a toy. The old dirty ward needs a colour wash and old cement floors which have big cracks need to be tiled to avoid germs. Even windows do not have curtains", he said. Dr. W.M.T.B. Wijekoon, Provincial Director of Health Services of the North Central Provincial Council said that the council did not get the necessary allocation and the routine operations would be performed soon as the repairing of the theatres would be finished next week. Judicial Medical Office The unbearable stench emanating from bodies that are kept in the broken down coolers at the Mortuary, have become a big health problem as most of the wards including the surgical wards are located adjacent to the mortuary. There are six mortuary coolers, including 4 imported from Japan in 1972. The rest were imported from an Indian Company, recently, by the Provincial Council. These can accommodate 16 bodies. But there are at present more than 40 bodies stored in these coolers. Next to Jaffna, for the NCP, the AGH morgue is the largest, where post-mortems are held. Dr. H. A. Karunatilake, Assistant JMO claimed that the mortuary coolers imported from India were substandard and only has the cooling capacity of a normal air conditioner. " Now all coolers are out of order and the mortuary does not have any cooling facilities. The cooling capacity of mortuary coolers should be -4 to -20 degrees but these coolers are 10 centigrade. The doors are broken. We protested to the Council when they fixed the first mortuary machine, but to no avail they imported 16 mortuary coolers without a technical evaluation report", he claimed. Dr. Karunatilake said that for the last six months the Council was informed about the problem, but there had been no response. According to Dr. Karunatilake, preservation of bodies is a major problem not only for the AGH but all other hospitals which received these substandard coolers. The AGH mortuary receive 10 bodies daily and all post mortem examinations have been stopped due to the poor facilities. The Consultant Judicial Medical Officer was appointed for the first time in the history of AGH stopped his service due to the state of the mortuary. |
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