Tuesday, November 10, 2009

Doctors in pain.Frustrating, heart-rending working conditions force many to improvise.

"You often have patients that you know what to do but you just cannot because you don't have the wherewithal or the equipment to help," said Dr Dane Miller public relations officer of the Jamaica Medical Doctors Association (JMDA).
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Doctors in pain
Frustrating, heart-rending working conditions force many to improvise
By INGRID BROWN Observer senior reporter browni@jamaicaobserver.com
Tuesday, November 10, 2009

Public sector doctors yesterday highlighted extremely difficult and frustrating conditions under which they are required to work and that force them, in many instances, to improvise in order to save lives and, in a few cases, to employ triage.
"You often have patients that you know what to do but you just cannot because you don't have the wherewithal or the equipment to help," said Dr Dane Miller public relations officer of the Jamaica Medical Doctors Association (JMDA).


Public sector doctors yesterday

Dr Shane Alexis (right), president of the Jamaica Medical Doctors Association (JMDA), highlights the conditions under which public sector doctors have to work as he addresses the weekly Observer Monday Exchange meeting of reporters and editors at the newspaper's Beechwood Avenue headquarters yesterday. Beside him are Dr Vincent Riley, first vice president of the JMDA and Dr Romayne Edwards, editor of JMDA publications. (Photo: Lionel Rookwood)
highlighted extremely difficult and frustrating conditions under which they are required to work and that force them, in many instances, to improvise in order to save lives and, in a few cases, to employ triage.
"You often have patients that you know what to do but you just cannot because you don't have the wherewithal or the equipment to help," said Dr Dane Miller public relations officer of the Jamaica Medical Doctors Association (JMDA
).
According to Dr Miller, a junior surgical resident at the University Hospital of the West Indies (UHWI), doctors get things done under very challenging circumstances only because they are the "masters of improvisation".
Dr Miller and other members of the JMDA executive - president Dr Shane Alexis, first vice president Dr Vincent Riley, publications editor Dr Romayne Edwards, and secretary Dr Twesige Mugisa-Malcolm - were guests at the weekly Observer Monday Exchange meeting of reporters and editors at the newspaper's Beechwood Avenue headquarters.
Dr Miller, unable to camouflage the pain he felt at working in conditions that he described as "extremely frustrating and heart-rending", said that only last weekend he had to decide which of the three patients under his care needed more immediate attention since one was an emergency patient on the ward, another was in the Accident and Emergency (A&E) department and the condition of the third was deteriorating.
"I can't split myself into three, so I had to triage. go to A&E, sort that one out, and decide where to go next," Dr Miller said.
Triage is the action of sorting casualties according to priority. It is often used in hospital emergency rooms, on battlefields and at disaster sites when limited medical resources are available.
Dr Miller said that sometimes doctors are forced to use equipment which would normally have been replaced in a first-world setting.
Pressed about a worst case scenario resulting from the lack of equipment in hospitals, Dr Miller said he has been in a situation where the power went out in the middle of a surgery and the standby generator was not working.
"Nurses had to hold flashlights for us to continue," he said. However, he pointed out that similar situations have occurred in first-world settings. A mandate of the JMDA, he said, will be to identify ways to improve the conditions.
"We cannot continue along the path we are on," he stressed.
He argued that while health care has been made free, infrastructure and staffing have not caught up with the increased demand.
Dr Alexis, in his contribution to the discussion, said policies regarding free health care have to be revisited, given the new set of economic conditions facing the country.
"In other words, it is time for the policy makers, doctors and stakeholders to sit down and revisit our health sector and try and make the necessary improvement," Dr Alexis said.
He said the per capita expenditure for a country like the United States is upward of US$4,000 per year to treat a patient compared to Jamaica's US$400.
"What we have to look at is not developed versus developing but humans versus humans,"
he said, adding that there is a need to look at how much resource is dedicated to health care in Jamaica.
"The question we have to ask ourselves is how much is a man worth in Jamaica," he said.
Dr Alexis pointed to shortages of basic equipment such as lights, proper treatment and examination rooms, resuscitation sets, among other implements in critical areas.
Doctors, he said, do not even have a desk on the hospital wards and so all documentation has to be done standing either at the bedside or at the central administrative area.
"Sometimes sharing sensitive information, for example a patient who is HIV positive, you have to go into the storeroom sometimes to break the news to them," Dr Alexis said.
Dr Riley concurred, and added that working conditions at public hospitals are the same islandwide as there are too many patients with too few doctors and supplies.
Dr Riley, who works at the St Ann's Bay Hospital, said it is always a struggle to find bed space for patients.
He told the Observer that another grave problem is lack of diagnostic services at public hospitals.
There are only two CT scanners and no MRI services except at the UHWI, which is not considered to be a full public hospital, he revealed.
Simple machines like those used to measure oxygen concentration in the blood and do ECG (echocardiogram) often do not work.
"When that happens you have to make a decision based on clinical assessment to determine if persons can afford to have it done privately," he said.

Another concern, according to Dr Riley, is the issue of getting patients to another hospital to do tests, since there is an acute shortage of ambulances, many of which are out of service.
This affects other health care services as when patients arrive late at another facility for an appointment it throws off the schedule of others.

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