A plaque located on an outside wall at Kingston Public
Hospital (KPH) shows writing in recognition of its 240 years of providing
medical services in Jamaica. The public hospital was
founded during the slavery era in 1776. During that period, the downtown
Kingston hospital catered to the white population only until it began
accepting Black residents in 1838 after the abolition of slavery. Undoubtedly,
attention was paid during the earlier years to the historic hospital’s
development to prolong its longevity. However,
while red-brick colonial buildings remain and newer buildings were constructed to
accommodate the hospital’s rapid growth, poorly maintained interiors during the
later years confirm a lack of consistent upkeep. In addition, efforts have been
made to upgrade equipment with the latest technology, but too often critical care
machines break down leaving patients’ health in jeopardy. Customer service
practices have also drastically diminished throughout the year thereby implanting
a bad reputation on KPH’s medical staff for discourteous attitude and treatment
towards patients.
A typical day
for a person who goes to KPH’s emergency room is an unforgettable experience. While waiting, it
is not uncommon to hear people wailing in pain. One young girl screamed incessantly
that she had severe head pains. Her screams and cries of others did not seem to
bother the medical staff who appeared uncaring and numb to the sufferings of
those in the emergency waiting area. Also, a man who was referred by his
personal physician for heart attack symptoms, arrived at the emergency room at
1:30 PM. At 6:30 PM he, like others who arrived earlier, were still waiting to
receive any type of acknowledgement. His personal doctor's referral letter meant
nothing! After a series of miscommunication by emergency staff on whether
his x-rays were completed, he was eventually assigned
a bed in a ward at 3:30 AM the next morning. This typical lengthy
wait time at KPH may result in critical consequences as was the case of a lady
who was transported by an ambulance to the emergency unit but died in her
sister’s arms while sitting in the waiting area to be attended to. Arriving in
an ambulance meant nothing! KPH’s medical staff makes it quite clear to
those waiting that their priority is to attend to the gun-shot and knife
wounded victims from the surrounding, volatile inner-city where shootings
and gang retaliations are the norm. So, persons with medical
conditions such as heart attacks, possible brain aneurism, etc. will
take a back seat to those who frequently arrive in speeding cars that stop
abruptly at the emergency entrance where occupants quickly exit the vehicles
while yelling, “Gunshot”!! “Gunshot”!!
The procedures
for visitors is another aspect at KPH that seems unusual to
the standard practices of any hospital. The visiting
time is from 11:00 AM to 12:00 PM. and from 4:00PM to 6:30 PM. The
first step for a visitor is to line up at the information center
to get a worn-out cardboard which is called a pass.
When requesting the pass, the only expectation for visitors is to
provide a name and ward number to the service personnel sitting in an
encased-type room. These service personnel do not inquire or even have the
ability to check if the name and ward number provided to them is valid. So, security procedures
at this point is non-existent since service personnel hands out passes to
anyone. After getting the cardboard pass at about 10:45 AM,
the next step for visitors is to wait in a second line to be
processed by private security workers whose only gratification seems to be
that they are in control of visitors entering the main hospital compound. They are responsible for checking
bags to make sure no items on KPH’s restricted lists are brought into
the wards, and that includes every type of food and drinks
except fruits and water. They also are entrusted with a metal detector
that seems more symbolic than useful. An absurd practice is that security will
not allow ladies to pass through the gate to visit their loved ones if they are
wearing sleeveless blouses or dresses. As a result, the hospital projects an
impression that, in the gun-ridden neighborhood, harassing women wearing
sleeveless garments is more of a priority than focusing on the slack security
procedures of handing out visitor passes to anyone who requests one. Nevertheless,
as security usurps their limited powers, they will not begin their visitor
processing duties until precisely at 11:00 AM, 4:00 PM or thereafter. So, the visitors
will lose some of their visiting time while going through the prison-like entry
process. But, the wait time is never boring in this lively atmosphere
where intriguing residents, living in the politically charged neighboring community,
use the hospital premises as their main walkway. From their
residences, they walk nonchalantly onto the hospital compound; boldly pass the
hospital’s police sub-station; and proceed to downtown Kingston and back. It
is also common to see sellers passing by and haggling
their products such as water, fruits, phone cards, and even a male
vendor walks by selling women’s half-slip undergarments. Waiting is
frequently interrupted when security opens the tall, heavy gates to allow the
entrance of luxury vehicles driven by doctors or other personnel who haughtily
hold their heads high as they drive through. Further, if visitors know
someone connected to the hospital, communicating with a guard at the gate often
results in entry to see loved ones without standing in line. Waiting
visitors may even get caught up with the loud outbursts of people with mental
health issues who walk around aimlessly on the premises. Visitors could also witness a
commotion from family and friends who are mourning loudly and uncontrollably
over the loss of a loved one who they accompanied to the emergency unit but never
survived gun shots or knife wounds.
