14ymedio, Luz Escobar, Havana, 2 December 2019 — It’s Saturday night in the Calixto García Hospital Emergency Room in Havana and there is no room for anyone else in the line of those waiting. Doctors know that on the weekend, when the sun goes down, emergency cases multiply, but serums, needles and gloves to care for patients remain scarce.
In the row of seats in front of the consultation, all cases seem urgent. A lady has spent hours with her hand on her ear because of a sharp pain and a young man enters almost dragging his elderly father. It can take hours to be seen and that does not guarantee a treatment, because the lack of supplies limits the work of doctors.
The economic crisis that crosses the Island is experienced with more drama in emergency hospital services. While health professionals must deal with the shortages in the Emergency Rooms where they work, patients face the dilemma of continuing to wait or going somewhere else, hoping it will be better stocked.
“We are going to another hospital, here I have been told that my father must stay admitted but since there are no beds, I must bring a chair from my house,” complains the young man who had arrived with the almost faint old man . The list of what is missing is long: stretchers, bandages, serums, syringes, wheelchairs and much more.
In another hospital near Calixto García the room is less crowded, but the doctor on duty is seen entering and leaving the office, going up and down the stairs, knocking on doors, calling on the phone while attending to a patient. Try to look everywhere for the missing supplies to alleviate the situation of a man who has arrived dehydrated.
“The first thing missing is the cannula, a thin tube that is used to channel the veins of patients who need basic medical attention in emergencies,” the doctor explains to 14ymedio, under the condition of anonymity. “We try to resolve it without the patient realizing that we are looking in another room, but that creates additional tension.”
The doctor points out that the supply of everything is “very intermittent” and that in the case of the cannula he never has at his disposal all the different sizes to be able to select the most appropriate one. Generally, many old people arrive at the Guard Corps “that almost always have thin, fragile veins and a large cannula cannot be placed on a patient with these characteristics, because it is very difficult to insert it,” he clarifies.
Last August, the cannula shortage reached its worst moment and in the Havana Emergency Rooms there were barely three to four units available for use each day. “If more patients arrived who needed them, you had to ’invent’ it yourself,” describes a nurse at the Joaquín Albarrán Surgical Clinical Hospital.
Patients, aware of the situation, sometimes arrive with their own resources. “I brought everything, several sizes of disposable syringes, alcohol and the sterilized cottons that my daughter sent me from Miami,” says a lady who is being treated for an injured leg.
A wide variety of these products are also sold on the Island’s black markets. Together with vitamins, pain relievers and skin creams, merchants in these informal networks offer hospital supplies, including the thread for surgical sutures. Those who have more resources get everything ready before being admitted.
However, most patients have to settle for what is available in public hospitals. “If a transfusion is going to be done or during an operation, one type of cannula is needed and there is another for cancer patients,” a young doctor tells this newspaper, saying that since he graduated he has never had “a complete collection of varieties.”
“The alternative is to use a needle that comes in disposable syringes, which are not intended to leave in the vein,” he says. “If the patient moves, the needle slips out of the vein and a bruise can occur or the medicine gets into the tissue around the vein, which becomes infected and inflamed.”
Venoclysis (infusion) devices, the system used to connect solutions and sera to the patient, are also in short supply. A shortage that “greatly affects medical care, when there are few, you have to get them from other rooms to guarantee emergency services,” says the doctor.
The state-owned company MediCuba imports supplies and technology annually worth $400,000 for Public Health, according to a recent report on national television. However, a source from the Ministry of Public Health explains that a large share of the of Venoclysis devices are manufactured in Cuba, but the distribution varies throughout the year.
Another item missing from the emergency rooms are the aqueous solutions for clinical use and among them, the most affected are the so-called crystalloids, which are used in intravenous therapy to replace lost fluids. Several doctors consulted say that when they are available they are imported from Uruguay, China and India, but that in Cuba they are hardly produced due to problems with the availability of packaging.
In an emergency room such as Calixto García’s, where in one day about 200 patients are treated, doctors only receive a maximum of about 30 sera for use throughout the day. A limitation that significantly affects the service and generates wide discomfort among patients and among doctors who demand more investments in the sector.
During 2018, the ’sale’ of Cuban medical services abroad brought nearly 6.4 billion dollars into the national coffers, according to data from the National Bureau of Statistics and Information, but health professionals regret that these resources are not reflected of the Island’s hospitals.
“These billions of dollars have been coming in for many years and the situation in the emergency rooms remains critical,” adds a doctor from Calixto Garcia as he walks the halls in search of serum for a patient who has just arrived.
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