Geisha Kow­lessar

The South West Re­gion­al Health Au­thor­i­ty (SWRHA) has been forced to shell out thou­sands of dol­lars to pay doc­tors work­ing at pri­vate in­sti­tu­tions to per­form Cae­sare­an sec­tions at San Fer­nan­do Gen­er­al Hos­pi­tal.The cost of a Cae­sare­an sec­tion ranges be­tween $25,000 and $30,000. Be­tween four and five are done at the hos­pi­tal each day, doc­tors at the in­sti­tu­tion have con­firmed.Ac­cord­ing to med­ical sources yes­ter­day, the SWRHA's board had no choice but to hire pri­vate doc­tors be­cause of a se­vere short­age of med­ical prac­ti­tion­ers which had crip­pled the hos­pi­tal's Ob­stet­rics and Gy­nae­col­o­gy De­part­ment.The short­age, sources added, wors­ened af­ter five doc­tors at the hos­pi­tal were sus­pend­ed af­ter the death of 29-year-old Chrys­tal Boodoo-Ram­soomair on March 4.Boodoo-Ram­soomair died af­ter un­der­go­ing a third Cae­sare­an sec­tion.

Ac­cord­ing to med­ical sources, the de­ci­sion to hire doc­tors from the pri­vate sec­tor was tak­en about a month ago when ad­min­is­tra­tive heads at the hos­pi­tal re­alised Cae­sare­an sec­tions were pre­car­i­ous­ly back­ing up.Sources added that be­cause the short­age, the hos­pi­tal's gy­nae­co­log­i­cal clin­ic had not been func­tion­ing and pa­tients sched­uled for elec­tive surg­eries, who had to wait be­tween four and six months, had been forced to wait even longer.Med­ical sources said the five sus­pend­ed doc­tors at the Ob­stet­rics and Gy­nae­col­o­gy De­part­ment had in­di­cat­ed their re­luc­tance to come back to work, cit­ing un­fair treat­ment.Ac­cord­ing to a spokesman, Dr Er­ic Richards, a se­nior con­sul­tant who was the de­part­ment's head for the past six months, ten­dered his res­ig­na­tion last month.Dr Ash­meed Mo­hammed, who re­placed Richards, was one of the sus­pend­ed doc­tors.

At the end of an in­quiry in­to Boodoo-Ram­soomair's death, Mo­hammed who per­formed the woman's sec­ond Cae­sare­an, took three weeks' leave.Dr Sunil Per­sad, who re­placed Mo­hammed as the head of the de­part­ment, has now gone on ten months' va­ca­tion.Col­leagues said it was still un­de­cid­ed whether Mo­hammed would re­turn to work.Dr Rosh­ni Bis­son­datt, who was hired a year and a half ago to con­duct pro­to­col ad­min­is­tra­tion, has gone on ma­ter­ni­ty leave and sources said she, too, had told col­leagues that her re­turn to work was ten­ta­tive.Dr Ro­ma Jag­ger­nauth, a qual­i­fied reg­is­trar, has al­so tak­en four months' leave and may al­so not re­turn.

At present in the de­part­ment are Dr Kr­ish­na Ram­per­sads­ingh, a se­nior con­sul­tant, Dr Reiza Mo­hammed and Dr Michael Prasad, two reg­is­trars.Dr Pe­ter Mor­ris, an ob­ste­tri­cian who worked in a pri­vate hos­pi­tal, was hired about a week ago as a con­sul­tant and was made the de­part­ment's head, sources said.They said a se­nior mem­ber of the hos­pi­tal's ad­min­is­tra­tion who met with two staff mem­bers over the week­end had been "beg­ging" them to re­turn to work."Since the sus­pen­sion of the doc­tors, the Ob­stet­rics and Gy­nae­col­o­gy De­part­ment at the San Fer­nan­do Gen­er­al Hos­pi­tal has been func­tion­ing on emer­gency du­ty on­ly," a source said.

"Mean­ing peo­ple who were booked or non-emer­gency surg­eries like hys­terec­tomies were not hav­ing it done due to the short­age." An­oth­er spokesman said pa­tients who vis­it­ed the elec­tive gy­nae­co­log­i­cal clin­ic were not seen by their reg­u­lar team of doc­tors as none were avail­able."Pa­tients who would nor­mal­ly see their par­tic­u­lar team of doc­tors were forced to see whichev­er doc­tor who was avail­able," the source said.The source said the short­age al­so caused a back­log of Cae­sare­an surg­eries as doc­tors who were on "call day" could not per­form those pro­ce­dures.

