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‘A phenomenal burden’

The high level of violent crime is stretching resources all around, and officials at Princess Margaret Hospital(PMH)know that all too well.

Hosptial statistics show that while there were fewer”encounters”or cases at the Accident and Emergency Department(A&E)in the first quarter of 2011 compared to the same period last year, there were more severe matters that placed a strain on the department.

For instance, the numbers show that gunshot cases were up 40 percent(from 45 to 63)and stabbing cases were up 100 percent(from 27 to 54).

“I think that it has been said repeatedly that the impact of violence, crime, accidents on the public health care system has been almost overwelming,”said Senator Dr. Duane Sands, who is consultant surgeon at PMH.

“The national statistics would seem to suggest that we have a murder count of whatever. In reality that number, the number of absolute deaths from violence belies the real problem.

“And this is not a phenomenon. This is something that has been going on now for at least a decade.”

But Sands noted that the hospital continues to see more gunshot victims.

“We see on average in this country, in excess of 400 major stabbing or shooting traumas(every year),”he said.

“What has happened in the last three years is we’ve seen the knife been replaced by the gun. And so what that does to the emergency room, what that does to the operating room, the intensive care unit and the wards is put a phenomenal burden.”

Sands noted that Medical Advisor to the Public Hospitals Authority Dr. Glen Beneby recently released a report that examined occupancy rates in all of the hospitals that fall under the PHA.

“While there’s no question that the hospital is challeged on most of the wards–Pediatrics, Gynecology, Obstetrics etc. The typical occupancy rates would run around 80 percent or less–on the surgical wards, however, the occupancy rates range from 92 percent to 104 percent,”Sands said.

Hospital officials have created another ward in what used to be the out patient area of PMH.

“If we look at the impact on the operating room, the operating room basically has now been forced to focus on emergencies and trauma,”Sands said.

“If you look at the impact on the Intensive Care Unit, the Blood Bank; if you look at the impact ont the pathology lab(it’s great).”

This means that on many occassions, elective surgeries are constantly put off, Sands noted.

“And so if you look at the impact on health care in general from violence is a lot more signficant than just the numbers we are seeing in the public,”he said.

“Resources are indeed stretched and we take this as a duty. We have to respond. And so the hospital responds however we can.

What the public sees from this growing problem is increased waiting times, a shortage of blood at the Blood Bank and the postponement of those elective surgeries, as mentioned.

“This is the real impact of the violence and trauma on regular, ordinary people,”Sands added.

“It is a big, big problem.”

A RISKY ENVIRONMENT

“If you look at the impact of all of the violence and trauma. Let’s take my house staff in surgery or in the emergency department. They are constantly exposed to the most outrageous forms of violence–seeing people beaten, stabbed, raped, molested etc.

“It is almost surreal, the impact on these individuals…They see the worst of people every single day. You couple that with a public response, which is not terribly supportive…and while we understand this, bear in mind that those two things put together create a very challenging emotional and psychological environment that we try to provide support for.

“To be very candid with you I don’t think we do a good a job as we should.”

The high stress level for the medical professionals is sometimes worsened when street fights continue into the emergency room.

“Notwithstanding that we have beefed up security significantly it is not foolproof.”

THE WAY FORWARD

“The debate about the way forward with health care is a debate about choices,”Sands said.

“And this governemnt has made it very clear that it is going to adjust the resources upward for the provsion of health care and has done a number of things.

“There is no question that we need a new hospital and that is going to create a whole lot of dicsussion about where those funds are coming from.”

The government had intended to use proceeds from the sale of a majority stake in BTC to build a new hospital.

But with a dramatic downturn in the economy, the government was forced to increase borrowing, which resulted in rising debt levels.

The new plan is to use the proceeds from the sale of BTC to CWC to pay down the debt.

The government has instead opted to build a new critical care block on PMH’s compound. It will have an additional six operating rooms.

“But we have other challenges that have to be dealt with and we are preparing various position papers to put forward to the administration and the Ministry(of Health)to consider,”Sands said.

“While we all have a duty to try and intercede on behalf of this carnage that’s going on in this country, we have to stand in the gap.

“So the physicians, the nurses, the ancillary staff, the hospital administrators, we don’t have a choice. This hospital does not close and we have to do what we can with the resources that we have.”

Sands added,”It is a real, real problem and it is the direct impact that everything that’s going on and that choices that Bahamians are making, and fundamentally resoloving this is going to require the engergy and the effort of every single Bahamian.”

Sands said the hope is is that there is not a further escalation in demands being placed on PMH because the hospital has no other choice but to care for people who come for treatment.”

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