Consultant blames lack of accountability for neonatal woes

A consultant at the San Fernando General Hospital (SFGH) said the problems being experienced with the supply of equipment, staffing and conditions at the Neonatal Unit relate to a “lack of system and accountability.” Dr Kerryn Brahim, of the Neonatal Unit of the SFGH said many of the problems highlighted by Dr Petronella Manning, head of the Neonatal Intensive Care Unit were similar to that of the south hospital. As if to illustrate this point, he mentioned ventilators and incubators purchased four years ago using funds from the Inter American Development Bank. He said two incubators were completely destroyed, and the others were “fairing badly” and constantly broke down. Dr Brahim said the company has since gone out of business.

In an interview with Sunday Newsday on Thursday, Dr Manning also made reference to equipment  which has broken down and has not been repaired. It was bought from the same company. “That should be investigated. Why was that equipment purchased. There is no accountability in purchasing what is required and what is actually provided,” Dr Brahim said. He also referred to the delay in supply of equipment for the paediatric wards. He said in June, doctors met with the Executive Medical Director of the South West Regional Health Authority (SWRHA) about procuring equipment. The meeting followed the SWRHA invitation to doctors to submit their immediate and long term needs.

Dr Brahim said the Health Ministry sent “final specifications to the RHA” but doctors were still waiting for pumps, monitors, incubators and ventilators. He said the doctors have asked for servicing and maintenance to be included in the contracts for equipment. Dr Brahim said the incubators and ventilators in use should be serviced every two months, but this has not been happening. There are ventilators from 2000 which have never been serviced. He admitted that the Neonatal Unit has benefited from one incubator donated by the Unit Trust Corporation, and two from Dr Manning. In 2003 the SWRHA supplied three incubators, two ventilators, two monitors and three infusion pumps which did “help.” In addition to equipment, Dr Brahim referred to staffing and overcrowding. He said the months of October, November and December were busiest for births and the nurse to patient ratio has risen. On Thursday, the unit was trying to get another nurse for the 10 pm shift because there was only one for 20 babies.

While the Neonatal Unit can accommodate six babies, it has had to make room for more. There were ten last month. Dr Brahim warned of the risk of infection in situations of overcrowding. He said each baby should have a 3x3 sq ft area space around them. The delay in starting refurbishment of the Neonatal Unit is also a concern for doctors. Dr Brahim said that refurbishing was supposed to start late last year. He said a four pronged approach is needed if perinatal mortality is to be reduced in TT from its current level of 35 per 100,000: Focus on ante natal care in communities and hospitals; optimal care in the labour ward; adequate space, staff in the neonatal unit, and addressing the equipment needs and maintenance of machinery.