Medical Staff Not Trained To Operate Them
by Nirmala Kannangara
- All hospitals in the country need these modern medical equipment with high technology but what is the use of them if the hospitals do not have the trained staff to operate these equipment
- When there is no proper building to start an ETU, no specialized doctors and medical officers to manage the patients brought to the ETUs, what is the purpose of having these high technology machines
The Central Province (CP) Department of Health Services (DHS) is accused of spending millions of tax payers’ hard earned money to purchase medical equipment with high technology but not providing the necessary training to the medical staff to operate them. As a result most of the hospitals in the province have rejected these vital devices.
Provincial Director of Health Service, Central Province Dr. Shanthi Samarasinghe had come under severe criticism for purchasing high technology medical equipment which are vital to provide a better medical service for the sick, but without providing the basic infrastructure facilities to the hospitals. “All hospitals in the country need these modern medical equipment with high technology but what is the use of them if the hospitals do not have the trained staff to operate these equipment and the required medicine to treat the patients once the illness is diagnosed,” Chairman, Health Statistical Officers Union (Central Province) Pradeep Dharmasuriya said.
Dharmasuriya leveled allegations against Dr. Samarasinghe for the purchase of high advanced Cardiolife Defibillators with added high technology each unit costing a staggering Rs.1.99 million although the same unit without certain added functions were purchased for Rs.642, 000 each in 2015.
Defibillator is an apparatus used to control heart fibrillation by application of an electric current to the chest wall or heart to revive the heart beat.
According to Dharmasuriya, each basic defibillators that have been purchased in 2013 was Rs.498, 000 while they cost Rs.560, 000 and Rs.642, 000 when purchased in 2014 and 2015 respectively. He further queried as to why the latest high technology machines were purchased when the Provincial Director have failed to give the necessary training to the medical staff to operate these machineries nor had taken any step to provide the necessary medicine to manage the heart patients once their condition is revived through these machines.
Dharmasuriya further said as to how the Multi Para Monitors –a display device to observe the condition of one or several medical factors at a time of a critically ill patient were purchased with out skilled staff to operate them. Ten out of the twelve hospitals in the central province have rejected them.
According to Dharmasuriya, when the 18 hospitals rejected the defibrillators that were sent to them, claiming that they do not have skilled staff to operate the highly sophisticated machines, Dr. Samarasinghe had taken a decision to allow the supplier to remove the additional features and refund the money.
“The staff can now operate the defibrillators without the additional feature- ETCO2. The company deducted Rs.270, 000 from each machine for taking back the ETCO2 unit and the new price for the machine is Rs.1.72 million. But the same services could have obtained from the 2015 machine which cost only Rs.642, 000 – less than over Rs.1 million for each unit,” Dharmasuriya said.
These 18 defibrillators had been sent to District Hospitals at Wattegama, Bokkawela, Talatu Oya, Galaha, Panwilatenna, Kolongoda, Hasalaka, Jambugahapitiya, Morayaya, Galagedara and Ambagahapelessa in the Kandy district, Leliambe, Muwandeniya, Maraka and Illukkumbura in Matale district and Gonagantenna, Lindula and Walapane Base Hostipals in Nuwara Eliya district.
No Plans to start ETUs
According to Dharmasuriya, although the Provincial Health Director claims that these machines were purchased on the request of the Health Directors of Nuwara Eliya, Kandy and Matale districts in order to start Emergency Treatment Units (ETU) in the above mentioned hospitals, none of the Medical Superintendents/ Directors of these hospitals have asked for such machines when there were no plans to start ETUs. “Every hospital in the country needs to have ETUs with all the necessary medical equipment. When there is no proper building to start an ETU, no specialized doctors and medical officers to manage the patients brought to the ETUs, what is the purpose of having these high technology machines? Let the Provincial Health Ministry give these hospitals the necessary infrastructure facilities and then equip them with the modern machines. What we understand is that the Provincial Health Director is spending the budgetary allocations to show that she had provided every hospital with the best equipment but no idea as to where these machines are going to be installed, who is going to operate the machine and whether the Provincial Health Department had provided the necessary medicine to treat these patients. This shows her lack of skill in administration,” a Medical Superintendent said on condition of anonymity.
According to him, defibrillation is a procedure used to treat life threatening conditions that affect the rhythm of the heart such as cardiac arrhythmia, ventricular fibrillation and pulseless ventricular tachycardia. The procedure involves the delivery of an electric shock to the heart which causes depolarisation of the heart muscles and re-establishes normal conduction of the heart’s electrical impulse. The machine used to deliver this therapeutic shock to the heart is called a defibrillator. Although this is a very useful machines to start treatments on heart patients, this machine with the ETCO2 functions cannot be used by most hospitals due to lack of skilled staff which the Provincial Health Director knows very well. Instead of purchasing 21 such machines in 2016 spending Rs.1.99 million for each unit, she could have spent this staggering amount to provide infrastructure facilities to start ETUs how beneficial it would have been for the people,” the Medical Superintendent said.
Meanwhile, Dharmasuriya further accused the Provincial Health Director of trying to prove that two parts of a defibrillator had been removed and the cost reimbursed although only one part the –ETCO2 had been removed and the money reimbursed.
