Overcrowding compromises care at Marina
Baboki Kayawe | Wednesday August 26, 2015 15:13
Officials said the hospital’s 567 beds had to contend with 750 in-patients, weighing on service delivery and quality. Absenteeism is rising as staff files sick notes to get away from the depressing demand for their services.
Briefing the media yesterday, the hospital’s clinical director, Dr Ishmael Makone, said the facility received about 100 patients daily in the accidents and emergency department, of which 60 percent are admitted. Consequently, the bed occupancy rate exceeds 100 percent.
Overcrowding is worsened by the absence of a district hospital in Gaborone, meaning that patients go directly from clinics to the referral hospital. Population growth in Gaborone and surrounding villages also contribute to the congestion.
“Most commonly affected areas are the maternity wards, post-natal wards, gynecological and neonatal ward and some surgical wards,” Makone said.
Factors within Princess Marina Hospital also worsen the congestion. Supply chain management, where the facility receives insufficient blood and blood products, results in operations being postponed and planned discharges being delayed.
“Infrastructural issues are yet another hindrance as space is limited and cannot be expanded,” he said. “Hence, the hospital cannot cope with the city’s increasing population and this leads to a shortage of space for consultation, theatre time and new services.”
Dr Makone added that Princess Marina Hospital serves as a lodging facility for patients in transit to South African health facilities and vice versa.
“We also have mothers lodging with their children, who are often more than 100 on a daily basis, as well as abandoned babies brought by police and the public,” he added.
External factors that worsen congestion include lack of specialists at primary and district hospitals, resulting in high referral rates to Princess Marina. “For instance Princess Marina is the only public facility admitting sick newborns in southern Botswana and those who require intensive care unit treatment,” he said.
The referral hospital also handles post-natal surgeries on newly born babies and other childhood cases, cancer and heart problems.
Dr Makone said self-referrals were also problematic. Patients come with illnesses that could be treated at clinics.
One nurse must look after four patients. However, overcrowding increases the number of patients per nurse to 10, meaning that the quality of care is compromised.
“The staff also gets burnt out, resulting in a lot of sick leaves, and consequently absenteeism,” he said. “This also could lead to increased morbidity and mortality. It also becomes difficult to control spread of infection or clean properly with congestion and floor beds.”
Security and patient confidentiality are also compromised as doctors often examine patients in the presence of other patients. Congestion also occurs when relatives come in their numbers to visit the patients.
To curb the situation, Makone said an arrangement has been made with Scottish Livingstone Hospital in Molepolole to have healthy and stable babies admitted there; and to discourage mothers of the under-fives who are not in critical conditions and have accommodation in Gaborone not to lodge.
Princess Marina Hospital is also encouraging low-risk deliveries to be done in clinics.
Kelebogile Motumise, the hospital superintendent, said lower deliveries were registered at the five maternity clinics in Broadhurst, Mafitlhakgosi in Tlokweng, Gaborone West, Old Naledi and Leserane.
Last year, these clinics collectively registered just under 2,000 births while Princess Marina on the other hand recorded 6,500. Of these, 4,500 were normal births while 3,000 were low risk. “What we are saying is that it is not good to have the hospital congested while other facilities with trained midwives and proper equipment are underutilised,” he said.
Princess Marina officials hope the planned opening of the University of Botswana medical hospital will ease the overcrowding.
Princess Marina was opened in 1966 and its last major upgrade was in 1994.