Space dilemma for hospitals

ONE cannot help but notice the over-crowding at Sarawak General Hospital (SGH) in Kuching, contrasting sharply with the “tranquility” and clear under-utilisation of SGH Heart Centre in Kota Samarahan.

To most of the public, the solution is simple — move some services at SGH to SGH Heart Centre. This will ease congestion at SGH and increase utilisation of the seemingly empty Heart Centre.

If only things are that simple.

Fully aware of SGH’s long-standing congestion issue and the fact that one-and-a-half floor at SGH Heart Centre is left unused, SGH director Dr Abdul Rahim Abdullah, who also looks after the Heart Centre, has been

trying to resolve the delimma facing the two hospitals under his charge — too little space at one and too much space at the other.

He is hopeful a solution can be found in good time.

Changes, of course, cannot be made in haste as there are many things to consider such as facilities, manpower and the leasing of premises for the Heart Centre — all crucial factors not known to the public.

Right now, ownership of the premises is still under Sarawak International Medical Centre (SIMC) which, incidentally, has failed to take off.

SGH has been leasing from SIMC to operate at the premises. As the Heart Centre is on a relatively short-term leasing term, it would be counter-productive for SGH to spend or invest a monstrous sum to refurbish the premises.

“We have been thinking of buying up the whole place from SIMC from day one. It’s still one of the options in the planning stage. Only when the premises belongs to us legally can we plan how to use it,” Dr Abdul Rahim explained.

Meanwhile, gradual occupation of the space at the Heart Centre has been taking place.

Part of the Centre is also a Kidney and Stone centre that provides specialist outpatient and selected daycare services aside from offering selected daycare radiotherapy services for cancer patients.

The biggest challenge Dr Abdul Rahim faces is the design of the premises, originally meant to be a premium private hospital with selective and fewer facilities compared to SGH.

“It was built to be a private hospital. A lot of renovation and modification is needed first before it can be turned into a public general hospital,” he said.

As SGH has yet to claim ownership of the premises, extensive renovation or installing of costly equipment will not be a wise move at this juncture.

With fewer comprehensive essential facilities and equipment at the premises, shifting departments from SGH to the Heart Centre will not be easy.

“For example, a lot of facilties and equipment for cancer treatment such as radiotherapy are already in place at SGH.

“It will cost millions to have them reinstalled and start up the service. It’s not so easy to just move them to a new premise to start afresh,” Dr Abdul Rahim pointed out.

Stretching manpower

Even after SGH has designated the premises as its Heart Centre, the latter has yet to be fully utilised due to shortage of staff.

“Full utilisation for independent operation will require over 1,000 medical staff. Now, only a third of the posts has been approved and mostly filled while the rest of the staff are from SGH.

“We are actually stretching our staff to run both SGH and the Heart Centre,” he noted.

Even with all its 166 beds taken up, the Heart Centre will still look empty due to its design and very spacious compound.

“SGH which has 934 beds will definitely look much busier and more congested than the Heart Centre which offers only 166 beds — less than one-fifth the capacity of SGH.

“Now, the Heart Centre has an average occupancy of 75 per cent. Even if all the beds are occupied, the Heart Centre itself will still look very empty while the compound very spacious with ample parking. That was the initial intention of the design,” Dr Abdul Rahim explained.

After the initial opening of the first to the fourth floor of the Heart Centre on January 1, 2011, the last two-and-a-half years have seen the fifth and sixth floors being utilised.

Acknowledging that one-and-a-half floor is still idle, Dr Abdul Rahim said there is a short-term plan to turn the seventh floor into a geriartic ward for patients above 60 although in the long term, he envisages the Heart Centre becoming a Heart Institution, especially for Sarawakians.

“Right now, half the floor is dedicated as a geriartic ward. We plan to open up the whole floor for this purpose. The problem is we do not have enough staff, at present, to do this. But with adequate manpower eventually, I think we will be able to help relieve SGH of its congestion – to a certain extent at least.”

Solution to congestion

The setting up of Petrajaya Hospital at Demak Laut is one of the solutions for easing congestion at SGH. The project has already been started with site preparation getting underway more than a month ago. The close to RM500 million project is expected to be completed in three or three-and-a-half years.

This new hospital which will be a general specialist hospital like Sibu Hospital or Miri Hospital can cater for about 300 inpatients — more than the 200 average SGH has been receiving from across the river in Petrajaya everyday.

However, with the Petrajaya Hospital projected to absorb 20 per cent of SGH inpatients, Dr Abdul Rahim said this will relieve SGH considerably not only of patient congestion but also parking problems.

Patient congestion is just one problem SGH has to deal with as there has also been the problem of lack of clinic rooms for examination by specialists.

Most pressing of all is the lack of parking space – a long standing problem but one that has not been tackled  head-on so far.

There are about 4,000 staff at SGH alone. The carpark is not even enough for the staff, let alone patients and visitors.

For many years, there have been talks of building a multi-storey carpark but the project has moved no further than the drawing board. This time round, however, Dr Abdul Rahim hopes it will not be just words.

“The selection of contractors is being finalised. We expect the long-standing project to start this year. Apart from the carpark building, there will also be a block for a daycare centre and a new pathology and blood bank centre.

“The staff carpark block will be built first. We plan to complete the two buildings within three to three-and-a-half years,” he said.

He estimated the costs of these development projects at both SGH and the Petrajaya Hospital to come close to RM1 billion.

Increasing stress

Over the years, socio-economic development in Kuching — which leads to rural migration or inter-town migration into the city — has been also putting increasing stress on SGH.

“We have been feeling it quite for sometime already. The increase in Kuching population means more patients for us,” Dr Abdul Rahman pointed out.

In 2009, SGH registered 45,000 patients but in 2012, inpatients increased to over 53,000 – a jump of well over 8,000 or 18 per cent.

“Apart from rural-urban migration, our patients have been on the increase due to more referrals from other hospitals such as those from Miri, Sibu and Bintulu,” he said.

To Dr Abdul Rahim, referrals to SGH should not be the only solution. In the long term, he pointed out, both Miri Hospital and Sibu Hospital should also be upgraded to handle more serious cases to relieve dependency on SGH.

“It’s the concept of our current Director General of Health Datuk Seri Dr Noor Hisham Abdullah to form hospital clusters to provide better healthcare and optimise utiisation of healthcare resources. The new concept is in line with the Health Ministry’s system transformation,” he added.

An idea has been mooted for sometime to have three regional hospitals in Sarawak — southern region (Kuching), central region (Sibu) and northern region (Miri).

“The concept will empower these regional hospitals to make quick decisions. Now, decisions will have to be referred to SGH and they may take a long time to reach us.

“For example, if there is a serious case in Kapit that needs to be transferred, empowerment of Sibu Hospital with higher levels of care in selected disciplines will enable Kapit Hospital to  get an immediate response from Sibu and transfer the patient out,” Dr Abdul Rahman said.

Empowerment plans like these take time to materialise. First, Sibu Hospital and Miri Hospital will have to be upgraded in terms of manpower and facilities or equipment to meet real needs and this has to be clearly identified.

While purchasing medical equipment might take two or three years to be approved, adequate specialists, nurses and other allied healthcare professionals will take even longer to train and nurture.