Collapse of state healthcare imminent, doctors predict

… Heart surgery unit understaffed and dysfunctional

By Confidente Reporter

THE adult cardiac unit at Windhoek Central Hospital is allegedly on the brink of collapse following the depletion of critical medicine, which has also led to the consumption of expired consumables, a situation that has now put over 500 cardiac patients at risk.

Leaked documents in Confidente’s possession compiled by medical specialists show that challenges facing the cardiac unit that serves as the State’s 24/7 Heart Attack Centre worsened after funding for adult cardiology allegedly stopped in 2018.

According to the documents, as of November 2019, consumables required for coronary angiograms (a special x-ray test) and other heart-related procedures were not in stock, which saw the unit unable to perform any angiograms safely. The unit will also not be performing angiograms from January 2020 until stock of consumables is restored.

It is also revealed in the documents that the back-up generator for the Cath lab (an examination room with diagnostic equipment used to visualize the heart) has been out of order for some time. This means that in the event of a power cut in the middle of a procedure, patients could be hurt or even killed.

It is further noted that while the hospital has two cardiac technicians, one is attending sessions at a private hospital rather than being at the state cardiac unit, while the other is barely able to cope with the workload.

The unit has reportedly also not had pacemakers for over a year and doctors were therefore unable to implant pacemakers during the 2018/2019 financial year. The hospital only received 30 single-chamber pacemakers that will be used during January on patients that have been on the waiting list.

Confidente understands that since October 2019, cardiologists have been performing critical procedures with only two nurses and without a radiographer or technician.  Most cardiologists reportedly refused to work under those circumstances.

The specialists also noted with concern a critical shortage of medical specialists to adequately assist hundreds of state cardiac patients, revealing that there are currently only four cardiologists in the country, one at Windhoek Central Hospital and three at private health hospitals.

Despite this shortage, Confidente understands that the only specialist at Windhoek Central Hospital is working without contract and as such is only able to attend to the state unit once a week, which is insufficient to provide quality care to state cardiac patients.

“As a result, we are unable to provide decent cardiac care at the state hospital currently.  We cannot perform emergency procedures at all, the cardiac emergencies must be directed to Katutura Casualty for their management. We are unable to accommodate outpatients in the cardiac clinic or to slot elective cardiac procedures in a timely fashion. The waiting times are very long,” the documents state.

The specialists proposed that intervention procedures rather be performed at cost price at the Roman Catholic Hospital or at Ongwediva Medipark Hospital.

“This system would save the ministries of health and finance a lot of money per capita and free the State Cardiac Unit for cardiac surgical patients and pediatric cardiac patients. The condition is that the Ministry of Health has a good payment discipline as the private hospitals must buy the extra stock of consumables and keep it on the books. In the case of non-payment or late payment, the private hospitals would be put under financial distress as the number of state cardiac patients far exceeds the number of private cardiac patients…

“There has been no response, election time was in the way. Let’s wait and see what happens in early 2020. Until then, consider the adult cardiac service at the Windhoek Central Hospital non-functional.”

Health executive director, Benetus Nangombe said that while there has been shortages of essential medicine, “It cannot be right that the cardiac unit has not been funded since 2018.  We will address challenges facing the health ministry (during a press conference today),” Nangombe said.

The specialists fear that 2020 is going to be an extremely challenging year for the health sector in general, saying private medical aid funds are under financial distress as the volume of private healthcare has reached its maximum capacity.

“Any further expansion of private healthcare could cause a collapse of some or all the medical aids and with them the private healthcare in Namibia would also cause a severe crisis in the private healthcare industry. This would yet be another blow to the already fragile economy, likely to cause more unemployment and hardship in the country.

The specialists further say that for private funders and providers to survive 2020 and beyond, compulsory reductions of their costs and claims is crucial.

“We may even need to voluntarily cut our fees in the interest of our own survival. Any new procedure should be the replacement of the old one at the same or reduced cost.  Our private medical aids must survive and we must help. Otherwise, even the private healthcare will fall under the regulatory hand of the government with all the predictable consequences.”