THE Jamaica Medical Doctors Association (JMDA) on Friday painted a picture of a public health system that is on the brink of collapse with hospitals lacking equipment vital for surgeries and doctors working in sub-standard conditions that pose serious risk to patients and themselves.
“We have flies in the operating theatre. We have to reuse single-use instruments that aren’t disposed of but [are] washed and placed in antibacterial solution and used on another patient,” a member of the JMDA who works at May Pen Hospital in Clarendon told the Jamaica Observer.
Another member of the JMDA, who is assigned to Spanish Town Hospital and who opted for anonymity, said pads and pencils
used with electrosurgical machines, which sends electrical current to blood vessels to stop bleeding, are also reused.
“The pencils are soaked in disinfectant and reused till they stop working,” the doctor said. However, he pointed out that the reused pencils run the risk of burning the patient and causing electrical fires.
Another doctor said they often practise what they term ‘socialist medicine’ as leftovers from an individual’s surgery are used on someone else.
“We have a mesh that is used to fix hernias. We ask patients to buy them as the hospital always runs out. When we don’t use all of the sterile mesh in the surgery for the patient who bought it, we soak it in disinfectant and use the leftover on a patient who couldn’t afford to buy their own,” he said.
The doctors’ claims were corroborated by JMDA President Dr Alfred Dawes during a news conference on Friday.
“We see where anaesthetic machines give inaccurate readings. There are no sutures, the air-conditioning breaks down and we have to end up using fans, which result in sweat dripping in wounds, plus there is a limited supply of antibiotics,” Dr Dawes told journalists.
Dr Dawes used a PowerPoint presentation to juxtapose what is required for surgery and what the doctors have to ‘make do’ with.
He said that proper antibacterial soap is not available.
“What we are supposed to scrub with for surgery is an antiseptic solution to ensure bacteria is dead, but what we use is antibacterial soap, which is cut in half to last,” Dr Dawes said.
The surgeon further pointed out that even the infrastructure presents a higher than normal risk of infection, which places people’s lives at risk.
“We are supposed to operate in a sterile unit in an operating theatre and we have to have buckets catching water,” Dr Dawes said. “There are operating theatres with mildew on the walls. To make matters worse, theatre doors should be closed to prevent bacteria from getting in and out and we’re operating in theatres where doors can’t be closed and are left open for the duration of the surgery.”
Dr Dawes also said that he and other surgeons are forced to operate without proper surgical gowns, which result in patients’ blood soaking through onto their skin.
“I lost underwear when I was operating on a trauma victim as a patient’s blood soaked through my surgical gown, because I was wearing a garbage bag [instead of a surgical apron], which signals a lack of supplies,” he said.
Dr Dawes cited poor resource management as another issue and said even the masks they wear for surgeries are not suitable.
“We are supposed to wear standard theatre masks and what we are using are N95 Ebola masks. The stockpiles of these masks are being used as regular masks in the operating theatre because we cannot get cheaper surgical masks. This is about inventory management and a dysfunctional supply chain that needs to be corrected,” he said.
The problem also extends to a lack of surgical equipment, for which the doctors, according to Dawes, often have to improvise.
“When we do not have a tube to drain blood from your chest, we have to take a tube for breathing and cut holes in it and that is what we insert in the patient’s chest to use in surgery. We have to be operating with one machine that is showing blood pressure and pulse and another machine showing the oxygen saturation because neither machine can give you both,” he said.
Dr Dawes argued that if any complications arise from the surgeries, the surgeon is liable as surgeries should not be conducted under such conditions and legal representation from the State is not guaranteed.
“The Office of the Attorney General will not provide support for any doctor who uses substandard equipment. If a case comes up we are on our own and we only hope the patient will understand that we did what we had to do for them to get their surgery,” Dr Dawes said.
He also charged that there was a problem with lighting in the theatres, saying that they often have to “tie the lights with cloth” in order to prevent them from going out during surgeries.
One of his colleagues, who works at Spanish Town Hospital and who also preferred not to be named, said they have experienced sudden power cuts during surgeries.
He also said that he had found termite dust, which fell from the hospital ceiling, on the neck of a patient on a ward.
When the Sunday Observer contacted permanent secretary in the Ministry of Health, Dr Kevin Harvey, he said that while he does not wish to have a public fight with the JMDA he agrees that there are issues in the system and the ministry is taking steps to address them.
“We recognise that we have a limited budget and for this fiscal year the budget for maintenance moved from $80 million to over $500 million, while the budget for supplies also moved from $4 billion to over $8 billion. We cannot fix the system overnight, but we are making steps to fix it,” Dr Harvey said.
“We are only a month into the fiscal year and we are working to address the longstanding issues, which have been in existence for over 20 years. I know the frustration, but we have to take the steps and now more than ever we are closer to addressing the issues.”
He added that the ministry has asked all the regional health directors and health authorities to create a list of all the items they require and submit them promptly.
In addition to the working conditions, the JMDA used the news conference to speak about its objection to a shift system for doctors proposed by the health ministry.
“The JMDA has proposed a system in the health centres that would see extended opening hours, specialty clinics, screening clinics for cancers and other chronic diseases in health facilities closer and more accessible to the public. This would have the added advantage of decreasing the overcrowding of hospital emergency rooms,” Dr Dawes said.
Earlier last week, the JMDA had told the health ministry in a letter that it would withdraw from a task force to examine how best the shift system could work and that, if it is implemented, only emergency care will be guaranteed at public health facilities.
At the time the Sunday Observer contacted Dr Harvey, he said that while there have been conversations surrounding the possible implementation of a shift system, he could comment no further.
“I can’t comment on that. No shift system is being implemented. What we’re doing is exploring the possibility of it, but nothing is being implemented,” Dr Harvey insisted.