A public outcry on the deficiencies of Princess Marina Hospital’s capacity to handle high risk patients has been validated by a report titled ‘Quality Improvement Initiatives at the facility’ compiled by Dr Tjeza Matenge.
The report which has been anticipated for some time, was comparing the “ideal Princess Marina Hospital to the current state of the hospital”. This study depicts a deep-seated problem in Botswana’s flagship hospital, a situation which calls on government to make amends if the health care system is to offer meticulous health services to the citizens.
For some time the hospital has been under scrutiny with the numbers of negligence and mortality cases increasing. The ever increasing cases of negligence at Princess Marina have earned the hospital a bad reputation, with some expressing misgivings about its inability to deal with most common diseases. This week at the hospital’s Pitso addressed by stakeholders including the minister of Health and Wellness, councilors and health experts, a new damning report was released. The main aim of the meeting was to deliberate on solutions to overcrowding, referral system, shortage of medicines, health system shortfalls, maintenance of facilities and staff burnout among others.
At the very top in the report is the congestion issue at the hospital’s maternity ward. This is caused by added beds, floor beds with patients in labour pains sitting on chairs. This has contributed to morbidity and mortality incident reports. The report further highlighted that there is fatigue and burnout from the staff which leads to poor monitoring and more mistakes that end up compromising people’s health. “Hygiene is also compromised and transmission of nosocomial infections,” the report states.
The congestion is said to be caused by “low midwife numbers, low bed capacity yet high number of deliveries and congestion of hospital’s wards. Less transfer to clinics and less number of deliveries by District Health Management Team (DHMT) clinics despite higher number of midwives and beds are other factors contributing to crowding”. Transport and poor communication, confusion of staff regarding discharge status of patients referred to clinics are also hinted as additional causes of the anomaly.
“Ante Natal Ward’s Ideal bed capacity is 30 but now it has 18 additional beds which make the total to 48. On average, four patients in labour pains idle on chairs daily,” said the report. “The post-natal ward ideal bed is 52, with 22 additional beds and 18 floor beds making the total to 92. These are some of the factors that lead to high mortality rates as personnel – patients’ ratio is unbalanced,” added Matenge.
Marina, according to the research paper, has a total of 75 midwives. On average, the midwife-patient ratio at the hospital’s Ante Natal Ward is 1:12; in labour ward 1:4 and in Post Natal Ward is 1:23. Ideal nurse patient ratio in a general ward should be 1:8 according to Dr Matenge. On the other hand the Australian nursing and midwifery federation recommends 1:4 in a medical or surgical ward and 1:3 in specialized nursing areas like delivery suites, emergency departments because of high acuity.
On average Marina records 576 deliveries monthly while primigravida (first time mothers) is 129 on monthly average. While the short-term interventions continue to get intensified, the hospital wants long-term definitive strategies to be put in place. “To have the capacity of the building (Marina hospital) expanded,” one recommendation says. “We should have an MOU (midwife-obstetric unit) for greater Gaborone which admits intermediate risk patients only, such that Marina admits only high risk patients,” reads the report under recommendations.
Currently Marina admits both intermediate and high risk patients. It is said, this could take one of the clinics to be converted into an obstetrics primary clinic with theatre facilities or a new building altogether. The clinic could even become an obstetric center of excellence and can be run by family physicians and midwives.
The report recommends units like Marina which are delivering more than 6000 per annum, should aim to reach full consultant obstetric presence (168 hour cover per week). It was further said a “24 hour consultant obstetrician based should always be in the labour ward. The consultant obstetrician should be backed by 2-3 specialist trainees 4 of which our equivalent is medical officers.”
The Directorate of Public Prosecutions (DPP)’s decision to reject and appeal the High Court’s verdict on a case involving High Court Judge, Dr Zein Kebonang has frustrated the Judicial Service Commission (JSC) and Judge Kebonang’s back to work discussions.
JSC and Kebonang have been in constant discussions over the latter’s return to work following a ruling by a High Court panel of judges clearing him of any wrong doing in the National Petroleum Fund criminal case filed by the DPP. However the finalization of the matter has been hanged on whether the DPP will appeal the matter or not – the prosecution body has since appealed.
Botswana Democratic Party (BDP) top brass has declined a request by Umbrella for Democratic Change (UDC) to negotiate the legal fees occasioned by 2019 general elections petition in which the latter disputed in court the outcome of the elections.
