Sickly Health

By Faraza Farook and Tania Fernando

The cadre shortage which has been a long standing problem in the health sector has taken a serious turn with officials failing to foresee the rise in demand and to work out adequate strategies to minimize this problem.

While the shortage of specialist consultants is felt, the scarcity of nurses whose services are a vital component for the efficient discharge of health care work is much more grave. 

Although annually, a certain number of trainee nurses are taken in, the output is still inadequate when compared to the demand. The training period for nurses lasts for three years and by the time they have passed out, the demand has further increased.

According to the annual health bulletin the number of nurses per 100,000 population increased from 75 in 1997 to 77 in 1998 and decreased to 74 in 1999. 

Today's cadre requirement for nurses stands at 30,000 but only half the demand has been catered to. Although 1200 nurses are said to be passing out this year, this is merely a drop in the ocean compared to the number required which is around 15,000.

The Public Service United Nurses Union General Secretary Ajantha Gamage said nurses lack the basic facilities to carry out their duties effectively. "In a ward of about 150 patients, there are only two to three thermometers, which makes our task time consuming".

Nurses who are expected to work only six hour shifts have to in some instances go on for more than 18 hours. Usually every five patients are allocated one nurse in a ward, but the deficiency has resulted in their having to care for more than five.

A visit to the ICU of the Cardiology Unit, revealed the seriousness of the problem. There were only six nurses for the 18 patients, when one nurse is required for every patient. 

According to Ms. Gamage, the shortfall is mainly in Colombo due to the high cost of living and deprivation of living quarters for married nurses. "Nurses always request for transfers to their home towns to reduce any additional financial burdens".

Sometimes, clinics are not conducted due to the lack of consultants and most clinics at the national hospital are deprived of a nurse due to its acute deficiency.

The government, in a bid to try and improve patient care service has opened extensions to existing hospitals which have become a complete failure due to the inadequate distribution of infrastructure, manpower and other resources. 

The Mirigama Base Hospital which has only six wards has 13 MBBS doctors wasting their time with very little to do. Often patients are transferred to the Wathupitiwala base Hospital, which is 20 minutes away, with doctors failing to take responsibility for critical patients due to the lack of facilities. 

"At the slightest doubt, we transfer the patient", a doctor attached to the hospital said. 

Ad hoc appointments are another serious issue. Most often, while the demand for doctors exist in one particular hospital, postings are made to another institution where their services are of little use.

Surgeons in particular, are forced to idle unable to put their skilled hands to work with no theatre and lack of infrastructure. Sometimes they don't have enough trained nursing staff too.

The Jaffna Teaching Hospital is also facing a crisis of not being able to fill the approved cadre. Some of the vacancies in specialised fields include Pathologists, Physicians, Surgeons, Neuro Surgeons, Anaesthetists, Obstetrician and Gynaecologists. The total cadre approved for the teaching hospital is 28, while only four of the posts have been filled.

Meanwhile, President of the Government Medical Officers Association (GMOA) Wimal Jayantha said the problem was due to the lack of proper planning.

The Lady Ridgeway Hospital, (LRH) the only pioneering Paediatric institution in Sri Lanka recently opened a new 10 storied building consisting of 14 units inclusive of an Accident Service, Cardiology unit, Cardiothoracic unit, Nephrology, Neurology, Surgical Intensive Care and a theatre complex.

Built within a period of two years with assistance from the Chinese Government which loaned 500 million rupees, only a few of the units are currently functioning. Although the hospital is not fully functional, the loan received from the Chinese government has to be paid back.

Only four of the 14 units are functioning due to an acute shortage of staff. Though the ministry of health approved the cadre requirement for the new units which was given at 625, the hospital received only 75.

The approved cadre for nurses for the hospital is 605, but only 305 have been appointed. "There is always a drain out, but only a few replacing them", Dr. Jayantha said.

He also said that the government was planning to declare LRH the National Referral Centre for Paediatric care. 

The LRH consists of six new operating theatres with four of them being equipped. The new ICU has a capacity to accommodate 18 beds and 90% of the equipment is available. However, the units remain closed due to the lack of staff.

With congenital heart disease rated the second commonest form of illness in Sri Lanka, more than 600 patients get added to the already overcrowded waiting list for the Paediatric Cardiothoracic surgery. "They develop failure and die during the waiting time", Dr. Jayantha pointed out.

Suranganie Kumari a mother of a 10-year-old from Mahiyangana lamented at the number of times her son's surgery was postponed. Having been diagnosed with hole in the heart, the boy's surgery has been postponed over 10 times. Doctors have said it might soon become inoperable .

Similar cries are echoed from many patients seeking treatment from state hospitals. The public sector provides health care for nearly 60 per cent of the population. Ninety five per cent of inpatient care is provided by the public sector. 

Sri Lanka has a total of 893 public health care institutions including Central Dispensaries, peripheral units and rural hospitals. More and more hospitals in rural areas are coming up to ensure that all people will have easy access to primary health care services. Yet, these hospitals are not fully equipped to function effectively lacking in both infrastructure and staff.

Though most services are concentrated in Colombo, it has been observed that even the National Hospital in Sri Lanka, which is also a national referral centre, lacks the services of adequate staff to cater to the thousands who pour in daily for varied medical care including some 3000 patients who call over at the OPD.

It's not a rare sight to see the poor conditions of our public hospitals and the pathetic sight of patients who arrive even before dawn to obtain some sort of medical attention. Very often they have to return many times to ensure that at least some tests get carried out.

Jayantha Perera from Anuradhapura was at the ENT Clinic of the National Hospital with his wife crying in pain suffering from an ear problem. Having arrived late at the clinic, he said that they had been rudely turned away by the nurses. "She can't bear the pain and even on humanitarian grounds they are not willing to admit her", he said.

He also said that since they were travelling from far, it was difficult for them to even find a place to stay. "Since we can't afford private medication, I have to watch her suffer in pain" Perera said.
 
 

Inside the glass house

Editorial/ Opinion Contents