Health services under stress

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One would think that falling sick in Qatar would not be a big issue. However, in reality the system is not without its problems. A growing population with little information about the services, increasing need for expensive treatments and a healthcare infrastructure panting to keep up with the needs is straining the whole system.

Since the country opened its first hospital more than 50 years ago, many changes and improvements have been introduced. The public healthcare system, which is free or highly subsidised, is available to all and, generally speaking, is of an excellent standard.

So what is the problem?

Hamad Medical CorporationHamad Medical Corporation

HMCHMC

With these facilities in place, the healthcare system should be working smoothly. But that is not happening here. When people go to emergency units, pharmacies or outpatient clinics for diagnosis, hospital admission or surgeries, there is a long wait that can last hours, days or months. Patients blame the healthcare facilities and vice versa.

HMCHMC

HMCHMC

HMCHMC

Though there a number of healthcare projects in the pipeline, including the Sidra Medical and Research Center, which is one of the largest projects in the region, the expansion is not keeping pace with the fast growing population. Opening of hospitals like the Heart Hospital has been put off since long and as per the latest announcement it will be officially inaugurated the coming autumn.

Meanwhile, bed shortages are making hospital officials work much harder to find solutions. Though the HMCHMC has been in existence for more than three decades, the number of hospital beds hasn't increased. Women's Hospital today has the same number of 248 beds that it had when it opened in 1988. These factors burden the healthcare system.

A couple of days ago, procedures at Women's Hospital, which sees more than 50 births each day, came to a standstill. The emergency services were stuck, the labour room was jammed and the inpatient beds were all occupied.

"Who has to be blamed here? When doctors say patients are fit to go home, we are responsible for them. We are not pushing them; we just need to make space for an equally important patient. Is it not unfair to leave a woman in labour spasm to deliver in the emergency," asks Dr Halima Al Tamimi, Chairperson, Gynaecology & Obstetrics Department, Women's Hospital.

Patients occupying hospital beds long after they are discharged has been putting a big stress on various HMCHMC hospitals for long. The hospitals, despite a number of expansion works, are facing acute bed shortages and have long lists of those waiting to be admitted.

According to statistics, revealed in early 2009, one-fifth of the total beds available in the Hamad General hospital (HGH) were occupied by in-patients who refused to leave the hospital. Of the then available 600 beds, 120 were occupied by those whose medical treatment was over long ago.

The story is worse in the other hospitals. Last year, in Rumailah Hospital, 180 out of 230 old-age or geriatric patients were fit to go home. Twenty-eight paediatric beds and 12 female beds were also occupied by similar patients. The hospitals had some 15 stable coma cases in which the patient's stay at the hospital or home would make no difference. To make matters worse, many adult patients often refuse to shift from ICUs to normal wards once the critical stage is over. The reasons for this can be as trivial as unavailability of private rooms. The situation is not different with the NICU, where many babies born with congenital diseases are abandoned by families.

The effect of such long-term stay by some patients is felt by the public as there is a huge backlog of those waiting to be admitted.

Healthcare, which is a right of all in the country, then, is monopolised by a few who refuse to leave hospitals. Each bed at HMCHMC costs QR4,300 a day. Some exploit the free services and disrupt the smooth flow of the system. One extra day of stay in hospital can at times cause critical problems as each day 25 patients in the emergency are waiting for a bed to be vacated.

Most of those who overstay in hospitals are those with congenital problems, victims of road accidents and those in coma with irreversible conditions. In these cases, families or allied healthcare providers should be taking care of the patients.

Once diagnosed, treated and fit, these patients should be transferred to other facilities for continuation of healthcare procedures, like nursing homes and day care centres. Though HMCHMC, over the last few years, has started facilities like home care units and assistance services, more needs to be done in this field. More rehabilitation, nursing and supportive centres along with community services are needed to curb overstay by patients as the average inpatient stay in HMCHMC is 8.5 days compared to six days in developed countries.

HMCHMC is doing much beyond its scope as a secondary and tertiary healthcare provider. This is evident in patients who merely need nursing services staying in the hospital occupying specialist beds.

