Off The Cuff - Hospitals need special upkeep

FOR all intents and purposes, hospitals, especially the ubiquitous government ones across the country, are special facilities compared to other buildings.

Unlike office blocks or shopping malls, general hospitals in particular are heavily used on all fronts and running round the clock, and cannot even stop operating for even a second.

Even a clock takes a break but not hospitals.

One needs to take a look at general hospitals, for instance, to see the congestion as people from everywhere and beyond seek treatment virtually free in a country that has one of the world's best healthcare systems.

In a previous column, I described the over-worked hospital staff as "unsung heroes".

The point I'm making is that maintenance-wise, hospitals certainly cannot follow the SOP adopted for other buildings and facilities. They are in a world of their own.

If Jose Mourinho, the Manchester United manager, is called the Special One, general hospitals and other public hospitals in the country are the Special Ones and their maintenance should be extra special, too.

The issue has become even more critical in the light of Tuesday's fire at Johor Baru's Hospital Sultanah Aminah (HSA). Six Intensive Care Unit patients died in this heart-wrenching tragedy that struck in the most unlikely of places often deemed as the safest.

Amid the pandemonium that followed, the heroic acts of hospital staff and the prompt action by the firefighters helped save many lives.

Of course like for all tragedies, an investigation panel is being set up to determine its cause but the more important thing is always prevention which is closely tied again to the question of maintenance.

It's only after this tragedy that we hear of Health Minister Datuk Seri Dr S. Subramaniam talking about an auditing exercise to be carried out to look into the state of government hospitals, especially those 50 years old and more, especially from the fire risk point of view.

The HSA is 143 years old and one of the country's oldest hospitals.

According to a very senior doctor, a short circuit occurred at the ICU of the hospital a week earlier and the ward was shut down.

Malaysia is known as having First World public facilities but the maintenance aspect is still not a Malaysian culture and some would describe it as Third World. Even roofs of a newly-commissioned sports stadium and a hospital have collapsed.

The senior doctor told me that all old hospitals in the country do not have floor plans of buildings and they are not even kept at the archives of the Public Works Department.

And when five services at government hospitals were privatised 15 years ago, whenever there's a system break down, like the electrical system, the concession company will give conditional appraisal of the present condition and the costing to rectify the system.

The hospital concerned will then send an application for a budget to normalise the system to the Ministry of Health but more often than not "life goes on as usual" as the ministry faces budget constraints, the doctor told me.

Then finger pointing follows as the top ministry officers often blame the concession companies for lack of maintenance but the companies can't do much without extra budget and changing the system is not part of their contracts.

This being so, it's time to revisit such contracts where a higher priority is placed on maintenance.

The doctor said prioritising maintenance works in the budget is very much on an ad hoc basis.

In the event of a fire, a hospital cannot depend 100% on the Fire Department (Bomba) as it takes a while for fire engines to arrive.

"Every hospital must be prepared to go into action when there's a fire with all resources focused and diverted to help in that affected area and the hospital's own fire marshals to take charge while waiting for Bomba to arrive," said the doctor.

The doctor is worried that with the tragedy at the HSA, now all allocations would most likely be diverted to this hospital perhaps at the expense of others which are also facing similar risks especially the aging ones.

Almost all hospitals especially in the states are treating well beyond the number of patients they were built for, causing serious wear and tear plus under-maintenance.

If there's a silver lining or lesson that ought to be learnt from this tragedy, it certainly is for decision makers at the Health Ministry to get their act together on the maintenance of the Special Ones.