Is there no drain? Then just make a gastric tube

“Sometimes you have to tinker a little,” says Navin Ramdhani, head of the intensive care unit at the University Hospital Paramaribo (AZP) in Suriname. The chest drains were gone. These remove accumulated fluid from the chest cavity, for example in patients with lung disease. Gastric tubes were still there, and just like chest drains, they are silicone tubes. “So we cut some holes in it, and put that gastric tube into a lung,” says Ramdhani, who is also an anesthesiologist-intensivist. “That went fine.”

There are often shortages in hospital care in Suriname – in medicines, consumables (needles, ampoules, tubes), staff. As a doctor or nurse you learn to deal creatively with what is there. For example, there was recently a national shortage anesthetics, which meant that operations had to be postponed. In Ramdhani’s ICU there was a shortage of opiates. “So we used other anesthetics to keep people asleep, such as ketamine and a little Valium. You have your tricks.” The disadvantage: the more expensive medicines also run out faster.

More difficult to solve with inventive tricks is the staff shortage, which is affecting the entire healthcare system in Suriname. Many young people go to study in the Netherlands and continue to work there. Or they leave after their training for the Netherlands or the Caribbean islands, especially Aruba, Bonaire or Curaçao. Both in the Netherlands and in the countries near Suriname, salaries in healthcare are higher than in Suriname. A nurse in Suriname earns about 200 euros per month, in the Netherlands that is more than ten times as much. The fact that life is a bit cheaper in Suriname does not make up for that by a long shot.

operation assistantLucia Pradon The ship continues sailing, but crew often jump overboard

The people who do stay are trying to “keep a sinking ship sailing” in the AZP, says Pieter Voigt, Suriname’s only heart and lung surgeon. Operations assistant Lucia Pradon corrects him: “The ship continues to sail, but crew jumps overboard too often.” Voigt’s department once had fourteen employees in the operating rooms: nurses, laboratory technicians, assistants. Now there are four.

Pradon and Voigt both studied in the Netherlands, after which they returned to Suriname. It is indeed more difficult to build a life here, says Pradon, but she has never regretted it. “Suriname needs me more.”

Also read
Also read: These entrepreneurs did return to Suriname

The poor economic situation in Suriname is one of the reasons why staff are leaving. There is less and less money to spend on healthcare. Since the end of 2020, the Surinamese dollar (SRD) has fallen significantly in value and the country is experiencing annual inflation of 50 to 60 percent. When the new government of President Chan Santokhi (VHP) took office in 2020, it turned out that the country under predecessor Desi Bouterse had incurred billions of euros in debt at high interest rates, including with China.

If the economy is having a hard time, healthcare is also having a hard time, says surgeon Voigt. “We used to have around 350 to 450 euros per inhabitant to spend on healthcare in Suriname every year. Now it is only 90 to 140 euros. Not much is possible with that money.” Yet doctors, nurses and employees manage to keep the hospital running. Their duties go beyond medical matters: for example, doctors themselves look for donors for maintenance of the building or for medical equipment.

Sweltering hot

In the hallway of the AZP children’s center, three men are working with a ladder, installing new air conditioning. The old ones had recently stopped working. “It became very hot in the department,” says pediatrician Laurindo Kloof. The temperature in Suriname almost never drops below 30 degrees. There was no money for repairs or replacement at the hospital. Doctors themselves found a private company willing to pay for new air conditioning and their installation.

pediatricianLaurindo Kloof Often we train people only to see them leave

There are often leaks in the hospital, says Kloof. Not only because of broken air conditioners, but also because of rain – the roof of the hospital cannot withstand heavy rainfall everywhere. That is inconvenient, in a country where regular sibibusi’s (heavy tropical rain showers) fall from the sky. The paint is peeling off the wall in the neonatology department. “The building is not maintained. We arrange the necessary things ourselves.”

Beep, beep, beep. Ten monitors hang on the walls of the intensive care unit of the children’s center. There are only five beds. “We had to close the other five,” says Kloof. In fact, each monitor should have a bed, but the department does not have enough staff to staff ten beds.

There are also three incubators in the ICU, two of which are occupied – two babies are happily cooing at the staff, who are wearing Santa hats this Friday in December. These incubators are suitable for babies from 750 grams. “That is very small,” says Kloof. What he wants to say: a lot is possible in the department, the doctors are equipped with good equipment. But none of this is possible without nursing staff.

