For many years now, over­crowd­ing has been and con­tin­ues to be a great chal­lenge at the San Fer­nan­do Gen­er­al Hos­pi­tal (SFGH), which has on­ly ap­prox­i­mate­ly 650 beds and which serves a catch­ment area of 600,000 peo­ple.It is hoped that with the avail­abil­i­ty of the San Fer­nan­do Teach­ing Hos­pi­tal at Chancery Lane in the not-too-dis­tant fu­ture, more beds will be­come avail­able for those pa­tients who seek med­ical care at the SFGH.

In the mean­time, the South-West Re­gion­al Health Au­thor­i­ty (SWRHA) has em­barked on a se­ries of ini­tia­tives with the in­ten­tion of mak­ing beds avail­able for pa­tients who gen­uine­ly need hos­pi­tal ad­mis­sion.

These ini­tia­tives in­clude ac­com­mo­dat­ing pa­tients at the Area Hos­pi­tal, Point Fortin, fast-track­ing of ra­di­o­log­i­cal and haema­to­log­i­cal in­ves­ti­ga­tions so as to min­imise the stay of pa­tients at the SFGH, and al­so mak­ing al­ter­na­tive arrange­ments for pa­tients with ir­re­versible pathol­o­gy to be looked af­ter at home by their loved ones with as­sis­tance from the dis­trict health nurs­es and doc­tors at­tached to the near­est health cen­tres.

The SFGH faces a re­al chal­lenge when it comes to pa­tients with ir­re­versible kid­ney fail­ure. Many of these (we have an av­er­age num­ber of ten-15 pa­tients) have been stay­ing at the SFGH for weeks so that they can be af­ford­ed haemodial­y­sis (a pro­ce­dure which in­volves pass­ing the pa­tient's blood through a ma­chine which takes the place of the kid­neys).

Many are re­luc­tant to be dis­charged from the hos­pi­tal, fear­ing that they will not be able to ac­cess haemodial­y­sis at the SFGH, and that they will be left to die at home. They feel more se­cure in the com­fort of the hos­pi­tal and as such, with their in­creas­ing num­bers, add great­ly to our chal­lenge of mak­ing beds avail­able for those pa­tients who have re­versible ill­ness­es.

More­over, some of these pa­tients with ir­re­versible kid­ney dis­ease are not even suit­able for haemodial­y­sis be­cause of oth­er patho­log­i­cal con­di­tions, but even in these in­stances, the pa­tients are re­luc­tant to go home, there­by oc­cu­py­ing beds which are pre­cious com­modi­ties and which are at a pre­mi­um at the SFGH.

In ad­di­tion, with the de­vel­op­ment of the spe­cial­ty of on­col­o­gy (which deals with can­cer pa­tients), the SFGH was and is fast be­com­ing a haven for pa­tients with ir­re­versible pathol­o­gy, there­by lim­it­ing and re­duc­ing con­sid­er­ably the num­ber of beds for pa­tients with treat­able, sal­vage­able, re­versible con­di­tions.

In an at­tempt to get a han­dle on this sit­u­a­tion, I have sug­gest­ed (and these sug­ges­tions have not yet been im­ple­ment­ed) to the min­is­ter and to the ex­ec­u­tive of the SWRHA that many and per­haps most of these long-stay pa­tients that we have had for weeks be sent home to the bo­som of their loved ones, and be af­ford­ed sup­port­ive care as out­pa­tients.

Al­ready we have a sys­tem in place where­by our med­ical so­cial work­ers are work­ing fever­ish­ly to pro­cure fund­ing for these pa­tients to have their haemodial­y­sis done pri­vate­ly, since at the SFGH, the de­mand for haemodial­y­sis far ex­ceeds the sup­ply, notwith­stand­ing the fact that we have 11 haemodial­y­sis ma­chines that op­er­ate for 14 hours Mon­day to Fri­day and for nine hours on Sat­ur­days.

At the present time, we are putting mea­sures in place to ex­tend the hours for haemodial­y­sis for a fur­ther three hours each day, Mon­day to Sat­ur­day, so that our pa­tients can re­ceive their much-need­ed dial­y­sis a min­i­mum of twice per week.

In ad­di­tion, we are re­fur­bish­ing a ten-bed­ded nephrol­o­gy ward for pa­tients with end-stage re­nal dis­ease and in­tend in the near fu­ture to use oth­er well-ac­cept­ed meth­ods of treat­ing these pa­tients. It is note­wor­thy that the oth­er RHAs do not keep their pa­tients in the hos­pi­tal for long pe­ri­ods, with the re­sult that the SFGH has tak­en up the slack for them.Some pa­tients can af­ford haemodial­y­sis at pri­vate med­ical cen­tres and may very well choose to go that way when pos­si­ble and when con­ve­nient.

Those pa­tients who can­not af­ford to pay can have their haemodial­y­sis done at the hos­pi­tal, af­ter which, they will re­turn to their re­spec­tive homes. And of course, they will be fol­lowed up in the kid­ney clin­ic here at the SFGH by our nephrol­o­gists.

The point here is that there is no rea­son for these pa­tients to stay for weeks on end at the hos­pi­tal. Both the kid­ney pa­tients as well as those pa­tients on pal­lia­tive treat­ment for ter­mi­nal can­cer can be vis­it­ed at their homes by the dis­trict health nurs­es and doc­tors at­tached to the near­est health cen­tre. Rel­a­tives, fam­i­ly and friends can bring them back to the hos­pi­tal if they feel the need to so do at any time.

It is im­por­tant for us to let these pa­tients know that we are not aban­don­ing them and that we are not turn­ing our backs on them. They need to know that we still do care about them, for our hearts are not made of stone, and we will con­tin­ue to mon­i­tor their sit­u­a­tion.

Some pa­tients can­not ac­cept the fact that their ill­ness­es have reached a stage where there is noth­ing more we can to do for them at the SFGH than can be done at their homes. We even have pa­tients who have re­fused haemodial­y­sis but who are nonethe­less un­will­ing to leave the hos­pi­tal.

And yet, as a health care or­gan­i­sa­tion, in this day and age of mod­ern and fast-de­vel­op­ing tech­nol­o­gy, these are is­sues that we will see more and more with the pas­sage of time and which we will have to ad­dress in a hu­mane and com­pas­sion­ate way. Deal with them we must, for our re­sources are lim­it­ed and the de­mands be­ing made of us grow greater and greater with each pass­ing day.

Dr Cha­toor­goon is the med­ical

di­rec­tor at the San Fer­nan­do

Gen­er­al Hos­pi­tal