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Marina far from ideal hospital - Report

Publishing Date : 03 September, 2018


A public outcry on the deficiencies of Princess Marina Hospital’s capacity to handle high risk patients has been validated by a report titled ‘Quality Improvement Initiatives at the facility’ compiled by Dr Tjeza Matenge.

The report which has been anticipated for some time, was comparing the “ideal Princess Marina Hospital to the current state of the hospital”. This study depicts a deep-seated problem in Botswana’s flagship hospital, a situation which calls on government to make amends if the health care system is to offer meticulous health services to the citizens.

For some time the hospital has been under scrutiny with the numbers of negligence and mortality cases increasing. The ever increasing cases of negligence at Princess Marina have earned the hospital a bad reputation, with some expressing misgivings about its inability to deal with most common diseases. This week at the hospital’s Pitso addressed by stakeholders including the minister of Health and Wellness, councilors and health experts, a new damning report was released. The main aim of the meeting was to deliberate on solutions to overcrowding, referral system, shortage of medicines, health system shortfalls, maintenance of facilities and staff burnout among others.

At the very top in the report is the congestion issue at the hospital’s maternity ward. This is caused by added beds, floor beds with patients in labour pains sitting on chairs. This has contributed to morbidity and mortality incident reports. The report further highlighted that there is fatigue and burnout from the staff which leads to poor monitoring and more mistakes that end up compromising people’s health.  “Hygiene is also compromised and transmission of nosocomial infections,” the report states.

The congestion is said to be caused by “low midwife numbers, low bed capacity yet high number of deliveries and congestion of hospital’s wards. Less transfer to clinics and less number of deliveries by District Health Management Team (DHMT) clinics despite higher number of midwives and beds are other factors contributing to crowding”. Transport and poor communication, confusion of staff regarding discharge status of patients referred to clinics are also hinted as additional causes of the anomaly.

 “Ante Natal Ward’s Ideal bed capacity is 30 but now it has 18 additional beds which make the total to 48.  On average, four patients in labour pains idle on chairs daily,” said the report.  “The post-natal ward ideal bed is 52, with 22 additional beds and 18 floor beds making the total to 92. These are some of the factors that lead to high mortality rates as personnel - patients’ ratio is unbalanced,” added Matenge.

Marina, according to the research paper, has a total of 75 midwives. On average, the midwife-patient ratio at the hospital’s Ante Natal Ward is 1:12; in labour ward 1:4 and in Post Natal Ward is 1:23. Ideal nurse patient ratio in a general ward should be 1:8 according to Dr Matenge. On the other hand the Australian nursing and midwifery federation recommends 1:4 in a medical or surgical ward and 1:3 in specialized nursing areas like delivery suites, emergency departments because of high acuity.

On average Marina records 576 deliveries monthly while primigravida (first time mothers) is 129 on monthly average. While the short-term interventions continue to get intensified, the hospital wants long-term definitive strategies to be put in place.  “To have the capacity of the building (Marina hospital) expanded,” one recommendation says.  “We should have an MOU (midwife-obstetric unit) for greater Gaborone which admits intermediate risk patients only, such that Marina admits only high risk patients,” reads the report under recommendations.

Currently Marina admits both intermediate and high risk patients. It is said, this could take one of the clinics to be converted into an obstetrics primary clinic with theatre facilities or a new building altogether.  The clinic could even become an obstetric center of excellence and can be run by family physicians and midwives.

The report recommends units like Marina which are delivering more than 6000 per annum, should aim to reach full consultant obstetric presence (168 hour cover per week). It was further said a “24 hour consultant obstetrician based should always be in the labour ward. The consultant obstetrician should be backed by 2-3 specialist trainees 4 of which our equivalent is medical officers.”



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