The outpatient
clinic waiting process is an all-day fiasco. Since a computerized patient system
does not exist at KPH in this 21st century, the outpatient courtyard
is overcrowded with people sitting and waiting for their names to be called so
that they may move on to the next step in their effort to see a doctor. Noise
and confusion abounds as people must wait for their dockets, or medical files,
to be located and brought by foot to another building where the out-patient
must go after leaving the courtyard in order to see his/her specialists. Others
may be immediately directed to crammed rooms where they need to make
appointments, obtain consultation from a nurse, or see a specialist. People
must arrive during the wee hours of the morning at KPH’s patient clinic to
ensure that they are attended to by a doctor since their appointment wait time
could be as long as six months in between visits. But, outpatient
inconveniences also extend to patients while they are admitted in KPH wards. Broken,
life-saving medical equipment requires patients to get tests outside the
hospital. But, the lack of ambulances to take patients to other public
facilities mean that a patient must make their own personal travel arrangements
to leave the hospital on a doctor’s authorized pass to get the tests at private
facilities, if they can afford to pay exorbitant testing fees. If patients
cannot afford the fees for private tests while admitted at KPH, then they will
be released without obtaining important medical exams.
The buildings and common areas are reminiscent of a great many
years of neglect that has result in dilapidated conditions. Such appearance
makes visitors wonder if they are actually inside a hospital because cleanliness
and order are nowhere to be seen. As visitors enter a building, they are confronted
with peeling paint on dirty walls. Concrete, uneven and uncovered slab floors
intermingle with worn-out linoleum covered floors. Hidden, dingy stairways in
poorly lighted locations are the only way to access upstairs floors since
out-of-the-way elevators are restricted to patients who are transported in
wheelchairs or on hospital beds. Untidy, deplorable conditions are seen in
workers’ maintenance rooms where all is visible with wide open doors or no
doors. The conditions of some patient wards are unspeakable as an unmistakable,
lingering stench confronts a visitor’s nostrils on approaching the entrance. The
stained concrete floors are lined with rows of old beds with malfunctioning
headboard recline levers attached to them. The large, open 30-bed or more wards
also include limited number of rusty storage bedside cabinets with stuck doors
for patients’ use. Bathrooms with no doors clearly expose a couple of cracked
sinks with aged faucets and two walled urine stalls for the 30-bed ward or more
capacity. But, more concerning is that ceiling fans and open windows and doors
are expected to keep patients cool throughout the days and nights in the hospital’s
dangerous, downtown neighborhood where even staff sometimes have to run for
cover at the sound of a barrage of gunshots. When it rains, leaking ceiling and
the open windows and doors cause some wards to be flooded which results in the
need for patients to be moved elsewhere in the overcrowded ward. The appearance
of the doctor/nursing station is consistent with the rundown conditions of some
wards. The poor conditions will make anyone curious as to where all the
millions of dollars donated by worldwide NGOs and international governments
have gone not only for this squalor hospital but other government hospitals in even worse conditions.
Jamaica is an island where social services for persons with disabilities are not commonly seen throughout the country. So, people with disabilities have to contend with the daily difficulties that impede their ability to be self-sufficient during their daily movements outside their homes. Even today, newly constructed commercial buildings are not attainable to those persons with disabilities which means that they have continued to experience problems accessing not only the top level floors but even the first level. This problem was commonly noticed in the new city of Portmore where recently constructed buildings such as a medical complex, which is expected to cater to the sick and people with disabilities, do not provide them with accommodations to get to the upper level floors. Since previous and current Jamaican governments has never given any attention to even the buildings they occupy, there is no surprise in their lack of efforts in introducing laws that ensure that commercial buildings throughout the island are constructed with disability access.
