Obrempong Writes: When the ‘no-bed monster’ stared my sick daughter’s face

My daughter is 5. She took ill on Friday August 2018 at about 5:40am. I took her to the Kwesimintsim Government Hospital in Takoradi to seek healthcare. There were many patients there already; over 100 of them.

From the 7:10am that we got to the facility till the time her folder was retrieved, her vitals checked and we saw a doctor till we were asked to go home for lack of beds, took 7 hours.

That wasn't all. I also got to see how medical care is provided under some shocking circumstances and how depressed some nurses and other workers are due to their discontent with how things have had to be done. Before I start my story this is a short overview of the Kwesimintsim Government Hospital.

The Hospital
The Kwesiminstim Government hospital serves as the Effia Kwesiminstim Municipal Hospital. Statistics available show that, the facility takes care of over 7000 patients every month. People from the densely populated Kwesimintsim, Asakae, Apowa, Biaho, Ewusi Ejo, Anaji whindo and parts of the Sekondi Takoradi Metropolitan Area patronize this hospital.

On the average, there are 260 patients who visit the facility daily. On top of it, all road accidents happening on the Kwesimintsim Agona Nkwanta Highway are sent to this hospital.

Absence of critical staff sparks hours of delays
“I came to deliver two weeks ago but I lost my twins. But for the past three days, I have been feeling so much pain in my abdomen. So I am coming to report to the doctor. I came here at 9am. I had my folder and vitals checked by 9: 40am. But its 6 minutes to 12:00pm and my name has not been mentioned to start a queue to see the doctor. The pain in my abdomen is so severe that I cannot sit. That's why I have had to sleep on this chair. Not that I want to deprive other patients from sitting” Gifty, a 29 year old who has lost her first set of twins a few days after birth told me.

Of the over 7,000 patients that visit the facility monthly, only four medical doctors are available to care for them. This has led to serious delays running through from the point of picking folder to checking vitals to seeing a doctor.

In my case, after the folder was picked, it didn't take long before her vitals were checked at the next department. But after this, I wish I had gone home to work on some other things. We spent 3 hours without been called by the nurses to even line up to go to the consulting room. Our folder had been piled up at the Vitals room.

“Your problem isn't an issue”, a nursing mother who was sitting next to me told me. “I left home at 5:30am. What says your time?” She quizzed. “Its 11:13am”. I answered. “Well, that's how long we have had to wait. We are yet to see a doctor. When we asked why we have had to wait for this long, we were told it is an issue with the number of doctors. There is only one doctor attending to the numbers you see here”.

I didn't understand so I went up to the hospital's administrator, Mr. Felix Kesse. His honest explanation weakened me. This country!

He explained that “when one of them [doctors] is on leave, as we have at hand now, what happens is that, two of them will do ward rounds in the morning and the remaining medical officer will come and start the OPD. The medical officer starting the OPD is the same person on call for emergency cases at the Theatre. So if a call comes from the theatre, he has to leave the consulting room and then attend to the case at the theatre”.

Mr. Kesse further explained that “Sometimes, the one who is supposed to come to the OPD in the morning is called to the theatre on his way from the house. When that happens, it creates a lot of inconvenience for our clients. But when we are alerted by the OPD staff, what we do is that, the two Medical Officers doing the ward rounds, we recall one to come to the consulting room, so that when the one at the theatre is done with the case, before the one who was doing the consulting will go back to the ward.”

What this means is that, the ward rounds will also delay but we do not have a choice. If we get three extra doctors, we would have satisfied the numbers as far as medical doctors are concerned”.

NO BED SYNDROME
It's now 12:30pm. The other doctor at the ward had come to Consulting Room 1 and so there are two doctors attending to OPD cases. [One at Consulting Room 1, and the other in Consulting Room 4.]

I have been assigned to consulting room 4 with the long queue. Here I got to skip the queue because my daughter was showing signs of severe malaria. In fact, the rest of the patients in the queue pleaded with one another to allow me go after 6 patients had been served.

In the consulting room, I felt like I was daydreaming when the female doctor told me that my daughter ought to be admitted but she doubts if there is a bed to accommodate her. I asked if this was a no bed syndrome problem or just a case in isolation. Honestly, I needed not to wait for an answer when I saw the facial expression of the other female medical assistant.

