There may be some flaws in the Georgetown Public Hospital Corporation's (GPHC) procedures in dealing with sick persons brought in from off the street but there are also difficult issues involved, according to Medical Director, Dr Madan Rambarran.
Dr Rambarran said the case of six-year-old Akeem Trotman might have been dealt with wrongly and as such the hospital's administration should seek to address the issue.
Two weeks ago, Trotman, who is chronically ill, was brought to the hospital by a public-spirited citizen and was turned away because there was no one to remain with him. He was finally admitted to the institution after a policeman accompanied the citizen to the hospital.
Dr Rambarran was one of the persons who told this newspaper that the child could not be left at the hospital without someone remaining with him to take full responsibility.
In an interview with Stabroek News Dr Rambarran explained that when a child was involved the hospital would want a responsible person to be present especially if it was a case where the child could be treated and sent home.
"We just can't just take people's children generally speaking, of course there are issues like that (Akeem's case) where there is nobody and indeed we need to clarify what should be done in those cases...."
He said that the real problem was managing with people who were destitute and abandoned. "They may be children they are sometimes adults, all over the hospitals we have this problem. They are presented to the hospital or some Good Samaritan brings them in and leaves them at the Accident & Emergency. Many times there is not any real medical problem and they could be treated for whatever complaints they have. But then as it is there is nowhere for them to go so we have to end up keeping them and they are left in the wards like that......."
According to Dr Rambarran the social workers department would then have to become involved and work along with those persons. He said at times it is found that parents of children would take the children to the hospital and when they were admitted never come back.
"As you know we have a high turnover, we have great demands on our capacity and when these kinds of situations present themselves there is a problem......"
He said that the social workers would sometimes work along with the Ministry of Human Services and Social Security in an effort to get the children into homes.
However, this in itself is another problem since many times the homes have criteria and some of the children might have an illness which could be infectious.
In the case of Akeem, Dr Rambarran said that they would have to look deeper into the case. Akeem has said that he does not want to return home and his mother, Melissa admitted that she could not take care of her son properly since she had to work. She has said that she would not mind if her son were to go into a home where he could receive special treatment.
Dr Rambarran said the social workers would have to work on the case and in the end they would make a recommendation on whether it was sensible to send the child back into the same home environment. He said that they would also be looking at whether they could work along with the mother in an effort to get her to understand her responsibilities towards the child.
Should they recommend that the child not be returned home then they would have to work along with government agencies to place the child in a foster home.
"But that is the problem. Now they may make that recommendation but maybe there is no such thing as a home for him as has happened in many instances. And as a hospital we have a certain mandate, and everybody is demanding and our mandate is expanding. We are for medical problems.
If the child does not have a medical problem we understand and appreciate the social issue, but if there is no need for them to be hospitalised we shouldn't be called upon to maintain them in the hospitals because those beds in the hospital are maybe needed by a real sick child."
Dr Rambarran told Stabroek News that Akeem could be dealt with as an outpatient. He said the child had been admitted to the hospital before and when he was discharged his mother did not take him to the clinic for his prescribed treatment.
The doctor said that he had been assured that Akeem could be treated as an outpatient but there were certain nutritional guidelines that would have to be followed.
Dr Rambarran noted that after the story on Akeem was published in the Sunday Stabroek it was found out that many people were willing to help. He said what could be a good idea is to compile a database of such people at the Ministry of Human Services and "whenever these situations arise they could tap their resources...."
He said another idea is that fostering could be arranged so that a family could take a child into their home. In the US there is a fostering arrangement where the government gives subventions to families who take children into their homes.
Touching on another issue, Dr Rambarran pointed out that too often there was a tendency to sensationalise the exceptional problems while "not recognising that a lot of good things do happen. Like one Akeem comes and we may have not been as accommodating to him as was possible but hundreds of Akeems come everyday and have been treated."
He said they do have issues of maternal deaths but this should be put in the perspective of 7,000 babies being delivered every year and in that number there might have be one or too complaints. "I am not saying or trying to defend everything........ and that there are issues but there are also good things...."
And on the positive side, Dr Rambarran said the hospital had forty-nine cases of persons being admitted to the hospital with gunshot and stab wounds between November 1, 2002 and January 31, 2003 and out of that number only one person had died.