Killing time for bypass operations

By Chathuri Dissanayake

The waiting time of some 30,000 patients who need bypass heart surgeries to undergo operations has increased from six months to one year during 2008. The country has only four hospitals which are equipped to carry out cardiothoracic surgeries– the National, Kandy and Karapitiya Hospitals carry out adult operations and Lady Ridgeway Hospital carries out only paediatric surgeries.

According to GMOA assistant secretary Dr. Upul Gunesekera, none of these centres are running at their optimum levels. Mismanagement and lack of a proper policy were the cause for the longer waiting time for patients, the GMOA claimed.

"Colombo National Hospital has carried out the most number of surgeries in the last few years. Usually we have carried out over 1,000 open heart surgeries per year. In 2006 we have done 1,300 surgeries while in 2007 we did over 1,000 operations. But this time we can't achieve that kind of figure this year due to various reasons," Dr. Gunesekera said.

The National hospital has four theatres where cardiothoracic surgeries can be performed. How ever the number of surgeries depends on the bed availability in the two Intensive Care Units (ICUs) and High Dependency Unit (HDU).

"After each heart operation it is a must to place the patient in the ICU because the patient has to be kept on the machine till he/she stabilises. But we have only 10 beds functioning out of 11 ICU beds and since 2002 only four beds functioning in the HDU which was initially planned to hold 12 beds. So we have to limit the surgeries according to bed availability," he said.

Dr. Gunesekera claimed that the main reason for this bottleneck in bed availability is the lack of trained nurses to care for the patients. "We have been asking the ministry to give us an adequate number of nurses to run this unit as it is a critical unit. We have four theatres and we can do only four surgeries. But when there were beds available we have done more than 10 surgeries a day when there was a possibility. If we are given resources we can do it," he said.

Dr. Gunesekera also said there was a need to increase the number of ICU beds in the National Hospital as there is an increase in patients in recent times.

"The 11 beds have been there for a long time but now there is an increase in the number of cases. Further there are four doctors performing surgeries whereas earlier there were only three doctors. There are not enough beds for the patients who are being operated on by four doctors. So we have to increase the number of beds and nurses to this unit," he said.

He said that even though a request was made for 20 nurses to start functioning four more beds in the HDU, only five nurses were provided to fill the vacancies created by nurses who go on leave for training.
Dr. Gunesekera also claimed that over 130 theatre schedules have been postponed for the past five months due to lack of ICU beds at the National Hospital where four theatre schedules are prepared per day for each of the four theatres.

"As theatre schedules are cancelled there are more patients who get added on to the list every day. This is why the waiting time has grown longer. The reason for the cancellations is that the hospital does not have enough nurses and equipment. There are days when a single surgery has not been performed due to lack of ICU beds. We have informed the ministry in writing to arrange a meeting to resolve this matter, but so far nothing has been done. To date we have not received the full requirement of nurses for these units," he said.

Dr. Gunesekera also said that there the ministry has not allocated the doctors according to the requirement of the hospitals. He said that the National Hospital currently has five cardiothoracic surgeons but has only four theatres. However in Karapitiya hospital there are two theatres but the hospital has only one cardiothoracic surgeon.

"We had a meeting at the ministry about a month ago with Health Secretary Dr. Athula Kahandaliyanage, Director General Dr. Ajith Mendis and cardiothoracic surgeons in the country. At the meeting we asked the ministry to summon all the surgeons and prepare a strategic plan and a policy to develop the cardiothoracic section but unfortunately nothing has been done in this regard. There is a new problem brewing now because cardiothoracic surgeons are leaving the country. Doctors are beginning to get frustrated because of the issues in the service," he said.

However, National Hospital Director Dr. Hector Werasinghe claimed that the issue of nurse shortage has been sorted out by now since a new batch of nurses has been allocated for the vacant posts in the ICU. Meanwhile Dr. Kahandaliyanage said that the solution offered by the ministry to the whole issue was to prevent people from getting the disease.

"We know that the list for bypass surgeries is increasing but we don't have money to open new units so we have to take preventive measures," he said. However, he admitted there was a lack of equipment and nursing staff at present in most of the hospitals which carry out cardiothoracic surgeries.

"We are planning to provide the equipment and fill the vacancies for nurses in all other hospitals by the end of next year. This year there will be 2,000 more nurses passing out after their training and another 4,000 to 5,000 will pass out next year. So we will be able to fill the vacancies then," he said.

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