Queen II on its knees

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INVESTIGATIONS by the Lesotho Times have revealed depressing details about the deteriorating standards at Queen Elizabeth II Hospital, the country’s biggest and only referral health institution.

As explained in our lead story, authorities have watched the hospital sliding into near-paralysis because of what we fear could be a blatant case of abdication of duty and sheer negligence.

Otherwise what else could explain the hospital’s decision to suspend critical surgical operations because of erratic power supplies and the lack of basics such as oxygen?

It’s disquieting that the country’s major hospital cannot attend to critical cases because someone does not bother to check why the electricity supplies at the hospital are erratic.

We are thinking of the up to 50 patients that the surgical department has to take into its theatres every week.

How about the expecting women who might need ceasarian sections?

Then there are emergency cases of people who would have been either shot, stabbed or injured in road accidents.

Isn’t it alarming that there are other emergencies such as bowel obstruction, appendicitis and ruptured ectopic pregnancies as well as urgent cases referred from district hospitals?

We have learnt that the crisis at the hospital is even deeper. Basic drugs that any health institution, let alone a referral hospital, should have are nowhere near Queen Elizabeth II Hospital. The blood reserves are always at critical levels. Essential things such as surgical gloves are in short supply.

We know that some patients sleep on the floor, and there is no hot water for their baths. Add to that a disaffected workforce that has to endure long hours in deplorable conditions. Doctors are forced to work long shifts because the hospital simply doesn’t have enough of them.

Nurses struggle to cope with the multitudes that have nowhere else to seek health services.

Some of the health workers complain that either their salaries are too low or delayed – or both – yet we expect committed and diligent service from them.

Needless to say, Queen Elizabeth II Hospital buildings are dilapidated. Private hospitals and clinics that offer better services in cleaner and friendlier conditions are there but they are for those who can afford.

Lest we forget, the majority of Lesotho’s 1.8 million people live below one United States dollar a day in a country where one in every four people has HIV, the virus that causes Aids.

This means the majority of the poor people of this country have no choice but to go to Queen Elizabeth II Hospital when they are sick or involved in accidents because that is the only place they can afford.

But if the conditions at the country’s major hospital are that ominous, we shudder to imagine how the situation is like at district hospitals and clinics.

It is the duty of every responsible government to ensure that the country’s healthcare system is in order. Curiously, a spokesman in the ministry of health said the problems at Queen Elizabeth II Hospital were minor and will be sorted out.

The powers-that-be are likely to be quick to remind us that they are building a new referral hospital which they say will be well-equipped. But as long as no one understands the underlying problems in our health sector, the crisis will never end. The priority should be to put proper systems in place.

The supply side is clearly one area the government can get right.

If the chosen supplier cannot deliver basic medicines and ancillary items, why should he be kept?

If the drugs and equipment are available at the central stores, then whoever is tasked with making orders for Queen Elizabeth II Hospital must not draw a single cent of taxpayers’ money.

And if there is no money to buy all those essentials, including functional power generators, the government should consider revising its spending.

That includes not buying ministers luxury four-wheel-drive vehicles ahead of more urgent priorities.

As long as we see the worrying situation in our healthcare system as a “minor problem” then we will continue to have a much bigger problem.

As it is we are sitting on a ticking time bomb – and we’ll continue losing lives unnecessarily – until the government takes drastic measures to revamp the entire health care system.

Access to health care should not be reduced to a privilege. It is a basic human right.

MASERU — If you have a serious injury or illness today there is a high possibility that you might die because Queen Elizabeth II Hospital, Lesotho’s only referral health institution, does not have enough basic medicines and machines are breaking down.

Surgical operations are frequently stalled because of erratic power cuts.

The food served at the hospital is bad, but patients do not complain because most of them say it’s better than what they eat at home.

The majority of Lesotho’s population of 1.8 million – who live on less than US$1 a day – seek medical services at Queen Elizabeth II Hospital.

The hospital charges a consultation fee of M15.

Queen Elizabeth II Hospital is in a serious crisis and doctors fear the situation could get worse unless urgent action is taken by the authorities.

A two-week investigation conducted by the Lesotho Times has revealed that the situation is dire at Lesotho’s biggest hospital.

Diagnostic machines don’t work properly or they are simply not there.

Or they are wrong machines for the job altogether.

Basic medicines are in short supply and the blood bank – where they keep blood for transfusion – is virtually empty.

On Tuesday morning the hospital was forced to cancel all surgical operations because of sporadic power cuts. 

Last week the hospital also cancelled operations because of erratic power supplies.

