G/Town Hospital in dire need of upgrades

Sep 11, 2022 News

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…plagued with some similar challenges as N/A, Linden facilities – IDB August Report

By Kiana Wilburg

Kaieteur News – The August 2022 Environmental and Social Assessment (ESA) of the Inter-American Development Bank (IDB), which has been reported on by this publication for the past few weeks, not only places the spotlight on the troubling conditions at the Linden and New Amsterdam Hospitals but also some similar challenges plaguing the Georgetown Public Hospital Corporation (GPHC).

Following its July 21, 2022 visit, the IDB said GPHC which is the main national referral hospital in the country as well as the premier medical teaching and research facility, has approximately 200,000 clinic visits and 24,000 admissions annually. The financial institution said, however, that the hospital requires urgent infrastructural improvements to overcome gaps relating to capacity, quality, and growing demand for specialist services.

Elaborating on the foregoing, the financial institution said inpatient bed supply is inadequate, with some wards consistently experiencing over 100 percent occupancy rates. It was keen to point out that the general Intensive Care Unit (ICU) has only seven beds. It said specialised ICUs and high dependency units frequently have waiting lists.

As a shift progresses to more sophisticated and minimally invasive surgery techniques and non-invasive procedures, the IDB said the lack of specific outpatient day recovery beds is becoming an important limitation. It said the main operating theatre currently has just six suites, which is insufficient to attend to the growing quantity of elective surgeries requested by an expanded array of medical specialists.

As for the Accident and Emergency (A&E) department, the bank said it has a bed assignment that covers merely 50 percent of demand and no areas for paediatric and psychological examination and isolation. In fact, the report states that the current A&E department has 19 beds catering to all patients. However, the bank said this is not ideal as children witness the treatment of injuries and sometimes death. In addition, it said the beds are organised in a space that is not adequate to accommodate them comfortably, as such, this results in the area being congested. The bank further noted that the current location of the A&E department was a temporary configuration introduced 30 years ago that became permanent, adding that there is need for expansion of the A&E services to reduce overcrowding and long wait time.

Kaieteur News understands that additional physical deficiencies exist in the laboratory, pharmacy, imaging, and support services (administration, warehousing, and staff environments). Expounding further, the bank said GPHC has one central pharmacy that serves all the departments, one that serves outpatients, and one for paediatric patients. As a result, waiting times for medicine are usually long in a waiting room with inadequate space.

Over the years, in the absence of a master plan, the IDB said the spontaneous addition of services in improvised infrastructure and settings on the GPHC campus has created a situation of improper patient flows, supply provision, and medical waste disposal, in which transfers occur in the open environment and sometimes across public thoroughfares. The financial institution said this generates risk for accidents and cross-contamination. In the most extreme cases, such as the maternity ward, it said wood buildings from the 19th century at GPHC are still operational and represent fire hazards due to faulty electrical installations.

In addition, the IDB said makeshift storage rooms using shipping containers are used to store medical supplies in two separate sections of the hospital grounds. This state of affairs it said needs to be improved.

Recently, some of GPHC’s facilities have undergone infrastructure changes to manage expanding patient needs. These include the expansion and rehabilitation of the maternity wards, an extension of the industry health centre, fabrication of a walk-in mortuary, and the construction of an 18-bed mental health ward.

Following an engagement with the hospital management team, including personnel from the operational health and safety, quality improvement, strategic planning, and facility maintenance departments, several recommendations were made about needed improvements. They are as follows:

1. Construct a new A&E facility with more beds and which will allow for better patient flow. This facility should be constructed with three floors and located within the compound close to the East Street entrance.
2. Construct a new inpatient and outpatient facility to accommodate increased patient load and free up beds in the A&E department. This facility should also include clinical services and should be constructed within the compound close to Lamaha Street. The ground floor would be designated for outpatients offering internal medicine, obstetrics/gynecologic, pediatric and surgery services. The first floor would accommodate wards and the second floor would be for the classrooms/lecture rooms. Some storage containers would have to be relocated to construct this facility.
3. Expand the main operating theatre from six to 11 rooms and the ICU from seven to 20 beds. Once other services such as A&E clinical services are relocated to the new buildings to be constructed space will become available to facilitate the expansion and relocation of the ICU and theatre.
4. Expand the medical lab and radiology. There is no space for additional equipment at the current lab. Once clinical services are relocated to the new outpatient building, space will become available for expansion of the labs.
5. Integrate support services such as the mortuary, laundry, housekeeping, warehousing, and catering services, into all the hospital buildings to reduce the risk of contamination and increase efficiency.
6. Construct a new administrative complex with staff facilities. The existing building is to be demolished and a new administrative building to be located to the extreme north of the southern half of the compound, where the present conference room building is located. The building will have four (4) floors with the ground floor designated for parking and the first to third floors for offices and conference.
7. Construct a warehouse with a fully automated inventory system. Currently, there are no warehousing facilities at the hospital. Storage is done in temporary containers. The proposed warehouse will occupy the footprint where the present administrative building is located.
8. Construct a new pathology laboratory.

SIMILAR SITUATIONS

Kaieteur News previously reported that similar situations also exist at the New Amsterdam Hospital and the Linden Hospital Complex. The New Amsterdam Hospital is the second largest hospital after GPHC, and along with the Linden Hospital Complex, serve a significant catchment area including receiving patients from other regions and the hinterland.

The IDB said both hospitals possess limited capacity in their accident and emergency departments, intensive care units, high dependency units, surgical rooms, and imaging departments. Moreover, New Amsterdam was constructed nearly 20 years ago lacks sufficient installations for outpatient clinics, inpatient wards, and the pathology laboratory and has no buildings to house a central sterilisation unit, administration, and medical and paramedical staff on call.

The Linden Hospital Complex is also in a troubling state, as it is unable to properly deliver the full contingent of obstetric, neonatal and child health services. It also does not have a burn unit to attend to accident patients. The bank said strengthening these regional hospitals to provide the full contingent of Level 4 services will also reduce the transfer of patients to the GPHC, thus reducing the patient load of that hospital.

The hospitals also currently have challenges regarding environmental management and safety, including infectious and liquid waste management, lack of established safety procedures, systems and equipment, etc.

Government has said it will tap approximately US$48M of a US$160M loan from the IDB to address the deficiencies outlined at each health institution.

 

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