Wednesday, October 20, 2021

Another type of shortage wreaking havoc at govt health facilities

When 49-year old Margaret Reid suffered an acute asthma attack on September 21, her family (including her brother, Frank) rushed her to the Maun Clinic. “When we arrived, only one nurse was attending to patients,” says Frank. “It took some time for the nurse to attend to my sister and that was after I had alerted her about my sister’s condition.” Being asthmatic himself, Frank is familiar with the emergency assistance administrated to asthma patients. His recollection is that the nurse orally administered a drug called salviathymol about four times in a vain attempt to stabilise his sister’s breathing. “I asked the nurse why she was repeating a treatment that was not working and why she couldn’t use hydrocortisone. I know the drug because I have it used myself,” he says. Hydrocortisone is a hormone cortisol that is used to treat asthma. Tragically and a sign of the times, this life-saving medication is not always available at government health facilities.

Frank says that not only did the clinic not have hydrocortisone but the Letsholathebe Memorial Hospital itself ÔÇô which essentially serves as a referral hospital for the North West district ÔÇô had also reportedly ran out of it. The nurse suggested that if the family had money it could buy the drug from private pharmacy in the village. She explained that this was standard practice. Her account can be confirmed by many more across the country (both health professionals and patients) who have had to do the same thing. The family car immediately set off for the nearest pharmacy and bought more drugs than was required just in case. Back at the clinic – an hour and half after Margaret arrived at the clinic for emergency medical assistance, the nurse was finally able to administer the hydrocortisone.  

By Frank’s account, there was no marked improvement in his sister’s condition. That notwithstanding, she went back home with the understanding that she would return to the clinic the following day. Frank says that Margaret’s blood pressure was still high when she was transported back home. Her condition had not improved the following day and the family deemed it wise to take her straight to Letsholathebe rather than the clinic. There she was rushed to the emergency room, hooked up to an intravenous unit and had a nebuliser placed over her face to assist her laboured breathing.

She removed the nebuliser, Frank says, because it restricted her breathing. On the instructions of the nurses, he stepped outside and waited anxiously by the door where he says he heard his sister’s muffled scream. When he came back inside, he saw her legs twitch and eyes hideously dilated. Minutes later, a doctor came in and after examining Margaret, certified her dead. To date, Frank retains the conviction that the muffled screams were a result of the nurses putting the nebulizer back over his sister’s face with force in an attempt to stabilize her breathing. “I believe they suffocated her to death,” he says. Outside forensic science, there would be great difficulty with proving such claim.

What can be easily proved though is that Margaret fell victim not just to asthma but severely compromised healthcare that occurs as a result of acute shortage of drugs and personnel. Through informal contact with an elderly, more experienced nurse, Frank later learned that the nurse at Maun Clinic should have immediately referred Margaret to Letsholathebe when she realised that her interventions were not working. On being told about Margaret’s experiences at Maun clinic, the elderly nurse was curious about the age of the nurse. Health facilities face not just the shortage of nurses but of experienced ones. The problem began at the turn of the century when there was an exodus of Botswana nurses to the greener pastures of the United Kingdom and Canada. Says a nurse source: “It was during this period that Botswana lost many well-trained and experienced nurses.”

Later and still for remuneration-related reasons, another wave of yet more well-trained and experienced nurses took up jobs at South African and Namibian hospitals. The brain drain only stopped in 2008 when the government started paying nurses an allowance of 30 percent of their salaries as overtime. However, that was merely the lull before the storm. The storm was the 2011 “mother of all strikes” by the Botswana Federation of Public Sector Unions and some of those striking were nurses. The inflection point came when, following the strike, the government fired nurses who, against policy that prohibits essential services personnel from going on strike, had done so.

This worsened the personnel shortage problem, in one respect making it extremely difficult and on some days downright impossible to activate triage protocols. That explains why Margaret was not attended to immediately upon arrival at the Maun Clinic. Six months later however, some were taken back ÔÇô in bad faith nursing sources allege, because a good number of them (some very well-experienced) were punitively redeployed to very remote areas. Others never made it back into the service and the result is that there is acute shortage of experienced nurses who can competently handle life-threatening situations.

The nurse at the clinic who treated Margaret is said to be very young and fairly new to the service. This is now a national problem. A senior nurse says that there are now younger, inexperienced nurses than there are older, experienced ones. Once upon a time, the latter would take the former under their wrong and show them the ropes through a structured induction process. However, not only does staff shortage make that near impossible, some of the older nurses reportedly want to stick to what their job description says. “Some nurses say “It’s not my responsibility to train fellow employees?”

What that means is that young nurses joining the service are basically thrown in the deep end and in a healthcare setting, experience or lack of it can mean the difference between life and death,” a nurse source says. Even in death, Margaret’s ordeal was not nearly over. Frank says after his sister died, family members were called to an office within the hospital and formally notified of the tragedy. What they weren’t told was that the hospital mortuary was out of order. That they would learn when they had left the office.

The mortuary service has been outsourced to a local private sector company whose hearse took a long while to arrive. By Frank’s account, the hearse arrived when the stomach had begun to distend as the extreme Maun heat caused the body to bloat.

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