Theatres at hospitals must have uninterrupted power supplies because most of the machines there use electricity.

When an operation starts a patient relies on an external breathing system which is powered by electricity.

Any power cut might kill the patient.

Besides, doctors need light to see.

A hospital must have a back-up generator that immediately triggers on once power has been cut off.

Although Queen Elizabeth II Hospital is said to have a generator it does not seem to be working.

The impact of this problem is huge. The hospital has five theatres that different departments use on allocated days a week.

The department of gynaecology is allocated Mondays and Wednesdays and deals with about 10 patients on each of the days.

The surgical department is allocated Tuesdays and Thursdays and it attends to about 25 patients per day.

Then there are traumatic cases of people who would have been either shot, stabbed or injured in accidents that might need to be taken to a theatre.

There are other emergencies such as bowel obstruction, appendicitis, ruptured ectopic pregnancies and urgent caesarean section operations as well as urgent cases referred from district hospitals. 

The hospital has to deal with such cases every day.

Doctors at the hospital say this means that if the theatres do not work for one day an average of 20 patients would have been put at the risk of dying. 

If they don’t open for a week the number of patients put at risk could run into hundreds, doctors say.

This also creates a backlog of patients who need operations.

The Lesotho Times understands that power cuts at the hospital have been going on for quite a long time but nothing has been done to rectify the problem.

Yet Ministry of Health spokesperson Tumisang Mokoai said the problem was minor.

He said the ministry had done all in its power to ensure that the hospital does not have power cuts.

“There is always a plan B during power cuts,” Mokoai said.

The hospital does not have an intensive care unit (ICU) which is one of the most critical units that a referral hospital must have. 

People who are so critical that they need life support have to be put in the ICU, including patients from major operations, patients in a coma or reduced consciousness as well as those  having difficulty breathing.

Also Queen Elizabeth II Hospital does not have a high-dependency unit, which is a step lower than the ICU.

Doctors say it is a scandal that Lesotho’s biggest hospital does not have such important units.

“Sometimes you watch patients die because there is very little you can do,” said one doctor who has worked at the hospital for the past two years.

Before the power supply problem, operations were being stopped because there was no oxygen, a critical requirement during operations.

During operations a patient is kept breathing by an external oxygen supply system but for some weeks Queen Elizabeth II Hospital did not have supplies.

Sources however say the supply has since slightly improved.

The hospital also has a serious shortage of intravenous fluids, popularly known as drips.

This is the most critical fluid that every hospital must have.

When the “drips” are available they are in 200ml packets instead of one litre.

The 200ml packets are used for children but at the moment Queen Elizabeth II Hospital is using them for adult patients.

The problem is that an adult patient needs five of these small packets to make the standard one litre.

But at the moment the hospital is so short-staffed that it is virtually impossible for nurses to change those drips for each patient.

The hospital is already crowded.

On average a nurse is responsible for 35 patients.

“There is no one to change those drips,” another senior doctor said. “That is why patients are dying because they are dehydrated.”

Some antibiotics are hard to come by at Queen Elizabeth II Hospital.

Doctors say they last saw some basic antibiotics in September last year.

The Lesotho Times can reveal that an important injectable antibiotic such as gentamycin is at many times not available at the hospital.

Gentamycin is a first-line antibiotic and one of the most important at any hospital.

There are other medicines that the hospital does not have.

A powerful, basic pain killer called diclofenac, which is normally used for people with serious injuries like fractures, is only available as injections, but not as tablets that the patient can take home.

Many patients thus complain that they keep getting the same pain killers, even when the pain killer is not or no longer effective.

This is mainly because of the shortage of other effective painkillers.

But the crisis is broader. 

The hospital does not have crucial vitamin tablets.

Vitamin B Complex, which is mostly used on Aids and malnourished patients, was last seen at the hospital last year.

Vitamin B Complex enhances metabolism and boosts the patient’s energy sources.

The supply of multivitamins which are very important for Aids patients is “extremely erratic”, according to doctors.

Neurobion, a high concentration of vitamins and minerals that helps nerve regeneration for stroke patients and other nerve-related injuries, is also not available.

The Lesotho Times understands that this was last supplied to the hospital last year.

The hospital also does not have enough blood for transfusion.

Blood levels are currently very low. 

Although Lesotho does not have a scientific study which indicates how much blood is needed it is estimated that the country needs between 550 and 600 units of blood per month.

People who lose too much blood in accidents need transfusion.

Those with gunshot and knife wounds normally require transfusion as well.

Doctors say the situation is frightening.

