Special Assignment

14th November 1999

Fighting a different battle at war hospital

By Hiranthi Fernando

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Seriously wounded soldiers from the warfront continue to be brought in to the Anuradhapura General Hospital for emergency treatment. Twenty one war casualties were admitted there on Wednesday night.

Visiting the hospital on Thursday, we found one soldier who was sent from Omanthai, with a severe lung injury being stabilised in the Surgical Intensive Care Unit (SICU). Thirty five other war casualties were recovering after surgery in the Army Ward. While the wounded soldiers are being turned away from the National Hospital in Colombo due to the nurses' strike, at the Anuradhapura General Hospital they are given priority treatment.

A special Army ward at the hospital has about 60 beds. Here, the hospital nursing staff is assisted by Army nurses and minor staff. In addition to the Army Ward, wounded soldiers, are also admitted to the Casualty Ward. For this month alone, so far about 150 war casualties have been admitted to the hospital.

"This hospital has been serving the forces for the past 15 years," said the Medical Superintendent. "The war imposes a tremendous burden on the hospital. Attention to civilian patients is affected. When there is a disaster situation in the operational areas, we evacuate civilians from the casualty ward to make room for the war casualties. Clinics are also cancelled at these times. During the last two weeks, we were unable to provide proper civilian services. When there is an escalation in military operations, we get 100 to 200 casualties for a day," he said.

The surgeons at the hospital recalled that on a Sunday evening last month, 173 Army casualties had been brought for admission. All staff, even those who were off duty had to be mobilised to assist with the emergency cases. According to the matron, 1002 casualties from the forces had been treated at the General Hospital, Anuradhapura for this year. In 1998, 2,456 casualties had been brought while the highest figure was 4,246, for 1997.

Consultants at the hospital say although Anuradhapura Hospital is a priority hospital in the country, there are many shortcomings. The hospital caters not only for the one million population of the North Central Province but also get many patients from the North and East. Being the main hospital in the district, seriously ill patients from over 50 small hospitals are transferred to Anuradhapura for treatment. Many patients are told that the hospital cannot admit them. There are many occasions when 100 patients have to be accommodated with only 50 beds available. Even in the ICU, which has five beds, eight patients have been treated, using trolleys as beds.

The hospital has no neurological facilities to undertake surgery on head injuries. 'For a neurosurgeon to work, we need a CT scanner', one consultant surgeon said.

An Emergency Treatment Unit is lacking. Serious patients are put directly into the Surgical Intensive Care Unit. Radiological facilities are also poor, the doctors say. Although a radiologist has been appointed to the hospital, he has not reported for duty. No action appears to have been taken in this regard. Physiotherapists too are insufficient to handle the work.

Considering the number of war casualties handled, the hospital is short of nursing staff, particularly in the operating theatre. Though the required cadre for the theatre is 36, there are only 22 nurses to handle the work load. When there are casualties, these nurses have to work round the clock without even breaks for meals. This situation sometimes continues for four to five days at a stretch.

In the SICU, too, the nurses often have to work long hours without a break, when there are emergencies. They even forego their off days. The minor staff too work overtime although they are paid only Rs. 800 a month for overtime irrespective of the number of hours. "They are doing voluntary service which no one appreciates," a doctor said.

According to the hospital authorities, they need additional facilities to cater to the cases they have to handle. Five years ago, a plan was drawn up to improve this hospital. Nothing has happened yet.

In spite of difficulties and shortcomings, the hospital authorities and a committed staff carry on with what is increasingly becoming an impossible task. This commitment is mostly due to the war situation in the country. Both doctors and other staff are often called upon to sacrifice their free time and family life to ensure that the war casualties are looked after.

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