Despite the efforts of the employees, the shortages sometimes cause life-threatening situations. In 2019, the AZP children’s center had to close all medium care beds. Sometimes babies – who still needed care – were left with their mothers, says Kloof. To die. “There were no people to give them the care they needed.” Kloof is sitting on a bench in the playground outside the department, between the seesaw and the swing. He looks straight ahead as he says it.

Ten thousand children are born in Suriname every year, but the AZP is the only hospital in Suriname with an intensive care unit for babies. With ten ICU beds, Kloof and his fellow pediatricians would be able to properly care for children in need of care, but with the current five this is not always possible. “We get calls all the time,” says Kloof. But they are also constantly calling: stable babies have to go to another hospital as quickly as possible, “so that there is a place available in the ICU.”

What the AZP children’s center benefits from is that other hospitals are having an even harder time and are closing departments. The AZP often takes over staff from those departments and trains them to become specialized nurses in intensive care for babies. The risk: the nurses are then specialized to such an extent that they can easily go elsewhere – abroad. “We often train people only to see them leave.”

The ICU for adults cannot operate at full capacity either. There are now eight beds available, while according to department head Ramdhani, at least eighteen are needed for the population of around 600,000 people. As a result, he has to keep about ten patients waiting every week. For example, they have to stay longer in another department before they can go to the ICU, even though they already need intensive care. “That reduces their chances of survival,” says Ramdhani. This concerns more than five hundred patients annually.

Doctors cannot do much about the economic conditions in the country, so they try to bind staff to the AZP in other ways. “We organize activities, hand out food parcels, pay a lot of attention to mental health,” says Kloof. His team deployed that strategy about two years ago. Since then, there has been slightly less outflow, but too many people are still leaving. “The only thing that would really help is if salaries matched those in neighboring countries.”

Rolls-Royce

Although Ramdhani does not have the staff to run an ICU with eighteen beds, it is currently under construction. The hospital received a loan from the Islamic Development Bank (IsDB), an international bank that finances development projects. During the interview in December, Ramdhani is still standing in a ruin, in six to nine months this will be the new intensive care unit. Why build an ICU with eighteen beds if you cannot staff it? “The money came now, so let’s do it right away. Because this is the need of Suriname. But it is indeed a bit like buying a Rolls-Royce without a driver and petrol, and that car remains stationary.”

Ramdhani also first studied and worked in the Netherlands, but he “could never completely let go of Suriname” and therefore returned. He flew, among other things, in the trauma helicopter of the Erasmus MC in Rotterdam. He has contacts in many Dutch hospitals, which he now uses often. He takes a wrapped tube from a pantry. “This is an emergency drain, expiration date September 2023. But it’s just a plastic tube, so the expiration date makes no sense!” Colleagues from the Netherlands sent the drains to him. “As a courtesy, but I would like this to be organized structurally, for example between hospitals or governments in the Netherlands and Suriname. Because the alternative in the Netherlands is throwing it away. Give it to us!”

He apologizes several times for raising his voice – “but it makes me so despondent.” He doesn’t want to beg, he says, and that shouldn’t be necessary: ​​”I don’t need money, I need things.”

With the hat on

Part of the IsDB loan went to Voigt’s heart and lung department, where a new operating room was built. But it was not ready for use: it was missing, for example, an X-ray machine, operating tables and new instruments (the old ones were thirty years old). There wasn’t enough money for that. Voigt: “So we passed the hat around to companies and private individuals.”

Passing the hat around is what the hospital departments and various hospitals do among themselves, says anesthetist in the thoracic department Rosita Bihariesingh, but for things instead of money. “Every day I go around the departments looking for things like ampoules or tubes. Or I call other hospitals to see if we can exchange something. Recently, the hospital in Nickerie (a district west of Paramaribo) sent an ambulance with magnesium ampoules. It’s a simple painkiller, but it was gone. We sent back other medicines.” These mutual collaborations are essential, says Bihariesingh.

Also read
With Bouterse’s conviction, the rule of law still prevails in Suriname after 41 years

Voigt calls it a “great achievement” that the doctors and nurses of the AZP manage to keep patient care running with few people and few resources. He has hope. In recent years, major oil discoveries have been made off the coast of Suriname, and the first billion-dollar projects for its extraction have started. “In a few years this should yield something, which will hopefully improve the economy and therefore healthcare. Until then, we will continue to do everything we can to keep our ship sailing: we have little, but we can do a lot.”

To share





Email the editor