A Princess decrowned, a glory faded
Nnasaretha Kgamanyane | Friday January 30, 2015 15:24
From its establishment as one of the first landmarks in the fledgling capital, Princess Marina Hospital has watched as the city burgeoned around it.
From a population of 5,000 people at Independence, the city now has more than 300,000 residents with an ever-deepening complexity of health care needs, over and above epidemics such as HIV/AIDS. Princess Marina’s age can be seen in that when it was established, the capital city was still known as Gaberones, a colonial misspelling of the word Gaborone, which would be adopted two years after the hospital opened its doors.
Over the years, the ballooning population of the city and other villages which use the hospital as a referral centre, has been unmatched by developments and expansions within the institute, with the establishment of citywide clinics failing to stem the tide.
This week, it was revealed that a staff compliment of 1,300 services the 2,500 patients seen daily in the Outpatients Department with about 100 seen in the Accident and Emergency Department.
The Hospital has 567 beds, which at any time cater for 750 patients, giving an unhealthy bed occupancy rate of between 120 to 150 percent.
Speaking recently, the hospital’s clinical director, Ishmael Makone said overcrowding could affect patients’ symptoms and clinical outcome. “It could affect physicians’ effectiveness, causing frustration among medical staff and even contributing towards violence in the wards,” he said.
Makone adds: “Overcrowding will place an increasing economic burden on the hospital, leading to a shortage of beds, delays in laboratory tests, and a shortage of nursing staff.
“It may compromise the quality of care and lead to poor infection control.”
Among the staff, overcrowding is leading to burnout with increased sick leaves, absenteeism and low morale, while also compromising confidentiality between patients and their doctors. Princess Marina is the largest and possibly the busiest of the country’s three referral hospitals serving mainly the southern region. Diseases of the heart, liver, kidney and chronic illnesses such as cancer are referred to the hospital as it carries the highest concentration of medical talent and technology among government institutions. However, the noble objectives that must have been replete in the speeches at the official opening would be offensive to many of the patients at the hospital today.
Some are squeezed in cubicles, wards are overflowing resulting in the use of ‘floor beds’ and the gap between one bed and another has been narrowing over the years. Patients are not completely blameless in this narrative however.
“The use of the emergency department for non-urgent health conditions is another contributory factor in overcrowding,” says Makone. “And it has been the subject of considerable debate. “Using the hospital emergency department for minor problems is inappropriate and expensive and it may hamper physicians’ ability to give medical attention to those needing emergency care.”
However, one of the unspoken but leading causes of overcrowding at Princess Marina is the golden principle that no patient can be turned away. With healthcare being a priority under the Vision 2016 document, all National Development Plans and various other policies, Princess Marina as the oldest government hospital has had little choice but to play the primary role in absorbing patients.
This quixotic outlook, however, has also been abused as medical practitioners point out that political interference in the hospital’s running has also contributed to overcrowding.
“The hospital is instructed to admit patients who could be assisted at other facilities,” said one doctor. “Sometimes a patient is on the verge of being turned over to another facility and they make a call. Then a politician or someone with political influence will come on the phone and instruct Marina authorities to provide that patient with health care. “It is, after all, a government-funded entity.”
Lodgers or parents who sleep over with their admitted children, also contribute to congestion while also running Marina’s coffers ragged. The lodgers are fed and use utilities free of charge for the duration that their children are admitted.
Marina’s woes are exacerbated by the absence of a primary or district hospital in Gaborone, which has meant increased direct referrals from clinics as well as self-referrals.
Dr Doreen Masire, an obstetrician-gynecologist, says patients need to be made to understand that self-referrals are unacceptable. She believes they need to be taught to go back to clinics near their homesteads.
“We also have to identify the root cause of the problems making people flock to Princess Marina leaving health facilities near their homes.
“Some patients refer themselves because the local clinic they had been going to lost their results,” she said. For Bokamoso’s Lesego Kantle, overcrowding hinders infection control.
“Moving around the patients is not only hazardous to them, but to people who are taking care of them,” she said. “In Bokamoso when a woman has delivered and is fine, we release her together with the child to avoid overcrowding, but when the baby is sick we admit and take care of it when the mother is released. “The mother then visits her child on a daily basis, which reduces overcrowding.” Authorities at Marina are not sitting about twiddling their thumbs however.
During its outreach services, the hospital has reportedly started training staff in peripheral hospitals to adequately care for common conditions in order to avoid unnecessary referrals. In addition, case management is being done with a team dedicated to following up patients in the wards in order to ensure timely investigations, referrals and discharges as well as devolution of services to certain clinics such as dermatology, neurology and others. Moreover, the hospital is transferring patients to nearby district facilities as well as local clinics as it maintains a strict referral policy.
The Department of Immigration’s Kelebogile Motube believes the Ministry of Health should empower clinics in Greater Gaborone with more resources and facilities to build patient trust and reduce referrals to Princess Marina. The authorities at Marina will be hoping their principals in the ministry are listening to the suggestions and ready to lend a hand in regaining the Princess’ crown.