No bed syndrome here at the Kwesimintsim Government Hospital? I said. The doctor said, “Yes. It's a big issue”. The doctor continued writing prescriptions in the folder, whilst the assistant doctor asked that I wait a while whilst she calls the “Children's Ward” to ask if someone has been discharged.

The doctor handed over the folder to me and asked that I go for drugs and other infusions because my daughter had to be given infusion to control rise in her temperature immediately. I went to the pharmacy to meet this long queue. Oh God, this is unfair! But here comes the assistant doctor who took the folder and went inside the pharmacy. In about 3 minutes she returned with the drugs and the infusion. Sigh! She directed me then to the “Children's Ward”.

The depressing condition of a supposed Children's Ward.

When I got to the supposed 'Children's Ward', I thanked God there was no space for my daughter. This isn't a Children's Ward! How on earth do you put accident victims in the same room with children on admission, with no demarcation of any sort, just an open space! How on earth? Children at one side whilst people with all manner of conditions needing emergency care also at another side! I mean how? This same room is the female ward. Why?

“Unfortunately this is the situation we find ourselves in. We don't have an accident and emergency unit, a unit dedicated for this purpose. We don't have a pediatric unit; a children's ward. So you will see that the ground floor is for both females, children and at the same time serving as accident and emergency.”

A& E and Female Ward is in the same room
“Accident cases come, and they are all rushed in there. When a female adult is admitted, she goes in there, when accident victims come, we rushed them in there, when children are admitted we rushed them in there too. One hall!”

But children are supposed to be protected from certain conditions. Why mix children with adults, because children have low immunity. But we do not have a choice! The Administrator, Felix Osei Kesse bemoaned!

When I met this situation, I asked a nurse on duty what I can do with my child. She told me that she will set the infusion line and administer the first care and plan the next line of action, of course, not in this room, but at the Injection Room far away from the supposed children's ward.

“She is supposed to take this after 12 hours. So you take her home and bring her after 12 hours so the next drugs will be administered. That is what we can do. There is no bed and no court for children. The “Children Ward” can take only 8 children. I am sorry but that's what it is”! She told me, and so that’s what happened.

Delays at the Pharmacy and Lab

“You see, it is so depressing that after being in long queues, from picking your folder, to checking your vitals, to seeing a doctor and him asking you for a lab test in another queue, and finally coming to meet yet another long queue at the pharmacy. It is so depressing and uncharacteristic of a country seeking universal healthcare. This system here, in my view, is designed for those resilient in health, not anybody” a Ghanaian with a British accent who has struggled with the health system told me.

“You know, the OPD system is a chain. Felix Kesse, the hospital's administrator explained. “You would have to start by picking your folder and following through to checking your vitals, and seeing a doctor. Some patients would have to go to the lab and finally we all meet at the pharmacy. In this process, when one department is not efficient, it will definitely affect the time a patient will spend at the hospital. So in looking at adding at least three more doctors to our present numbers, we have to look at these two departments”.

“But we lack the staff numbers required for the pharmacy and the lab. There is only one pharmacist in this hospital with three technical assistants. You cannot also have the only pharmacist stay here 24/7. So apart from the numbers she has had to deal with during the day, the hospital is without a pharmacist in late afternoon and throughout the night. Similar challenge is with the numbers at the lab. So if we would have to reduce the time, we need to look at these departments and provide the right numbers according to what our staffing norms says”.

Some nurses who wouldn’t speak to me on record narrated how depressing it is to know a doctor isn’t coming anytime soon, but they have to “manage” the patients till one returns. “Almost every department here has issues with staff. One nurse told me. “We stress ourselves just like the four doctors. I remember when the Auditor General came to verify payroll workers. The stress that befell on some of us, due to lack of backup numbers. I myself I am not well, but I have to be here. what can I do?”

My experience at the Kwesiminstim hospital makes me wonder whether the free healthcare system provided by the National Health Insurance Authority is anti-expansion of hospital infrastructure and services considering the increase in hospital’s numbers and services.

As we speak, some persons needing inpatient care are technically been turned away for lack of beds at the Kwesimintsim Government Hospital, whilst children on admission are exposed to the trauma of seeing people in all manner of ailments needing emergency medical services.