Haven or hell?
Overcrowded wards, unhygienic conditions, broken down medical apparatus are what greet patients who flock to the Kurunegala Teaching Hospital

By Faraza Farook
The Kurunegala Teaching hospital, a central referral centre and an important provincial hospital is in a sickly state with patients having to put up with poor hygiene standards and overcrowded wards. An investigation by The Sunday Times revealed that the numbers in the ward far exceeded the number of beds available, with patients scrambling for space even along the corridors where dogs and cats also fight for space.

More alarming were the conditions at the Premature Baby Room (PBR) and the Intensive Care Unit (ICU) of the Paediatric ward. Contrary to accepted medical practice, the PBR and the ICU appeared to be lacking in sterile conditions. The PBR comprises a smallish partitioned room, with three incubators and a few cots. Two incubators were left unused in the corridor just outside, as there was no space inside the PBR.

Regulated temperature and sterility are a must in a PBR. But the exhaust fan in the PBR doesn't function and there is no air conditioning either. Thus, the windows in the incubators are left open as the room temperature reaches a higher level than the incubator temperature resulting in the babies suffering from high fever. The whole purpose of using incubators therefore is lost. The risk of increased humidity is that the babies' nervous system could get affected and they could get dehydrated. Owing to the lack of sterility, paediatricians at the hospital, reportedly give strong antibiotics to avoid infections and unnecessary deaths.

Opposite the PBR is the ICU with the two units being divided by a narrow corridor. Here too doors and windows are left open and it lacks the sterility expected at any ICU in any hospital. People enter the ICU with their shoes on and the tiled floor is cracked in places allowing the easy settlement of germs and dirt.

The ICU is a cramped rectangular room with four beds, which are shared by two babies, and one ventilator. Monitors are positioned next to each bed, but they cannot be viewed from the nursing centre, which is located at one end of the room. Large rusty oxygen cylinders are placed by the side of each bed instead of wall oxygen which is usually used in ICUs. Adjoining the ICU is a smaller room where one finds the drug cupboard and a drug trolley. The trolley leans against a glossy wall stained with blood. Not far from the PBR and the ICU, a corridor leads to a large, open drain.

Added to this misery is the plight of mothers who have to feed their babies at regular intervals but do not have a waiting room close to the PBR. Mothers who have to express breast milk to feed their babies are forced to use a narrow corridor with chairs. Especially during visiting hours the lack of privacy makes it very uncomfortable for the mothers who wait with mugs to express milk.

One young mother who had given birth to twins and who had to come to the PBR every three hours to feed her babies said she had to wait for almost an hour before she got the privacy to quickly express some breast milk. There were others who said they felt dizzy having to walk all the way from the maternity ward to the PBR, especially those suffering from high blood pressure.

The play area section of the paediatric unit is also not very safe. In a not-so-large enclosure, the only safe thing around were the two swings. The seesaw was broken and the mat slide was not only broken but also rusted. The maternity unit was another dismal sight. On the way to the wards one finds pregnant mothers seated uncomfortably along the floor of the corridors and others on benches in overcrowded wards.

The hospital handles more than 1000 deliveries each month. The maternity section has two units in one big ward (ward 9) with 16 beds in each. When The Sunday Times visited the hospital, the total occupancy was 40 in one unit and 63 in the other. During the lunch hour too, mothers have their meals seated side by side along the corridors.

The medical ward was no different. Patients were all over - in the corridor, along the walk ways, on the beds and under the beds - just anywhere and everywhere there was space. An unfloded cardboard box made the mat for many of these old men and women lying on the floor. When it rained, they had little choice but to huddle together inside the already congested ward to avoid the spray from heavy rains.

With patients sleeping all over, doctors complain they find it difficult to do ward rounds or to attend to a patient in the night. The Kurunegala hospital has four surgical theatres, for Orthopaedics, ENT, Dental and Gynaecology and Obstetrics. All the theatres are in the same unit. Two of these have been under repairs for the past one and a half months. Therefore in place of five to six surgeries a day, only two or three are performed.

Moreover, the theatre doors, which are expected to close spontaneously, are under repair and surgeons complain that every time they go in and out, they have to close the door themselves. Oxygen cylinders, cupboards and broken equipment are seen lying around in the sterile area of the theatre complex.

Although the hospital is equipped with a generator, it has not been set up to connect to the power supply immediately after a power cut. Doctors claim that they have to sometimes stop surgery, until the generator is switched on.

The surgical ward has two units. The female unit has 15 beds in each unit, but on average the occupancy is about 50 in both. Everyday, 15 to 20 admissions are made. Wards 17 and 18 are for males and have a bed strength of 30. However, the occupancy rate is 50 or 60 at any given time.

Two other wards set aside for post operative care - Ward 15 for females and Ward 16 for males - are also overcrowded prompting doctors to discharge patients well ahead of the actual date. In the psychiatric unit there are 21 and 19 beds in the male and female wards respectively giving a total of 40 beds. However, on average, there are 75 patients in the unit.

A fluoroscopic machine (a screening machine) which had been purchased about ten months back is reportedly lying idle. As a result several tests are not done in the hospital forcing patients to pay high prices in the private hospitals. Although the hospital has a cancer surgeon, patients are referred to Colombo as the doctor has no ward or clinic to conduct his work in.

Patients and doctors say although construction work seems to be a continuing process at the hospital, the institution has little to show as development over the years. A newly constructed room to wash gloves remains closed, as the hospital has begun using disposable gloves. The hospital also does not have an incinerator.
The lack of storage facilities appeared to be another problem with boxes of drugs being left along corridors.

However, the hospital's Director Dr. Ananda Gunasekera said overcrowding was not unique to Kurunegala hospital as all hospitals in the country faced the same problem. When questioned about the conditions of the PBR and ICU units he said the hospital maintained sterility standards and followed WHO recommendations.

He also said there was no need for windows or doors to be kept shut or for the ICU and PBR units to be airconditioned to be sterile. He also said that a new PBR unit was being constructed and the present one would soon be closed down.

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