When it comes to emergency services, the issue is the same. On average, Hamad Emergency accommodates around 1,500 patients a day, making it one of the busiest emergencies. However, a vast majority of these cases are not urgent. Though the increasing population could be one of the reasons, more than that it is lack of awareness about other services that leads to the piling up of cases.

"Emergency cases are those which are beyond the scope of primary healthcare facilities, over the counter medicines and outpatient departments. These cases, mainly life threatening, have to be dealt with urgently or else they can have dire consequences. So we prioritise patients based on the urgency of the situation," an emergency official said.

Most of the cases seen in the emergency unit at HMCHMC or the Paediatric Emergency Center (PEC) at Al Sadd can be seen in a clinic. "If patients think they have to be seen in emergency, they should be willing to wait, because there might be cases which need immediate intervention. The normal waiting time in HMCHMC emergency is a maximum of 12 hours whereas in other places it can be up to 24 hours," a senior consultant told The Peninsula.

People should go to the emergency unit not if they have flu, cold or other minor issues, but when they have an acute injury or illness that poses an immediate risk to life or long-term health. Often when a large number of people with fever walk into the emergency unit, cases of stroke or heart attack which have to be attended to within an hour do not get the needed attention.

The fact that HMCHMC's emergency unit and the PEC see even patients without a health card is also a major reason for overcrowding. "This is true, but we cannot turn back patients who come to us. However, people have started abusing this service that we provide. In fact, these people are infringing on the rights of many other critical patients who are waiting to be treated. When a patient turns up without a health card, there is much file work or information that needs to be given during the registration, due to which others have to wait for long hours," a PEC consultant said.

Though HMCHMC has been working for the past few years on the issue of overcrowding in the Out Patient Department (OPD), a major issue now is the fact that many people get referrals from private doctors to get specialised services at HMCHMC.

"At Women's Hospital (WH), it has been noticed that some women go to private clinics and get referrals to the WH OPD much earlier than needed. Due to this, others with risk pregnancy have to wait. We are now moving to stop this tendency as there is a clear cut procedure and rulings for referrals," said Dr Al Tamimi.

So what prompts people with minor health problems to seek medical help from HMCHMC, disrupting the smooth running of the hospitals? Why is it that despite having extensive primary healthcare facilities throughout Qatar the burden is still borne by the secondary or tertiary healthcare centres?

Lack of awareness could be one reason. But why do people rush all the way through the traffic to the emergency unit when the majority of them have a PHC in their locality?

Under-utilisation of services at PHCs is one of the main causes of overcrowding in the Emergency Department of HMCHMC, according to experts.

But people have been calling for upgrading the PHC emergency services, which they say are not sufficient. "People feel that PHCs cannot deal with any situation except for diseases like flu or fever. Also, a majority of the people are unaware about services like emergency at PHCs and hence rush to Hamad or Al Sadd," said a national.

Some also feel that emergency services at PHCs are not comprehensive. "Often, when we go to the PHC, the pharmacy or laboratories are closed and also, apart from some very basic diagnostic tools, most of the PHCs do not have the needed machines."

Another major reason is lack of trust in the doctors. "A couple of years ago, I went to the PHC with an injured leg. The doctor sat at her desk munching an apple and asked me what my problem was. When I explained it, without even examining the injured part she wrote out the prescription. How can one expect me to return to these doctors again," said a lady.

A survey in 2009 by a local daily showed that 68 percent of the population was dissatisfied with the PHCs and those satisfied said that the health centres were helpful for those financially weak as they offered free services.

Many residents have now turned to expensive private healthcare providers or travel outside Qatar for healthcare, abandoning essentially free services at government-run facilities.

A majority of healthcare issues in Qatar can be resolved if people are informed about services at the PHCs. A strong primary healthcare system is central to improving public health and removing inequalities in healthcare. There is strong evidence of the effective contribution primary healthcare makes to improving treatment outcomes. The ultimate goal of primary healthcare is better health for all; in tune with Qatar's policy of healthcare for all.

By Huda NV

© The Peninsula 2010