Sunday, Jun 16, 2019

Critical state

There’s no shortage of horror stories from Princess Margaret Hospital (PMH) patients. It’s no secret that the decades-old facility has its share of problems.

Most of us have heard the stories. Some of us have lived it.

With affordable healthcare beyond the reach of so many Bahamians, they are forced to turn to the premier public institution, which has long been overburdened and undermanned.

Sixty-two-year-old Marie Spencer (name changed) recently spent what doctors expect to be some of her final days at PMH.

Suffering from stage four cancer that has spread to multiple organs, Spencer was hoping to find some relief from the onslaught of pain she had been experiencing over the last several months.

While extremely grateful that her nightly bouts of vomiting have subsided and the pain had lessened following her admission, Spencer said she experienced other indignities that left her feeling demoralized and desperate to return home.

Despite the short window she’s been given to live, Spencer says she’s holding onto faith that this is not the end. But she said her experience at PMH, while not all bad, did not help to foster that optimism.

She said her lowest point at PMH came on a particularly cold night, when most people were wrapped in blankets and sheets and unaware of her impending humiliation.

“The lights were out and the ward was silent except for a few groaning patients,” she said.

Spencer said she soon joined the low chorus of groans when she felt a familiar pang in her bladder. Eventually she called for help. She needed to relieve herself, but she was connected to various tubes and was too weak to make the trek to the bathroom without assistance. Likely awakened by her cries, Spencer’s neighbor also began crying out in an effort to get a nurse’s attention.

However, as the seconds ticked by, Spencer said the urge became too great for her to control. She was forced to relieve herself on the bed – an indignity she said she is trying to push to the back of her mind.

There were no call buttons for one to push when in need of help.

Spencer’s voice, which she suspects did not carry far enough to get a nurse’s attention that night, cracked as she relived the experience the following day. Her bed was among those farthest from the nursing station.

She eventually received help 20 minutes later. She said a smiling and compassionate nurse brought her a bucket of warm water to clean herself and removed the soiled sheets.

A few hours later, at 5 a.m., another nurse woke all of the patients on the ward to take their vitals. Tired and groggy from a restless night, Spencer wondered aloud if the process could not start at a more decent hour. Eventually they were fed around 9 a.m., she said.

Spencer said most of the nurses are nice. Others, she said, are short-tempered, and likely in need of a vacation.

But some nurses have reportedly had to forgo their vacations due to a severe nursing shortage.

According to data compiled in January 2019, PMH needs 403 nurses for its specialized units.

There is a dire need for 165 nurses in the critical care units at PMH.

The critical care units comprise of the Intensive Care unit (ICU), Neonatal Intensive Care Unit (NICU), operating theaters, Post-Anesthesia Care Unit (PACU), Accident and Emergency (A&E), Maternity Ward and Dialysis Unit.

The data also reveals that these specialized units need to fill a gap of 238 in order to allow nurses to receive benefit leave, which includes the allowance of vacation leave, study leave, maternity leave, etc.

Minister of Health Dr. Duane Sands said the shortage is concerning as it relates to the delivery of healthcare at the hospital.

“It has been a concern and it is the reason why [we] have had to close down critical care beds on occasion. It is the reason why even though you have 20 beds in the intensive care unit, sometimes only 16 or 15 can be opened,” he said recently.

“It is the reason why you cannot dialyze more patients in the Dialysis Unit. It is one of the challenges in the emergency room for maximizing patients. While all nurses are absolutely important, the strain on the institution of healthcare delivery is greatest felt in the critical care units.”

A nurse on the Children’s Ward told The Nassau Guardian this week that her ward could use an infusion of nurses as well.

She also decried the conditions of the ward that houses the hospital’s most vulnerable, but most resilient, patients. She fears they’ve been put on the back burner.

“The state we’re in, oh my gosh, it’s really sad,” she said.

“The staff of the Children’s Ward work together as a team and enjoy working with our patients, but we feel as though Children’s Ward is not a priority for the PHA (Public Hospitals Authority).

“The east section has been dilapidated for some two years now, with no work being done to fix it.

“Since Hurricane Irma in 2017, there was some structural damage and the unit was relocated to the old ICU ward. That was fine even though it was not conducive, with one bathroom for staff and patients. But that was temporary.

“There are three sections of the Children’s Ward: nursery (five months and under); east (toddlers) and north (five to 12 years old).”

She said worked stopped on the east section when the government changed as the project was placed on review.

“Staff are discouraged and have been complaining for almost a year now,” she continued. “After the air conditioning went bad in the old ICU building, the east section was then moved to back room of north section and has been there ever since.

“There is little room to work, cots are close to each other and there are no nursing stations to work from.

“It is discouraging, but nurses go to work and function as best as they can.

“Because of limited space, parents of those kids who need to be admitted have to stay in A&E with their children until a bed is available.”

She added that the shortage of supplies and medication is also among their issues.

Those issues are replicated on the Maternity Ward, according to another nurse.

“There are times when you have a very severe shortage of staff and you have nurses being pulled on both ends in order to meet the optimum level of care that patients require,” she said.

“In some cases, we don’t have the material on hand to provide the care, especially in the pharmacy. That’s a really serious issue when we can’t get medication, especially in the middle of the night.

“They’ve adopted a 24-hour pharmacy system, but after hours you can’t get anything from the pharmacy. Sometimes if you try to borrow, you’re not always able to find it. And recently the pharmacy has been [running out] of medication.”

She added that the working conditions are not conducive.

“There is no rest area for nurses,” she said. “If you work a 16 or 18-hour shift, and you want to take a break, there is nowhere for you to do that.”

Aside from the nursing and bed shortage, PHA is grappling with massive infrastructure issues, a lack of capital, along with a myriad of other concerns.

Some nurses and doctors are burned out, patients are frustrated and perplexed by the long wait times and the facility is not properly maintained.

Sands previously said renovations to the Children’s Ward, Male Surgical Ward and the old Intensive Care Unit (ICU) will be complete by the end of the summer.

The $900,000 renovations of the Corey Newbold Ward (Male Chest Ward) were recently completed, which has helped with the bed shortage. However, PMH still needs an additional 200 beds, according to Public Hospitals Authority Deputy Managing Director Lyrone Burrows.

Once renovations of the other three wards are complete, it will add an additional 50 to 60 bed spaces.

Sands said that solving the shortage of bed space at PMH will cost between $3 million to $5 million.

Adding to its woes, PMH doesn’t make much money. In fact, a lot of its revenue goes uncollected.

A snapshot of the hospital’s patient charges shows that, in 2017, nearly 48,000 patients racked up bills totaling nearly $77 million.

Asked earlier this year how much of that was collected by PMH, the minister said, “Certainly around $10 million is what our PHA collection is on an annual basis.”

He said the PHA is expected to collect between $11 million and $12 million this year.

Sands said the numbers illustrate the need for a system to be implemented with the aim of improving billing and collection at the hospital.

Last month, Sands said the Ministry of Health proposed the introduction of revised fees in the healthcare system that would go into effect on July 1, which would provide $40 million in annual revenue for the public health system.

Hopefully, this injection of cash will prompt additional upgrades to the facility.

Krystel Brown

Online Editor at Nassau Guardian
Krystel covers breaking news for The Nassau Guardian. Krystel also manages The Guardian’s social media pages. She joined The Nassau Guardian in 2007 as a staff reporter, covering national news. She was promoted to online editor in May 2017.
Education: Benedict College, BA in Mass Communications
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