To leaders of the Ministry of Health and Population:Have you visited Al-Jumhury Hospital in Aden recently? [Archives:2006/970/Health]

August 7 2006
A nurse drinks directly from the tap of a rusty basin. The hospital also experiences constant water cuts.
A nurse drinks directly from the tap of a rusty basin. The hospital also experiences constant water cuts.
One laundry machine works in the laundry department, where blankets and clothes of medical staff and patients at the hospital are washed with only hot water and one type of soap.
One laundry machine works in the laundry department, where blankets and clothes of medical staff and patients at the hospital are washed with only hot water and one type of soap.
Pipes in the central ventilator are subject to constant breakdowns and the biggest problem is that most spare parts are unavailable.
Pipes in the central ventilator are subject to constant breakdowns and the biggest problem is that most spare parts are unavailable.
By: Amel Al-Ariqi
[email protected]

Aden's Al-Jumhury Hospital recently became a common fixture in local newspaper headlines, which criticized its medical conditions and administrative system. Yemen Times visited the hospital to take a closer look at its current state.

Previously known as “Queen Hospital,” Al-Jumhury Hospital is one of five government hospitals in Aden. Established in 1954 and opened in 1958. According to hospital general director Dr. Khalid Al-Jaradi, with its British and Yemeni staff, the hospital was considered the best on the Arabian Peninsula. After South Yemen's independence, the hospital's name became Al-Jumhury Hospital (a public hospital).

According to Al-Jaradi, the hospital daily receives 500 patients, with 200 visiting the emergency room and 200-300 visiting outpatient clinics.

The hospital also is considered an educational hospital, with many medical students applying their studies and lessons there. Al-Jumhury Hospital covers several governorates, including Aden, Abeen, Shabwa, Al-Dhale and Lahj.

From best to worst

In the past, the hospital was described as the best in the Gulf, but it now suffers obvious damage and devastation, as anyone can see cracks in its roof and walls. Also, many ventilators aren't working and broken taps, rusty basins and damaged equipment exist throughout the hospital.

Located only half a kilometer from the sea, Al-Jaradi explained that Aden is characterized by high humidity, which can affect construction and equipment inside the building. “Since the hospital's establishment, it hasn't witnessed any type of maintenance since 1983,” he added.

“We recently contacted the Army Establishment to reconstruct water closest to the hospital. During digging to build water pipes, we found seawater in the ground. This water and the humidity gradually affect the hospital's foundation,” Al-Jaradi confirmed. He has informed the Ministry of Health and Aden's governor about the hospital's poor condition.

The hospital's maintenance supervisor pointed out damages clearly apparent in the hospital's central air system, which hasn't been maintained since 1996. “Since that time, the pipes in the central ventilator are subject to constant breakdowns and the biggest problem is that most spare parts are unavailable,” he explained.

The maintenance officer highlighted other problems in the laundry department, saying, “There's only one laundry machine that works in this department and it's used to clean and wash blankets and the clothes of medical staff and patients at the hospital.

“The launderers say they use only hot water and one type of soap to clean clothes that they mix in the only available laundry machine. They don't make any type of classification of the clothes which belong to patients suffering infectious diseases,” he added.

The employees are aware that this method of washing clothes is an easy way to allow germs to transfer. “However, I have no other choice. I'm working according to the available resources and equipment,” the officer noted.

The autopsy room also has problems. A morgue employee explained that the morgue has only two freezers to save the dead bodies kept inside the morgue for criminal reasons or until relatives come to identify the body and request burial. The worker mentioned that he normally receives approximately 15 dead bodies daily.

“One of the freezers hasn't worked, as the ventilator isn't working, so I keep moving bodies from place to another to provide space for incoming bodies,” the worker said.

Dr. Mansour Al-Hakimi, who is in charge of the surgery department, said the hospital has qualified surgeons performing many surgeries daily, but the old equipment they use requires constant care. He confessed that surgeons sometimes ask patients to buy medical supplies not existing at the hospital, but required to perform the surgery.

Physicians face infection risk

The laundry, central air system and the autopsy room aren't the only places needing maintenance and reconstruction. Many locations inside the hospital require better control and supervision. In the emergency room, which supposedly is a new department in the hospital, doctors and nurses treat injured or ill patients 24 hours a day; however, the lack of protective means for these employees is evident.

“We daily receive many patients subjected to car accidents or drowning. Many times, these patients also are suffering infectious diseases like AIDS, tuberculosis or hepatitis. Most of the time, they don't tell us about their conditions and so we're exposed to infection as we try to treat their wounds,” said a nurse not wishing to be named.

He confirmed that simple protective means like gloves and masks aren't available in the hospital, but after a nurse at the hospital contracted AIDS, hospital administration provided the emergency room with gloves and other protective tools. “However, we sometimes don't have the time to wear such gloves,” he noted.

Mushtak Abdulrahman, who works in the contagious disease department, confirmed that any nurse at the hospital is exposed to numerous types of infection due to lack of protective tools for medical staff. “Many times, we asked patients to buy gloves and other protective materials for us to be able to treat them,” he admitted.

Abdulrahman pointed out that medical staff many times have requested involved authorities such as hospital administration, the medical syndicate and Aden sector's medical office provide the hospital with these protective tools, but they received no response or reaction. “The problem is that when we become infected, we transmit this infection to our children and family,” he explained.

