Make proper plans for hospitals

Letters

IT is wonderful that our prime minister is planning to build modern provincial hospitals in the 22 provinces and a major referral hospital in Port Moresby next year.
However, I would like to sound a word of caution and that is we need to plan these hospitals appropriately for our needs.
To many, this may sound like an unnecessary caution.
But my experience with hospital planning in PNG over the past 40 years has made it clear to me that so much hospital construction and refurbishment that has taken place – especially since when decentralisation became constitutionally formalised in the mid-1990s – has not been appropriate and literally hundreds of millions of kina have been wasted.
Just a couple of examples of this might help readers understand what I am talking about.
The new wing of the Goroka Hospital that was built for K80 million, completed in 2018 and still awaits commissioning and use.
The reason usually given for not opening this new wing is that there are no staff to run it.
But one has to think that it was known before the foundations were laid that it would need staff to run it and surely it was not sensible to start the building unless funding for extra staff had been planned and approved by Department of Personal Management, and funding budgeted for and allocated.
Unfortunately all the high tech equipment in this new wing had never been used, and the warranties and service agreements for their care and function are about to expire.
Inspection of the plans of this new wing shows that it has many “non-functional” features.
The labour ward is on the top floor; how women in labour can or who have been referred in bleeding or with other labour and delivery problems going to walk up eight flights of stairs to get there.
Labour and delivery suites need to be on the ground floor.
The operating theatre does not have any sluice area where theatre linen and instruments can be disinfected and pre-wash soaked.
How are the soiled linen etc. (dripping with blood after surgery) going to be transported to the hospital laundry?
Or perhaps the designer of this facility considered that everything used would be disposable! (Same applies to the labour ward)
And the access to the rest of the hospital from the new wing is also non-functional.
Meanwhile Goroka Hospital are still using the old operating theatres which are dilapidated, and not entirely safe – so that doctors are unable to do any surgery except the most urgent emergencies: this has been going on for more than 10 years.
If the K80 million had been used wisely with a proper functional plan, EHP would now have an upgraded hospital with capacity to care for the people of the province properly.
About 10 years ago a new district hospital was built at Koroba, now in Hela.
This facility has never been commissioned or used.
The Health Department found that the structure did not meet PNG’s minimum standards for hospital construction.
Last year Oil Search Health Foundation committed K3 million to upgrade the hospital and it is now hoped that Koroba will actually get a functional facility in the near future.
In 2011, I was commissioned by the National Planning secretary to review the tendering process for the engineering and architectural documentation for a new Angau Hospital in Lae.
The previous hospital derived mostly from the 1950s and 1960s with some emergency temporary wards constructed in 2008 when most the hospital became unusable because of termite infestation.
I found that a previous Health minister had tried to bring in two overseas firms (American and Chinese) to design and build the new Angau hospital in 2010.
But both had been rejected by the Angau Hospital board as neither had any hospital construction experience or track record.
The 2011 international call for tenders for the design brief had resulted in six hospital construction companies putting in bids (which ranged from K23-K81million); the NEC had chosen the second highest bid of K65 million.
These bids were to just provide drawings and engineering reports (i.e. only paper work, no actually building construction).
It was not a transparent process as it was not possible to be clear on what basis the successful (very expensive) bid had been awarded.
Subsequently, Australia became involved and political trading between Kevin Rudd and Peter O’Neill occurred.
It was agreed that Australian aid would provide K600 million to construct a new Angau hospital, and PNG agreed to allow asylum seekers who had arrived in Australia by boat to be incarcerated at the old Lomburm naval base in Manus.
Unfortunately, seven years later, the new Angau hospital has still not been finished and there are again some design faults that are now difficult to rectify.
About five years ago the Enga Governor in collaboration with fellow Engan and former PNG ambassador to the USA (Evan Paki) negotiated a K527 million loan deal to build a new provincial hospital in Wabag.
This figure does not include medical equipment of fitting out the building for use.
The contract was for completion in three years, i.e. by 2020.
Neither of these gentlemen have any knowledge of hospital planning. The plan that they have accepted is an American design, is non-functional for PNG conditions and needs.
To date most of the K527m has been used up by the Chinese construction company, but the hospital building is only about 60 per cent complete. One wonders where (if ever) the money will come from for refinancing the loan.
The worst case scenario (which is becoming more likely by the day) – an inappropriate design hospital build that is never finished, and a K527 million loan that the Enga government will have to repay leaving no health money in the provincial budget to run the health services for the people of Enga.
Moresby residents will remember that the MVIL hospital was left unfurnished and never opened for 15 years after being built by the Skate government in the 1990s.
Over K28 million of MVIL money was used to build this hospital. But Fletcher Morobe Ltd, who did the construction, didn’t receive the full payment for their construction work.
Gerehu hospital has had at least three renovation and refurbishment projects to try and get it functional at a basic level – with total expenditure of nearly K15m.
But as of today it is still not possible even to have a normal birth at Gerehu.
The accounting for the various donor partner grants and PNG government allocations to develop Gerehu hospital since 1996 are not clear.
In 2018, K28 million was allocated to Port Moresby General Hospital to build three specialist services: namely, a cancer treatment centre, kidney dialysis unit, cardiac catheterisation centre.
In discussions with the then CEO of PMGH at that time (Dr Umesh Gupta), the senior doctors of PMGH advised him that we should put the development of the cancer treatment centre first and there must be priority given to sustainability.
The Kidney dialysis unit now treats a few people with terminal kidney failure every day, but there is no renal transplant service in PNG so there is no chance of these poor patients ever getting definitive treatment for their kidney failure.
The cardiac catheterisation unit was opened in 2019 and has done angiograms (imaging of the heart blood vessels) on a few people but there is no capacity to do bypass surgery if blockages are found.
The unit struggles to continue the angiography because of inadequate supply of the expensive disposables required for each patient.
The cancer centre was never built.
Last year Dr Gupta was terminated and given seven days to leave PNG; the accounting for the K28m remains undisclosed.
A master plan for the redevelopment of the women’s and children’s parts of PMGH was developed in 2015.
It is a very dysfunctional plan. It also puts the labour ward on an upper floor so that women in labour will have difficulty accessing it, and sick children’s wards are adjacent to maternity and the newborn baby units – a juxta position that is against all hospital planning principles.
When the division of Obstetrics and Gynaecology at PMGH tried to talk to the former CEO about changing the plans to be more functional and appropriate, we were told that it did not matter as we would all be retired or dead by the time the PNG government got around to implementing the plan.
I write this short piece on the PNG recent history of hospital planning and with a few points that PM James Marape and his hospital planning advisers could take into account to get things better for the future.
The bottom line I would like to emphasise is that hospital development should not be an opportunity for corrupt politicians and public servants and others to spin and scam commissions and consultancies out of the health budgets.

Professor Glen Mola,
Head of Reproductive Health, Obstetrics and Gynaecology, SMHS-UPNG

One thought on “Make proper plans for hospitals

  • Hypocrite. This year 2020 your Prime minister, your finance minister and treasury minister are looking for money. Next year 2021 you said you will have money to build 22 empty district hospitals for campaign plan to open on 22 election period. We totally don’t believe in you.

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