This publication is made aware that UDC Vice President Dumelang Saleshando was left with an egg on his face after the BDP big wigs, comprising of party Chairman Slumber Tsogwane and Secretary General Mpho Balopi rejected his plea.
“He was told that this is a legal matter and therefore their (UDC) lawyer should engage ours (BDP) for negotiations because it is way far from our jurisdiction,” BDP Head of Communications, Kagelelo Kentse, told this publication.
This spelt doom for the main opposition party and Saleshando who seems not to have confidence and that the UDC lawyers have the dexterity to negotiate these kind of matters. It is not clear whether Saleshando requested UDC lawyer Boingotlo Toteng to sit at the table with Bogopa Manewe, Tobedza and Co, who are representing the BDP to strike a deal as per the BDP top echelons suggested.
“From my understanding, the matter is dealt with politically as the two parties are negotiating how to resolve it, but by far nothing has come to me on the matter. So I believe they are still substantively engaging each other,” Toteng said briefly in an interview on Thursday.
UDC petitioners saddled with costs after mounting an unprecedented legal suit before the court to try and overturn BDP’s October 2019 victory. The participants in the legal matter involves 15 parliamentary candidates’ and nine councillors. The UDC petitioned the court and contested the outcome of the elections citing “irregularities in some of the constituencies”.
In a brief ruling in January 2020, Judge President Ian Kirby on behalf of a five-member panel said: “We have no jurisdiction to entertain these appeals. These appeals must be struck out each with costs including costs of counsel”. This was a second blow to the UDC in about a month after their 2019 appeals were dismissed by the High Court a day before Christmas Day.
This week BDP attorneys decided to attach UDC petitioners’ property in a bid to settle the debts. UDC President Duma Boko is among those that will see their property being attached with 14 of his party members. “We have attached some and we are on course. So far, Dr. Mpho Pheko (who contested Gaborone Central) and that of Dr, Micus Chimbombi (who contested Kgalagadi South) will have their assets being sold on the 5th of February 2021,” BDP attorney Basimane Bogopa said.
Asked whether they met with UDC lawyers to try solve the matter, Bogopa said no and added. “Remember we are trying to raise the client’s funds, so after these two others will follow. Right now we are just prioritising those from Court of Appeal, as soon as the high court is done with taxation we will attach.”
Saleshando, when contacted about the outcomes of the meeting with the BDP, told WeekendPost that: “It would not be proper and procedural for me to tell you about the meeting outcomes before I share with UDC National Executive Committee (NEC), so I will have to brief them first.”
UDC NEC will meet on the 20th of next month to deal with a number of thorny issues including settling the legal fees. Negotiations with other opposition parties- Alliance for Progressives and Botswana Patriotic Front (BPF) are also on the agenda.
Currently, UDC has raised P44 238 of the P565 000 needed to cover bills from the Court of Appeal (CoA). This is the amount in a UDC trust account which is paltry funds equating 7.8 per cent of the overall required money. In the past despite the petitioners maintaining that there was promise to assist them to settle legal fees, UDC Spokesperson, Moeti Mohwasa then said the party has never agreed in no way to help them.
“We have just been put in debt by someone,” one of the petitioners told this publication in the past. “President’s (Duma Boko) message was clear at the beginning that money has been sourced somewhere to help with the whole process but now we are here there is nothing and we are just running around trying to make ends meet and pay,” added the petitioner in an interview UDC NEC has in December last year directed all the 57 constituencies to each raise a minimum of P10, 000. The funds will be used to settle debts that are currently engulfing the petitioners with Sheriffs, who are already hovering around ready to attach their assets.
The petitioners, despite the party intervention, have every right to worry. “This is so because ‘the deadline for this initiative (P10, 000 per constituency) is the end of the first quarter of this year (2021),” a period in which the sheriffs would have long auctioned the properties.
President of the Umbrella for Democratic Change (UDC) Duma Boko’s alliance with former President Lt Gen Ian Khama continues to unsettle some quarters within the opposition collective, who believe the duo, if not managed, will once again result in an unsuccessful bid for government in 2024.
While Khama has denied that he has undeclared preference to have Boko remaining as leader of UDC, many believe that the two have a common programme, while other opposition leaders remain on the side-lines.