“Lots of people are dying because we just don’t have blood,” another doctor said.

There is also a shortage of critical things like latex and surgical gloves.

Doctors say getting gloves, the basic protective wear a health worker needs to examine patients, is a hassle.

The normal practice is that a doctor or nurse must use a different set of gloves for each patient.

This however is not being done because there is a shortage.

This is putting patients and health workers at risk because they have to use the same pair of gloves to examine different patients.

Diagnostic equipment is either not working or not there at all.

Currently the hospital does spine X-rays – for example, thoraco-lumber X-rays – only in very exceptional cases because the radiographers say the machine is not working properly.

Yet spine X-rays should be done routinely on all patients who are suspected of having spine problems.

This means that if you have an accident today you may have to be transferred to Bloemfontein, South Africa, for an X-ray that should otherwise be done in Lesotho if the hospital was maintaining its radiography machine.

Queen Elizabeth II Hospital cannot do CT scans which in other regional countries is considered a basic type of scan for people with strokes and other injuries.

Doctors say if you have a stroke it could mean that part of the brain is dead or there is bleeding in the brain.

This can only be precisely confirmed by a CT scan.

This means the scan is          important in helping the doctor decide whether to give certain drugs or not in stroke patients.

If there is bleeding in the brain after head trauma doctors may decide to drill a hole, called a burr-hole, through the skull to let the blood out and release pressure. 

Because the hospital does not have a CT scan machine it means doctors have to use their knowledge of the human body to make the decision whether to do a burr hole or not and to know precisely where on the skull to drill.

The problem however is that this diagnosis may not be accurate, which is why radiology is critical to confirm the doctor’s suspicions.

“We literary have to guess what the problem is,” said another doctor.

Sources in the health sector say a CT scan machine donated to Lesotho by well-wishers has been stuck in South Africa for the past few months because of bureaucracy.

There is a serious shortage of beds at the hospital.

A Lesotho Times crew witnessed dozens of patients who were sleeping on the floor and some sharing beds.

The wards don’t have heating as well, when winter temperatures can dip to as low as zero degrees Celsius.

The geyser at the hospital is not working, which means patients take cold baths if they are not fortunate enough to have personal electric kettles to heat up some water for themselves.

In some wards and along the corridors paint is peeling off the walls.

The toilets are filthy and hazardous to health.

Grass outside is overgrown.

Workers at the hospital complain about poor working conditions. 

“The nurses are underpaid and overworked,” another doctor said.

Doctors find themselves working 33-hour shifts, including on public holidays and weekends for an allowance of about M100 each time they are on “call duty”.

This, the doctors said, explains why Lesotho is one of the few countries in the world where being on call is compulsory for doctors.

“When you work for those long hours chances are very high that you will make mistakes because of fatigue,” the doctor added. 

Nurses are overwhelmed with work as well.

The other problem is that some of the workers have not received their salaries since April.

“I am working under bad conditions,” said a nurse who has been at the hospital for the past three years.

“I am overworked and underpaid. I am just not motivated.”

But the nursing problem is even bigger.

Doctors say the nurses are not well-trained.

The crisis at Queen Elizabeth II Hospital is deteriorating with each passing day.

Patients say the crisis is affecting their lives.

Many have been sent home without prescribed medication.

Some patients told the Lesotho Times that they have to wait for six hours in the queue before seeing a doctor.

“We have been waiting in the cold for hours. We arrived here at 3am but the doctors only arrived at around 10am,” said Motumi Motumi, a patient who visited the hospital yesterday.

Motumi is diabetic and he visits the hospital for monthly check-ups.

“This is putting my health at risk. I am not allowed to eat before seeing a doctor,” Motumi said.

“I have missed my breakfast which is an important meal for diabetics.”

He added: “The very same people who preach good health to us have become an obstruction.”

Motumi said he was disappointed when he did not get     all the prescribed medication after waiting for hours in the queue.    

Motumi and many other patients were sent back home without some medication.   

Seipati Mathoko, who was also at the hospital yesterday, said she had been told there was no medication for her two-year-old child.

Mathoko’s child had flu.

“The pharmacist said I should come back tomorrow to get medicine for my child but in the meantime the flu is getting worse,” Mathoko said.

“What if it gets worse?”

Mokoai said patients who claimed to have been sent home without medicine were just making up stories.

“It was just a little hiccup and it has been taken care of,” he said.

“Patients are making wrong accusations.

“The matter was taken care of two weeks ago and some pills were even distributed to district hospitals.

“Everything is under control.”

 

 

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