Only four ambulances on call

National Health Service General Manager, Leota Laki Sio has confirmed that the country only has four ambulances but says that two more are on the way.

There are two ambulances on Upolu, and two on Savai’i.

“We are currently ordering two more new ambulances,” Leota told Samoa Observer.

“Once these arrive we will be able to cater for ambulances based at the more remote district hospitals.”

Leota was responding to a complaint made by an outpatient at Leulumoega to Samoa Observer, that doctors only visited once a week, drugs were in short supply and there was no ambulance.

His response was sent early Thursday afternoon, around the same time as one of the Upolu ambulances was involved in an accident at Vaitele.

The ambulance is not thought to have been seriously damaged.

The small number of ambulances is despite a total Health budget this year of $ 113,450,023 according to the 2013/14 budget, including $18,900,275 in foreign capital project grants, and $6,911,587 in foreign “soft” loans.

Of that, only $ 72,994,171 is going to National Health Services, with the rest spent on construction of facilities, ministerial support budgets, policy advice, overseas memberships, meetings and dozens of other items.

Leota defended the limited availability of drugs at district health centres. “Leulumoega District Hospital, like all other district level health facilities, only stocks certain medications for dispensation to the public,” he said. Each centre carries a standard list of medications that they all stock, which is a “subset” of the full set of medications available from the pharmacies in TTM National Hospital and Malietoa Tanumafili II Hospital.

“The simple reason for their only stocking this subset, is that there are regulations to the dispensation of medicines, whereby many can only be dispensed by pharmacists or trained pharmacy technicians.”

Pharmacists and pharmacy technicians are trained in the side effects, including with other drugs and “many” other issues which must be considered, he said.

“Given our staffing shortage problems in the Pharmacy area and recognizing the level of demand at these district facilities, the medications available have been carefully worked out as those able to be safely dispensed by the nurses who staff these facilities.”

He described this list as “quite comprehensive”.

There are selected medications available for pain relief, gout, allergies, epilepsy, bacterial and other infections, hypertension, diabetes, heart disease, diarrhoea, family planning, mental disorders and many other conditions. Staff shortages were also behind the fact that there were limited doctors on call.

There are two main hospitals in Upolu and Savaii, with three district hospitals open 24 hours a day, seven days a week, he said. Only the two main hospitals have doctors on duty 24/7.

For emergencies at centres without doctors, “Nurses staffing the district hospitals and health centres are all trained to provide basic health checks and health care, and are trained in knowing when a patient needs an urgent referral for medical attention,” said Leota.

“These district facilities nurses have a direct line of enquiry to doctors at TTM National Hospital and MTII Referral Hospital, to request medical opinion and or facilitate referral.”

Leota was also asked why there are no statistics available from Samoa on the regional PacNet disease surveillance system, and why the World Health Organisation did not have any more recent statistics than 2000.

Responsibility for reporting overseas “lies with the Ministry of Health, not the National Health Service,” he said. His full comments are below, in verbatim. “As per your enquiry dated 6th March 2014.

I apologise for the delay as I had thought I had submitted response by email earlier. Please find response below to each of your queries. Do not hesitate to get back to us if you need further clarification.

(1) Can you confirm which hospitals/ districts hospitals and health centresare open 24/7 service in Samoa? All hospitals are open 24 hours 7 days a week.

These include the Tupua Tamasese Meaole National Hospital, the Malietoa Tanumafili II Referral hospital in Tuasivi, Savaii, and 3 district hospitals each for Upolu and Savaii. Health or Medical Centres are open weekdays from 8am to 4:30pm.

2. Can you confirm which hospitals/ districts hospitals and health centres have doctors available 24/7 service in Samoa?

Tupua Tamasese Meaole (T.T.M.) National Hospital in Motootua, and MalietoaTanumafili II (M.T.II) Hospital in Savaii have doctors on duty 24 hours, 7 days a week.

For the six district hospitals (3 each in Upolu and Savaii) we have contracted private General Practitioners (doctors) due to the shortage of medical staff employed under N.H.S., to work from each hospital at least one day a week.

We also contract a private practitioner specializing in maternal care to visit each of the district hospitals in Upolu at least once a fortnight in order to provider closer to home medical checks for pregnant women in the rural areas.

