We live in one of the most violent countries in the world

‘A phenomenal burden’

By CANDIA DAMES
Guardian News Editor
candia@nasguard.com


A closer look at the impact of crime on PMH


The high level of violent crime is stretching resources all around, and officials at Princess Margaret Hospital (PMH) know that all too well. “I think that it has been said repeatedly that the impact of violence, crime, accidents on the public health care system has been almost overwhelming,” said Senator Dr. Duane Sands, who is consultant surgeon at PMH.

“The national statistics would seem to suggest that we have a murder count of whatever. In reality that number, the number of absolute deaths from violence belies the real problem.

“And this is not a new phenomenon. This is something that has been going on now for at least a decade.”

But Sands noted that the hospital continues to see more gunshot victims than in the past.

“We see on average in this country, in excess of 400 major stabbing or shooting traumas (every year),” he added.

“What has happened in the last three years is we’ve seen the knife been replaced by the gun. And so what that does to the emergency room, what that does to the operating room, the Intensive Care Unit and the wards is put a phenomenal burden [on them].”

According to information provided by Sands, in 2000, there were 323.6 assaults recorded for every 100,000 inhabitants in the United States.

By extrapolation, The Bahamas might anticipate 900 to 1,000 assaults per year.

Instead, it is recording more than 3,000 at PMH alone.

“We live in one of the most violent countries in the world,” he noted in a recent presentation at the Medical Association of The Bahamas conference.

“Trauma is a major public health problem.”

Sands noted in an interview with National Review that Medical Advisor to the Public Hospitals Authority Dr. Glen Beneby recently released a report that examined occupancy rates in all of the hospitals that fall under the PHA.

He said while there is no question that PMH is challenged on most wards (Pediatrics, Gynecology, Obstetrics etc.), occupancy rates on the surgical wards range from 92 percent to 104 percent.

Hospital officials have created another ward in what used to be the out patient area of PMH.

“If we look at the impact on the operating room, the operating room basically has now been forced to focus on emergencies and trauma,” Sands said.

“If you look at the impact on the Intensive Care Unit, the Blood Bank; if you look at the impact on the pathology lab (it’s great).”

This means that on many occasions, elective surgeries are constantly put off, Sands noted.

“And so if you look at the impact on health care in general from violence, it is a lot more significant than just the numbers we are seeing in the public,” he said.

“Resources are indeed stretched and we take this as a duty. We have to respond. And so the hospital responds however we can.”

What the public sees from this growing problem is increased waiting times, a shortage of blood at the Blood Bank and the postponement of those elective surgeries, as mentioned.

“This is the real impact of the violence and trauma on regular, ordinary people,” Sands added.

“It is a big, big problem.”

A RISKY ENVIRONMENT

“If you look at the impact of all of the violence and trauma, let’s take my house staff in surgery or in the emergency department, they are constantly exposed to the most outrageous forms of violence — seeing people beaten, stabbed, raped, molested etc.,” Sands told National Review.

“It is almost surreal, the impact on these individuals...They see the worst of people every single day. You couple that with a public response, which is not terribly supportive...and while we understand this, bear in mind that those two things put together create a very challenging emotional and psychological environment that we try to provide support for.

“To be very candid with you I don’t think we do as good a job as we should.”

The high stress level for the medical professionals is sometimes worsened when street fights continue into the emergency room.

“Notwithstanding that we have beefed up security significantly, it is not foolproof,” Sands said.

The government spends a significant amount on initiatives to provide a safe environment for staff and patients, noted Coralee Adderley, PMH administrator.

She said there may be a need to improve security even further.

“I would say that 20 years ago as a young administrator the weekend report, when you got [it] on a Monday morning, a stab here or there, a gun shot once a month was a big story,” she said.

“Now it’s almost every day and that’s a huge cause for concern.

“Any particular evening you can find that the emergency room is inundated with shootings, stabbing and so forth.

“That coupled with the fact that a lot of these patients, once they are admitted to hospital are in police custody. So that creates another dynamic for us, not just in the emergency room.”

Dr. Sarah Friday, the physician in charge of A&E, admitted the situation takes a personal emotional and psychological toll.

“I’ve been in emergency medicine for quite some time and after a while the [constant flow of trauma] patients coming in and you’re not getting to see other people with the [other] medical problems as quickly because maybe somebody with a gunshot to the chest or a stab to the arm or something like that would take precedence,” Friday said.

“You have other people with the other medical emergencies but because of the time sensitive nature of a person who is bleeding you find that other persons may have a delay in their care because we have someone who’s bleeding and that of course will take priority.

“If you talk to a lot of the staff it does take a toll on you because you walk out of the trauma room having seen somebody stabbed to the chest and then you turn around and then somebody, a diabetic patient for instance who may have missed his medication, and you’ve just left somebody who may have died.

“And so [when you see] the next patient you’re still carrying that burden of a young 17-year-old just shot to the chest and is now dead and you have to see that next patient.”

A DOUBLE THREAT

With chronic non-communicable diseases (CNCD) already placing a strain on health care services, the rising cases that stem from violence are worsening an already bad situation.

The Pan American Health Organization (PAHO), which is the regional arm of the World Health Organization (WHO), predicts a 300 percent increase in deaths from cardiovascular diseases in the region over the next 20 years.

Sands pointed out in his recent presentation at the Medical Association of The Bahamas conference that The Bahamas, like the rest of the Caribbean and America, is experiencing an epidemic of deaths and morbidity from the CNCDs such as obesity, high cholesterol, diabetes, hypertension, tobacco use, physical inactivity and unhealthy diets.

Sands indicated that violence and trauma divert scarce resources from other medical conditions and have done so for many years.

He also noted that the “culture” of violence creates a hazardous work environment that adds to absenteeism and attrition among medical staff.

Sands also noted that trauma patients not operated on in a timely fashion suffer more infections and thrombotic complications.

THE WAY FORWARD

“The debate about the way forward with health care is a debate about choices,” Sands said.

“And this government has made it very clear that it is going to adjust the resources upward for the provision of health care and has done a number of things.

“There is no question that we need a new hospital and that is going to create a whole lot of discussion about where those funds are coming from.”

The government had intended to use proceeds from the sale of a majority stake in Bahamas Telecommunications Company (BTC) to build a new hospital.

But with a dramatic downturn in the economy, the government was forced to increase borrowing, which resulted in rising debt levels.

The new plan is to use the proceeds from the sale of BTC to Cable and Wireless Communications to pay down the debt.

The government has instead opted to build a new critical care block on PMH’s compound. It will have an additional six operating rooms.

“But we have other challenges that have to be dealt with and we are preparing various position papers to put forward to the administration and the Ministry (of Health) to consider,” Sands said.

“While we all have a duty to try and intercede [as a result of] this carnage that’s going on in this country, we (PMH) have to stand in the gap.

“So the physicians, the nurses, the ancillary staff, the hospital administrators, we don’t have a choice. This hospital does not close and we have to do what we can with the resources that we have.”

Sands said, “It is a real, real problem and it is the direct impact of everything that’s going on and the choices that Bahamians are making, and fundamentally resolving this is going to require the energy and the effort of every single Bahamian.”

He said the hope is that there is not a further escalation in demands being placed on PMH because the hospital has no other choice but to care for people who come for treatment.

Adderley added, “Despite the sometimes negative comments that we hear in the news from patients and family members, we do have a group of committed individuals here who want to see improvements to this facility, to our health system to provide the best in care.”

4/17/2011

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