There is no periodic testing for medical staff, according to Abdulrahman. “The only time the administration conducted tests was when one of the nurses discovered he had AIDS,” he said. “The administration arranged a training course to raise the medical staff's awareness of infectious diseases and how they deal with patients; however, these training courses haven't been offered to all physicians,” he added.

Medical waste

Physicians aren't the only hospital employees subject to infection. Cleaners also are at risk because the hospital doesn't take special care in disposing of wastes contaminated with blood and tissue. Doctors don't separate these hazardous wastes from ordinary waste. They put needles, scalpels and glassware, called “sharps,” outdated and unused drugs along with papers in one wastebasket, without any classification of these different wastes. Cleaners then carry these in plastic cases, cutting their hands on the sharp tools and thus becoming easy targets for infectious diseases.

Weak budget

Al-Jaradi said the hospital experiences many obstacles due to its small YR 4 million monthly budget. “As a manager of this hospital, I myself see no justification to have such a small budget for a central hospital receiving patients from various governorates,” he said.

According to Al-Jaradi, there are approximately 1,000 employees, consisting of 300 doctors, 500 nurses and 200 technicians and officers. While it has 500 beds, it daily receives approximately 500 patients from Aden, Lahj, Abeen, Shabwa and Al-Dhale because it provides medical services for five governorates, Al-Jaradi noted.

“Additionally, we receive car accident victims who may be citizens of Taiz, Dhamar or Al-Beidha, who had these accidents in their way to or from Aden,” he added, highlighting the strain upon the hospital.

The cost of beds at Aden's Al-Jumhury Hospital is YR 390, a small sum compared to Al-Thawra Hospital in Sana'a, whose beds cost YR 4,000, according to Al-Jaradi. He says the hospital's small budget affects its medical state and its performance. For example, the hospital's cleaning budget is only YR 500,000 monthly, but Al-Jaradi says it's not enough to provide materials used to clean clothes, hospital surfaces or enough containers and sterilizers.

“We are suffering and our scarcity is reflected in the hospital's performance. For example, the hospital needs ambulances and maintaining its central air system. The hospital is suffering water shortage and drug scarcity because the Drug Fund stopped providing the hospital with medicine. We now use Community Contribution funds to buy medication and equipment to meet these shortages,” he explained.

Al-Jaradi said he will propose that the Ministry of Health and Population increase the hospital's budget.

Physicians don't care

Regarding doctors' protection, Al-Jaradi pointed out that the possibility of infection among medical staff is that of any doctor or nurse in any hospital around the world. “However, we are focusing on raising the awareness of medical staff because it's very important to teach them how to deal with patients and how to avoid infections,” he added.

Al-Jaradi accused some physicians at the hospital of negligence because they deal with patients directly without considering the possibility their own infection. He insisted that all protective means are provided to medical staff but because of carelessness, they don't use them to avoid infection. He said hospital administration can't obligate medical staff to follow such protective measures.

He added that hospital administration is conducting annual tests for AIDS and hepatitis for medical staff. The results of these tests revealed the infection of one nurse with AIDS and some physicians with hepatitis, Al-Jaradi said.

Weak budget or mismanagement

One doctor insisted that the hospital's problem isn't its small budget but rather corruption and mismanagement; however, she refused to give her name, saying she didn't want trouble with the administration.

“For instance, the monthly income of the lab is YR 800,000, which is collected as fees patients pay. This money isn't used to provide the lab with medical solutions, equipment or any protective tools for medical staff inside the lab,” she explained.

“The lab's lack of new equipment and existing equipment mostly is broken or misreads results. Some tubes are broken and rats and insects are widespread and freely move throughout the hospital,” she added. She confirmed that staff working in the labs most of the time do so without protection and they must buy their own gloves from the pharmacy.

A technician, who also refused to give his name, agreed, saying that the hospital receives money from various sources like the Community Contribution and patient fees; however, the administration doesn't use such sources to improve medical services at the hospital. On the contrary, the hospital appears bad, leading people to believe that it's considered the worst hospital in Aden.

Dr. Al-Khadher Naser Al-Sawar, manager of Aden's Medical Office, pointed out the important role that medical management and leadership play in medical facilities. “I don't deny that the occupational budgets are small, but I don't believe that any medical services decline due to the small budget. Many hospitals are running with small budgets, but they can receive benefits from available resources,” he said.

He confirmed that an examining and monitoring department is interested in evaluating government hospitals' performance.

Al-Sawar denied that he's received any complaints from medical staff at Al-Jumhury Hospital, noting that he always visits the hospitals. He also referred to the importance of establishing an authority or committee to receive complaints and then investigate.

Last word

Although this report was done to clarify the medical state at Al-Jumhury Hospital, it also raises many questions: What's the problem? Is it the weak budget or mismanagement? Why are medical staff keeping quiet about problems facing them and patients? Are they afraid of any measures that may be taken against them or they just don't care? Does the Ministry of Health, which ordered shutting down, and suspending work at, many private medical facilities in many governorates for alleged failure to meet medical service standards, have a complete picture of this public hospital? These questions not only require answers but swift reactions too.