LIMITED CAPACITY A number of patients lie on makeshift stretchers and beds while others wait for hours in a corridor improvised as an extension of PGH’s emergency ward. —RICHARD A. REYES
(First of two parts)
MANILA, Philippines — Sleeping for days on flattened cardboard boxes laid on the cold pavement in Ermita, Manila, wasn’t what “Analyn” had expected in seeking medical treatment for her child.
But she was hoping that specialists at the Philippine General Hospital (PGH) could examine her 21-year-old daughter, “Carmel,” whose acute and recurring abdominal problems had rendered her skin and bones in just a year.
“Unlike other public hospitals, PGH has complete lab facilities and specialists,” Analyn, 45, pointed out. “Plus, services are free for poor people like us.”
Analyn decided to take Carmel to the PGH emergency room (ER) for a fresh diagnosis after spending a month at the Ospital ng Maynila. But the ER staff told her that other patients with more serious complications had priority, Analyn said, her quavering voice masking anger and frustration.
Lacking the money to commute to and from their native Pampanga, they camped out on the street while waiting to be attended to.
But the situation at the ER complex was hardly favorable.
Around 250 patients flock daily to the old complex that now houses PGH’s two temporary ERs, with only 25 beds for patients.
Outside the halls, a number of patients lie on makeshift stretchers and beds; others wait for hours in the corridor to be checked by doctors.
‘Like a garage’
PGH spokesperson Jonas del Rosario said the ongoing renovation of the ER complex had limited the rooms’ capacity and led to patient overcrowding. He said that before the renovation, around 100 patients could be accommodated in a day.
“We had appealed to the public to consider the ER’s limited capacity, but hundreds of patients still [come]. And we’re concerned because we need to attend to them also,” said Del Rosario, who was part of the PGH cardiology department for 15 years.
“The ER becomes like a garage. As for the new patients who are coming in, how can we accommodate them?” he said.
But hospitals can’t just simply send patients away, Del Rosario said, especially PGH which had become a “hospital of last resort.” The problem, he said, was that not all patients had “real emergencies.”
Hospitals define an emergency case as a life-threatening condition that needs immediate intervention at the risk of death. Emergency cases include heart attack, trauma, organ failure, injury from a vehicular accident, stroke and burn. Although cough, cold and diarrhea are urgent, they are not “emergencies the hospital hopes to cater to” given its current predicament, Del Rosario said.
He added: “PGH has become a place for patients who don’t have much. In the wee hours of the morning, there’s no place to go but the emergency room, so sometimes we tell them they can go to another hospital. But sometimes other government hospitals can’t accommodate them as well.”
The P500-million renovation project that was begun in June 2018 and is now 70-percent complete covers not only the ER but also the intensive care unit (ICU).
The project will expand the ER complex to accommodate 80 beds. But Del Rosario said the completion date had been pushed to February 2020—beyond the 10-month deadline—because of “unforeseen circumstances.”
“Construction-wise, there are things to be done which are not accurately anticipated,” he said.
OLD COMPLEX A nurse performs her tasks at an improvised emergency area, as the hospital undergoes another round of improvements. —PHOTOS BY RICHARD A. REYES
Crowded wards
PGH, which is administered and operated by the University of the Philippines (UP) Manila, admits around 600,000 patients annually. But its wards are notoriously crowded.
Patient evaluation, which includes deciding whether a patient should be admitted or sent home, normally takes one to two hours. Around 100 need to be admitted daily, but the wards are usually fully occupied.
“That’s when traffic arises: ERs are ready to admit these patients to the wards but the wards are telling us, ‘Wait, we’re not yet ready and we have limited capacity of 50 beds per ward,’” Del Rosario said.
Built in 1907, PGH is one of the oldest hospitals in the Philippines, but it has been 15 years since the ER was last renovated. Pipelines for water and electricity are in bad shape, the ceilings are cracked, and medical equipment need modernizing.
This year, PGH received a budget of P3.2 billion out of the P17-billion total appropriation for the UP system.
“We got the budget [for the renovation] so we took advantage of it,” Del Rosario said.
He said the new ER might improve the hospital’s services but that staff shortage and limited bed capacity were perennial problems that needed long-term solutions.
Premier training institution
At present, the nurse-patient ratio in PGH is 1:10, as against the ideal 1:5. At the ER, the staff-patient ratio sometimes reaches 1:30.
Said Del Rosario: “It concerns us because we’re not able to deliver the ideal management of patients. We have doctors and specialists who can treat any illness because PGH is a premier training institution. All the subspecialties are here, so the most complicated cases can be treated here.
“We’re just limited in our space. You can’t admit a patient because you have no more beds, or you can’t operate on a patient because of a long waiting list.”
According to Del Rosario, PGH needs parallel expansion in terms of improved facilities augmented with the right number of personnel.
“That’s the thing that frustrates most of us,” he said. “We want to serve more but our hands are tied right now because of limited resources. Expansion of our hospitals take time also.”
Endpoint
At Ospital ng Maynila (OM), a 300-bed multispecialty hospital funded by the local government of Manila, around 200 patients seek consultation and emergency services every day.
It caters to an average of 150,000 patients annually, with more than 25,000 emergency and outpatient cases for nonresidents of Manila.
“While we don’t have a problem with the doctor- and nurse-patient ratios here, we cannot easily increase our bed capacity, such as in the ICU, which has only 14 beds, because we have to comply with the requirements of the Department of Health and PhilHealth,” said OM director Rachel Marinas.
As a training hospital, OM has a steady roster of resident doctors specializing in various programs, Marinas said.
“OM’s services are free, so even patients who are not residents of Manila and are from the provinces also come here,” she said. “Maybe this is because other municipalities don’t have reliable hospitals. But here we cannot turn them away.”
OM also serves as the “endpoint” for patients who have gone to other hospitals in Manila but need more specialized care, she said.
Marinas said that with PGH under renovation, some patients turn to OM for medical care.
“For government hospitals, planning is very important,” she said. “We should always work within the budget approved by the city council and the city mayor.”
In 2020, OM hopes for a budget more than the P752.2 million it got this year, as government hospitals prepare for the universal health care program, Marinas said.
The ideal scenario
That even patients from as far as Cavite, Laguna and Batangas would rather go to PGH and OM than to a hospital in those provinces is reflective of the general state of the Philippine public health system, said Del Rosario.
“Patients tell us that they think they’d feel better in PGH. That they trust the system here. The hospitals in their provinces are not equipped, are sometimes limited in human resources and facilities, so why would they still line up there?” he said.
For the veteran doctor, the public health system needs two things: more specialized government hospitals and putting priority on preventive health care.
The ideal scenario is an advanced government hospital in every city or municipality, he said.
But the reality is this: Most provincial hospitals are classified as primary or secondary, and there are not enough tertiary hospitals to cater to low-income patients.
“The fact that a lot of patients come to PGH tells you that preventive health care is still not the focus. A lot of our patients come to us when their illness is in a very advanced stage, and you wonder why they waited for such a long time,” Del Rosario said.
This could be due to financial problems or lack of access to health care, he said, adding: “But a big part of it is we are a people who don’t really take care of ourselves. We should think of health as life. Prevention is more important, so there’d be less people going to hospitals and we’d be healthier people.”
(To be concluded)