Monday, October 15, 2012

Thailand - Thailand public health service in critical condition

Each year, hundreds of nurses at state hospitals leave their jobs due to hard work conditions and poor welfare. The staff exodus has forced some public hospitals to shut down wards.

Thailand's public health service, already plagued with a shortage of physicians and other problems, may face a worse state, as 17,000 nurses nationwide are threatening to quit unless the government improves job conditions.

Failure to properly resolve this long-running problem could hit state hospitals severely, as the ratio of nurses in Thailand is already lower than neighbours like Singapore and Malaysia.

In Thailand, there are just 1.5 nurses for every 1,000 people, compared to 5.9 in Singapore and 2.3 in Malaysia. In Norway, the country rated by the World Health Organisation to have the best medical care, the ratio is 31.9.

According to a survey by The Nation, many hospitals have to shut down wards - especially pediatric and surgical ones, because they don't have enough nurses to provide appropriate care to patients.

Rajavithi - a leading hospital and one of the country's biggest- has faced a shortage of nurses for more than 20 years. Due to this chronic problem, which has never been resolved, the hospital has had to close surgical rooms, as it hasn't enough nurses, who are the backbone of surgical teams.

"Shutting down surgical wards has made patients wait for so long and put them at risk of severe conditions," the hospital's director Dr Varunee Jinarat said in an exclusive interview.

The hospital has 36 surgical rooms but two have already been closed due to the lack of nurses.

"We cannot undertake surgery on [all] patients because we don't have enough surgical nurses to provide special care for patients even though we have many surgeons," she said.

The hospital needs at least 50-60 surgical nurses. It also needs more nurse anaesthetists to help doctors undertake surgery, Varunee said.

"We have to hire surgical nurses and nurse anaesthetists from private hospitals as a part-time job to help us undertake surgery and look after our patients," she said.

"We have to ask our nurses to use their connections - to invite their friends, who are nurses working at private hospitals, to work with us on a part-time basis. And we pay good money for them."

But it was tough to get nurses from private hospitals to do part-time work, as Rajavithi couldn't afford to pay rates over what they get at a private hospital.

At present, the hospital has 904 nurses and nursing assistants to look after patients. Some 881 of them are professional nurses and the rest nursing assistants. To reach top medical standards, the hospital should have 1,200 nurses to proving care, as it has about 1,200 beds for in-patients, Varunee said.

The hospital has to treat at least 4,500 patients a day at its outpatient department and nearly 1,200 a day at its in-patients department.

"The hospital's executives have been discussing the nursing shortage problem and finding a way out every week. We must to update the number of nurses working with the hospital every day," she said.

The shortage of nurses occurs not only in big hospitals in Bangkok like Rajavithi, but rural hospitals such as Chaibadarn Hospital in Lop Buri.

"We have to work around the clock, [with] no time for us to take a rest," Kanniga Panya-Amornwat, chief of nursing at Chaibadarn, said.

The Lop Buri hospital has only 90 nurses to care for 150 - 200 patients a day. And nearby hospitals also refer patients because it is the main facility in the district thanks to its specialist physicians in fields like obstetrics, pediatrics, and medicine.

Patient numbers at Chaibadarn have risen drastically in recent years. But due to the nurse shortage, some have to sleep in the corridor and can't get fast service.

This hospital should have 140 nurses to provide quality care to patients but only has 90 nurses, Kanniga said.

While Rajavithi Hospital had to close two wards, the severe lack of staff has prompted Chaibadarn to merge its pediatric and adult intensive care unit into the same room, so nurses can care for both young and adult patients.

At Bang Pa Han Hospital in Ayutthaya, they have the same problem. Two temporarily employed nurses resigned recently to get better pay at other hospitals.

Upcountry, at Maharat Nakhon Ratchasima Hospital, they also have a severe nurse shortage. Even though the hospital has enough money to offer nurses more than some other state facilities, recruitment ads win few applicants. Currently, nurses have to serve 12 patients in a day.

The nurse shortage at state hospitals across the country is caused by tough work conditions and poor job security. Some are hired on just temporary contracts, which must be renewed every year.

But those working for private hospitals can earn 30,000 baht (US$979) a month, excluding average overtime expenses of 187.5 baht per hour, while auxiliary nurses earn 15,000 baht a month and 62.5 baht per hour. These high rates encourage "temps" to seek higher-pay positions at private hospitals. And nurses who can also speak English are now being lured by foreign hospitals, particularly in Singapore, which is competing with Thailand to become the region's top medical hub.

"What will happen to them if someday the hospitals have no money and cancel their contracts? We have found some that have worked for six months without any pay," Krisada Sawaengdee, the second vice-president of Thailand's Nursing and Midwifery Council, said.

About 150,000 professional nurses aged up to 60 have registered for licences with the council but only 130,000 of them work at hospitals across the country. Some 17,000 have been hired as temporary nurses at state hospitals. But about 300 to 400 resigned from state hospitals every year.

The council estimates Thailand will need 50,000 nurses to work at both state and private hospitals by 2017 to care for the population, expected to be about 70 million then.

Tomorrow, about 3,000 temporary nurses plan to gather in front of Government House to call for a change in their job conditions. They want greater job security - for the government to offer permanent contracts and cut their workload.

Kanniga, a committee member of the Nursing and Midwifery Council, said about 17,000 temporary nurses were threatening to resign from state hospitals, if their demands are not met within three months.

Chularat Saengpassa and Pongphon Sarnsamak

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