MAIN HOSPITAL

Gaborone, 22 September 2004 (IRIN) - A major hospital in Botswana is struggling to cope with the mounting pressure of staff and resource shortages, the HIV/AIDS crisis and a high rate of road accidents.

The Princess Marina hospital was initially meant to be a referral facility for districts south of the capital, Gaborone, but has evolved into a national referral centre due to the of lack of specialised units in the rest of the country.

The hospital has begun to show the strain, as a shortage of beds has resulted in patients having to sleep on the floor.

But that is not the only problem Princess Marina faces: space is also in critically short supply and the authorities have been forced to convert a number of ward duty rooms, bathrooms and even kitchens into mini-wards to cope with the overcrowding.

"We are going through the most difficult time in the history of this institution. The hospital is facing shortages of all kinds, ranging from bedding through to space in the wards, to understaffing. The situation is dynamic: patients are admitted; others are discharged; and some die every day but there is never a drop in the bed occupancy rates - sometimes we have 200 percent bed occupancy in the wards," said Dr Howard Moffat, the hospital's superintendent.

He attributes the overcrowding to Botswana's high HIV prevalence rate - currently at 37.3 percent - road traffic accidents and the fact that Princess Marina now acts as the national referral centre.

"Seventy percent of our patients are suffering from HIV/AIDS-related diseases. Road traffic accidents also contribute heavily to the pressure in the paediatric, surgical and medical wards," he said.

According to Moffat, the hospital is operating with only 150 out of a standard staff of 450 nurses. Instead of the required 110 staff doctors, Marina is reported to be operating with less than 30.

The hospital's nurse-to-patient ratio is one of the highest in Southern Africa. The World Health Organisation (WHO) stipulates that one nurse should care for a maximum of six patients, but nurses at Marina say their average is 10, and can go up to 20 in times of crisis.

"We are extremely overworked, but underpaid. It is not easy to attend to patients on the beds, on the floors, on the trolleys and in cubicles. The wards are always flooded with people, yet there are so few of us," said a nursing sister.

The hospital has a normal capacity of 507 beds, but officials say the average admission has gone up to 665 at any given time. Hospital manager Tim Jones said wards designed to accommodate 24 patients were now taking in an average of 30, a figure that ballooned to 40 during admission peaks. "Our committed nurses are clearly overworked," he commented.