Not forgetting that at the same time, maternal checkups (pregnancy and post-pregnancy checks) is primarily a nursing function with appropriate referral when needed to doctors.

It is important to note that the nursing personnel who staff these district hospitals and health centres, are all trained in delivery of primary health care and are well trained to be able to deal with usual types of complaints presenting at these rural facilities, and appropriately refer for medical consultation when necessary.

3. How many hospitals/health centres within Savai’i and Upolu?

Refer table above – there are 13 health facilities altogether.

4. We have a complaint that the district hospital at Leulumoega does not have a full supply of medicine and does not have enough ambulances? Can you explain why? Leulumoega District Hospital, like all other district level health facilities, only stocks certain medications for dispensation to the public.

There is a standard list of medications that they and all other district health facilities stock, which is a subset of the full set of medications available from the pharmacies in T.T.M. National Hospital and MalietoaTanumafili II Hospital. The simple reason for their only stocking this subset, is that there are regulations to the dispensation of medicines, whereby many can only be dispensed by pharmacists or trained pharmacy technicians.

Pharmacists and pharmacy technicians are trained in the side effects, contraindications or interactions with other drugs and many other issues which must be considered and may require careful counselling of the patient, when the drug or medication is dispensed.

Given our staffing shortage problems in the Pharmacy area and recognizing the level of demand at these district facilities, the medications available have been carefully worked out as those able to be safely dispensed by the nurses who staff these facilities. This list is actually quite comprehensive and includes many of the drugs and medications that may typically be required at district facilities.

There are selected medications available for pain relief, gout, allergies, epilepsy, bacterial and other infections, hypertension, diabetes, heart disease, diarrhea, family planning, mental disorders and many other conditions.

As mentioned above, we have contracted private GP doctors visiting these health facilities. They are actually accompanied by pharmacy technicians with the full stock of medications so that any prescription issued can be dispensed then and there.

As well, there is a mobile X-ray van and staff which accompany so that general xrays required can also be done on site.

All district hospitals and health centres are re-stocked for pharmaceutical supplies once every week. At the same time, if there is any stock-out prior to the re-stocking visit, special delivery is made within the day. This process has been well honed so that stock-outs are rare.

As for the ambulance service, we only have two working ambulances at the moment in Upolu and two in Savaii. By necessity taking into account demand patterns they are based at TTM National Hospital and MTII Hospital in Tuasivi. We are currently ordering two more new ambulances – Once these arrive we will be able to cater for ambulances based at the more remote district hospitals.

5. Patients at Leulumoega said they can’t wait for one week for a doctor to check them, how long will the process of having one doctor once a week in those districts hospitals and health centres remain? 7. Do you think patient can hold on that long for those checkups?

Nurses staffing the district hospitals and health centres are all trained to provide basic health checks and health care, and are trained in knowing when a patient needs an urgent referral for medical attention. These district facilities nurses have a direct line of enquiry to doctors at TTM National Hospital and MTII Referral Hospital, to request medical opinion and or facilitate referral.

The bulk of patients being seen by the doctors we contract to provide services at the district health facilities, are Non Communicable Disease patients. Typical follow-up period for these patients is more than a week so the regularity of visitations by the GPs is adequate at the moment.

Lately, NHS has a doctor at Faleolo on Wednesdays, and that provides 2 doctors to that area twice a week with the one at Leulumoega on Tuesday. We hope given adequate resources, we will add another day to Leulumoega most like Thursday so that there are 2 days a week in Leulumoega and Wednesday in between at Faleolo. ie 3 days a week for that area.

6. Any Statistics or other facts on patients that have been treated at hospitals and medical centres? Refer to above answers in which I have mentioned relevant and pertinent facts on the patients at district health facilities.

8. Why is Samoa not sending reports to PacNet? The responsibility for country reporting to the World Health Organisation and the Pacific Public Health Surveillance Network (PACNET) run by the Secretariat of the Pacific Community, lies with the Ministry of Health, not the National Health Service.

9. W.H.O. has statistics on dengue up to 2000 but none after. Why is there no dengue statistics available from after 2000?

Please refer to answer to (8) above. Ma le faaaloalo.

Leota Laki Lamositele Sio GENERAL MANAGER”