Doctors: Couva Hospital dengue use good move

WHILE some concerns have been raised about the declaration of the Couva Hospital and Multi-Training Facility as a dengue early detection centre, most reactions have been positive.

Health Minister Terrence Deyalsingh made the announcement at a media conference at the ministry on August 13.

Head of the TT Nursing Association Idi Stuart said the association’s main concern was with staffing, as it has received several reports of understaffing in various facilities across the country.

Deyalsingh said in response to questions from Newsday that there were enough staff to fulfil the new need.

But Stuart said it was obvious the move would have a negative effect on staffing. He called on the minister to provide data showing there were enough nursing, medical and support staff to service the new unit.

"There’s a shortage of nursing staff across the country on our books. We have already started receiving complaints from nursing personnel in the SWRHA, which is where they’re pulling majority of the staff from, that they are further shorting the wards in San Fernando General Hospital to go to work in the Pt Fortin Hospital to manage additional cases up there.

"That’s a complaint we’re currently addressing and with this new and additional pull on the limited resources, it will further exacerbate the problem.

"Our data shows there’s a shortage of over 500 nursing personnel as we speak.
"Any people moved from the hospital setting would obviously create a shortage in the area you’re pulling from and it would not be enough to run a proper ward in these areas.

"It comes down to that we don’t have a mandatory patient-to-staff ratio where our health institutions are mandated to follow."

He said the reason the ministry was able to open the Couva Hospital during the covid19 period was because there were a number of nursing personnel who were waiting to be hired.

"Now there isn’t that vast amount of nursing personnel like during that period who we can now pull on.
"Couva Hospital was being slowly being decanted as we moved away from covid19, so people had already been transferred to other places. Those initially sent there from Southwest had returned to Southwest, those who came from the Arima Hospital have gone back to several facilities run by the NCRHA.
"So they were closing out until this dengue epidemic reared its head and is beginning to pull staff, particularly from Southwest, to operate that facility.
"There’s no regional health authority (RHA) in TT that is operating to an acceptable level of nursing personnel to patients as we speak."

NCRHA CEO Davlin Thomas said the hospital was using existing staff to care for the patients.

"We were providing services at Couva, like radiology services and a number of novelty clinics like transition clinics for paediatrics to adult diabetes, which is run by an endocrinologist, Dr Ragbir. We have a cardiac rehabilitation clinic that takes place there. We did over 4,000 X-rays in the last 12 months.
"Couva is currently providing relief services to other hospitals throughout the country.

"We do MRIs, CTs and so on from other areas as well as the Eric Williams Medical Sciences Complex, so we attempt to engage backlogs and so on. We were also offering limited inpatient services and as a spill-over area for emergency departments to ease congestion."

He said some of the inpatient services were repurposed to act on a contingency basis if patients had to be warded.

"So far we’ve taken five dengue patients from the Southwest RHA. We’re seeing 15-20 people a day and we’ve had an average of seven people who’ve had to be on drips each day. So 40-50 per cent on a daily basis would have come in via ambulance or walk-in, and after we did our ward tests, we realised they needed to have IVs. Two people came in, and it was serious enough for us to ward them.

"We’ve repurposed some areas and hired a minimal level of staff in terms of house officers. We’ve engaged some registrars, who are the people that have higher levels of core clinical competence."

He said there had been re-training by viral experts, as most of the clinical staff would have encountered dengue and other viruses previously.

"It was a matter of re-establishing the protocols and re-acquainting them with the current situation, as we already had the core competencies."

Thomas said the assumption that the hospital was difficult to access was incorrect.

"It’s located on a main artery of the country, the Uriah Butler Highway, and people drop off there and come in or drive in. The highway goes from north to south and people come. We have wheelchair patients who come in. Taxis come into the hospital as well. Some people take taxis from the Gran Couva side and those who get a south taxi to drop them."

Cumuto/Manzanilla MP Dr Rai Ragbir said the move was a prudent one, as all existing district health facilities, health centres and accident and emergency departments have been inundated.

"Bearing in mind we always have Saharan dust and respiratory infections; now we’re seeing more dengue cases.
"Since I started screening people for dengue on June 21, when the outbreak started, to about two days ago, I would have picked up 52 cases of dengue out of 140 patients tested. That’s one in three patients suspected of having dengue that would have been confirmed positive in the laboratory.

"When I get these results, they go to the surveillance department and the county medical officer of health at Couva, who sends the data to the Insect Vector Control Department and subsequently their internal departments link with the Local Government and Rural Development Ministry, etc, to determine what needs to be done about the particular area.”

Ragbir said he had spoken with colleagues who had been shifted from different areas of the Couva Hospital to work at the multi-disciplinary unit.

"I have been told they are doing screening, blood tests, and some outpatients have been admitted because when they did the tests, they realised the platelets were low. That’s significant."

Ragbir issued a warning to people who were on aspirin and other non-steroidal anti-inflammatory drugs who have or might suspect they have dengue.

"Older patients who have non-communicable diseases (NCDs) tend to be on aspirin, and we need to remind them that once you pick up any viral symptoms, or anyone in the home has been diagnosed with dengue, you need to hold up on (taking) the aspirin, because if you get dengue and you’re on aspirin, the chance of your platelets dropping very low can increase. So no aspirin, Cataflam, ibuprofen, Advil, nothing of the sort. The paracetamol, paracodeine, Panadeine, those are pretty safe."

He said people with connective-tissue diseases like lupus, psoriasis and rheumatoid arthritis who take aspirin and NSAIDs should be wary if they develop a fever, and go to a health professional as soon as possible.

"As a practitioner, what I and my colleagues are seeing is that at one point platelets can be 150-400, the next day it could be 130 and the next day it drops to 30.
"That’s a scary thing, because there’s no cure for dengue. It’s self-limiting.
"As a population, we need to realise that with dengue contracted from the Aedes aegypti mosquito, 80 per cent of people have no symptoms, 15 per cent have mild to moderate symptoms and five per cent have really severe symptoms."

Ragbir appealed to the population to engage in source reduction, as the mosquito likes to breed in clean stagnant water and can lay eggs in something as small as a bottlecap.

He said people can have dengue more than once.

"We have four strains of dengue, and once you’ve had it before, every time you get it, you’re at a higher risk of transmission of dengue haemorrhagic fever and dengue shock syndrome. With the symptoms of dengue, fever, retro-orbital pain, nausea, fatigue, etc, sometimes the symptoms abate and we start back again, so we think we’re good."

Ragbir said using the multi-disciplinary hospital at Couva will add to the management of the dengue outbreak, as many people who visit health facilities will go home because of the length of time they need to wait and will come back in an ambulance.

UNC MP Dr Lackram Bodoe said government should ensure proper resources were provided for the hospital.

"Do the official case numbers reported by the ministry include tests done at private laboratories? If not, then the caseload is much higher, and more effort needs to be directed to diagnosing cases of dengue haemorrhagic fever, which can result in more deaths if not treated early and aggressively.

"Dengue early screening centres must be staffed by experienced healthcare professionals to detect these cases.
"The 230-bed Couva Hospital, with ICU and HDU capabilities (as proven during the covid19 pandemic), can provide much more relief to citizens, in addition to being used as an early dengue screening centre."