Call day is usu­al­ly sched­uled for emer­gency surg­eries on­ly.Due to the acute back­log, the source said pri­vate doc­tors were hur­ried­ly hired and in some cas­es per­form­ing be­tween four and five Cae­sare­an sec­tions a day. The source added that the cost to per­form a Cae­sar­i­an sec­tion ranged be­tween $25,000 and $30,000.Com­plaints have al­so arisen re­gard­ing lack of beds and pri­va­cy at the hos­pi­tal's labour ward."The ob­stet­ric the­atre which is sup­posed to be used for preg­nant cas­es is not avail­able 24 hours," a source said."It clos­es af­ter 4 pm every day caus­ing all cas­es to go to the main op­er­at­ing the­atre."Doc­tors who have to per­form emer­gency surg­eries have to some­times fight to get the main the­atre," the source said.The lab, the source said, which used to be the doc­tors quar­ters, was in­con­ve­nient­ly lo­cat­ed at the back of the ob­stet­ric de­part­ment.

"There are no emer­gency blood porters to drop off sam­ples and doc­tors have had to go back and forth in an area that is poor­ly lit to the lab them­selves," the source said."This takes about 15 min­utes, and in that space of time a pa­tient could die."Act­ing med­ical di­rec­tor of the San Fer­nan­do Gen­er­al Hos­pi­tal, Dr Lester Goetz, in an in­ter­view, has ad­mit­ted that Cae­sare­an sec­tions were be­ing per­formed by pri­vate doc­tors."We have hired pri­vate doc­tors and it is very cost­ly but once we hire staff, the ser­vices of pri­vate doc­tors would no longer be need­ed," he said.

Goetz, how­ev­er, said in­ter­views were be­ing con­duct­ed and as­sured that "every­thing would be back to nor­mal" by next week."We lost an en­tire firm of doc­tors but we are con­duct­ing in­ter­views and every­thing would be back on track on May 9," he main­tained.An ad­ver­tise­ment placed last week in dai­ly news­pa­pers stat­ed the SWRHA was seek­ing spe­cial­ist med­ical of­fi­cers in the fields of anaes­thet­ics, ob­stet­rics and gy­nae­col­o­gy, neu­ro­surgery and neona­tol­ogy. Goetz said the ma­ter­ni­ty ward was re­cent­ly re­fur­bished and out­fit­ted with suf­fi­cient beds.

Dr She­henaz Mo­hammed, gen­er­al sec­re­tary of the Med­ical Pro­fes­sion­als As­so­ci­a­tion of Trinidad and To­ba­go (MPATT), said over the last few years, there had been an egress of health pro­fes­sion­als away from the pub­lic health sec­tor for var­i­ous rea­sons, in­clud­ing de­te­ri­o­ra­tion of in­sti­tu­tion­al ca­pac­i­ty."This has had a se­ri­ous im­pact on the de­liv­ery of one of the coun­try's most crit­i­cal "pub­lic goods" and needs to be rec­ti­fied," she added.She said MPATT stood com­mit­ted with its mem­ber­ship in sup­port­ing the build­ing of in­sti­tu­tion­al ca­pac­i­ty such as a blood bank, lab and imag­ing fa­cil­i­ties like mam­mog­ra­phy and ul­tra­sound, as well as fa­cil­i­ties for cer­vi­cal screen­ing and more op­er­at­ing the­atres.

"There must be con­tin­u­ous hu­man re­source de­vel­op­ment which must be in keep­ing with tech­no­log­i­cal ad­vances in health care," Mo­hammed said."Any­thing less of this on­ly con­tin­ues to de­mo­ti­vate and de­mor­alise health­care work­ers."When con­tact­ed last Thurs­day for a re­sponse on the is­sues Dr Lack­ram Bo­doe, chair­man of the South West Re­gion­al Health Au­thor­i­ty (SWRHA) re­quest­ed that the ques­tions be e-mailed to him.This was done. How­ev­er, up to late yes­ter­day there was no re­sponse and re­peat­ed calls to his cell phone al­so up to late yes­ter­day went unan­swered.