By letter dated January 23, 2017, Director Health Services Central Province Dr. Shanthi Samarasinghe to District Directors of Health Services in Nuwara Eliya, Matale and Kandy, had instructed them to allow the technical officers from the supplying company to remove the IBP (device to monitor the blood pressure) and the ETCO2 (device to monitor the carbon dioxide level of a patient) from the respective 18 hospitals as the supplier had agreed to reimburse the money for the two devices from each machine.
But however, according to Dharmasuriya, only the ETCO2 had been removed but not the IBP. “The supplier says that the IBP comes with the machine and not a separate device like the ETCO2 and had taken back only the ETCO2. In order to show at any future inquiry that she got two devices returned and took money, Dr. Samarasinghe had written the letter in such a manner. By getting the ETCO2 device removed the health ministry had got only Rs.270, 000 back and had she purchased the 2015 model the country could have saved at least Rs. 18 million,” Dharmasuriya said.
Dharmasuriya further revealed as to how Multi Para Monitors, syringe and infusion pumps too had been purchased spending further millions of rupees but are of no use since the skilled staff had not been appointed to most of the hospitals.
“This director has been in this post for the past 13 years and in order to ‘start ETUs’ these machines had been purchased. Multi Para Monitors are used to observe the patients conditions and each unit had cost Rs.700, 000. Twelve such machines had been given to District Base Hospitals in Teldeniya and Nawalapitiya, District Hospitals in Sangarajapura, Hatharaliyadda, Akurana, Naranpanawa, Gelioya, Ankumbura, Delthota, Dolosbage, Manikhinna and Uduwela. Other than the two District Base Hospitals in Teldeniya and Nawalapitiya all other ten district hospitals have refused to accept these monitors. As there was nothing to do with them, four months later, four machines each had been given to Nawalapitiya and Matale hospitals while the remaining two had been given to the Dambulla hospital. Although the Akurana hospital had received four of these machines as donations, still they had been given one Multi Para Monitor. If this Provincial Director and her staff are well versed in administration work, there was no necessity to purchase such a machine spending Rs.700, 000 to Akurana Hospital,” Dharmasuriya claimed.
Infusion pumps idle
Meanwhile in 2015 using HSDP (Health Sector Development Project) funds, several millions of rupees were spent to purchase Infusion pumps but none of these have been used to date at District Hospitals at Uduwela, Sangarajapura, Naranpanawa, Dolosbage, Yakgahapitiya, Akurana and Deltota. An infusion pump is a medical device that delivers fluids, such as nutrients and medications, into a patient’s body in controlled amounts. “An infusion pump too has to be operated by a trained officer, who programmes the rate and duration of fluid delivery through a built-in software interface. Infusion pumps offer significant advantages over manual administration of fluids, including the ability to deliver fluids in very small volumes, and the ability to deliver fluids at precisely programmed rates or automated intervals. They can deliver nutrients or medications, such as insulin or other hormones, antibiotics, chemotherapy drugs, and pain relievers. When there is no trained staff to operate this and also no medicine to follow the medication procedure, how could these be used? We have raised this question over and over and had even informed the central government Health Ministry as well. If no action is taken there is no other option but for us to go to the media to highlight these malpractices so the tax payers knows what is happening to their hard earned money, “ Dharmasuriya alleged.
He further said as to what happened to the eleven syringe pumps that were sent to District Hospitals in Wattegama, Talatuoya, Bokkawala, Galaha, Panwilatenna, Jambugahpitiya, Kurunduwatte, Udagama Atabage, Galagedara and Ambagahapelessa. “They too were rejected. An incubator was purchased and sent to Galagedara hospital but was rejected as the hospital does not have a pre- mature baby care unit. Later it was given to Rikillagaskada hospital,” Dharmsuriya added.
Meanwhile, General Manager, TMI Solutions, the supplier of Cardiolife Defibillators in 2015 and 2016 Sampath Kularatne said that they supplied 24 Defibillators (model no: TEC 5621 K) in 2015 at a price of Rs. 642, 000 each while 22 Defibillators (model no: TEC 8352 K) with added advance features with high technology in 2016 at a price of Rs.1.99 million each unit.
According to Kularatne, these machines are life saving equipment and the 2016 model was with the monitor and can check the patient’s blood pressure, temperature, suspended oxygen level (SPO2), respiratory level, ECG and many more at a time. “This device comes with two additional batteries to continue with its work even at a time when there is a power failure. When the critical patients are connected to this machine, based on their age and body mass, the limits of the blood pressure, oxygen, ECG and other body functions can be feed and in case if one or many of these functions drop below the limits the alarm gives a warning to the medical staff. In the 2015 machines the specifications were not up to the latest standard what we supplied in 2016. That was why the 2016 machine is expensive than that of the 2015 machines,” he added.
Kularatne confirmed that they removed ETCO2 equipment on the request of the Provincial Health Director and reimbursed Rs.270, 000 each out of the initial cost of Rs.1.99 million.
When asked whether they removed the IBP unit as well and how much they deducted for it, Kularatne said that the IBP is an inbuilt part of the machine and said that it cannot be separated from the defibrillator.
All attempts to contact Dr. Shanthi Samarasinghe for a comment failed as she did not answer the calls. Although a text message was sent seeking a comment for the allegations leveled against her and her officials in the Department of Health Services Central Province, she neither returned the calls nor sent her side of the story.