By Lasantha Pethiyagoda –

Prof Lasantha Pethiyagoda

I would like to outline the horrors of ward 30 at the “Teaching” hospital at Kandy, Sri Lanka, where I was an inpatient from 8th to 12th July.

A cardinal principle in a hospital is that it should not cause harm to a patient, especially through neglect. It was shocking to observe invasive procedures ranging from insertion of a cannula, catheter for drainage to intravenous medication are conducted almost casually and often aggressively with scant regard for patient health or comfort.

Most patients are quite weak on arrival, and therefore susceptible to infection, often with antibiotic resistant germs that grow in areas that are never properly cleaned.

In the apparent absence of publicly available data on rates of in-house infection, and a lack of standardised methodology or proper surveillance, patients seem to be severely compromised and at the mercy of their “destiny” when in hospital.

A considerable percentage of patients were observed to be wheezing and coughing, bringing up phlegm which is invariably emptied into open containers kept by their bedside. The stench itself is nauseating as beds are arranged less than a metre apart, most beds with frayed mattresses and paint peeled frames themselves being about a metre wide.

Patients always hold on to other patients’ bed rails to proceed to and from the abhorrently disgusting squat toilets which have gaping cracks and holes with highly visible faecal matter sloshing with water. The walls of toilets have layers of deposits in different shades of brown that are never dislodged by cleaners hosing them down.

The beds, walls, furniture or other fixtures are never wiped down with a detergent or disinfectant. Only floors are washed with buckets of water once a week, and merely swept on other days, with dust resettling on beds, patient food receptacles and clothes.

The cracked cement floor is pockmarked with holes and indents, obviously harbouring multitudes of pathogens. No microbiology staff were sighted taking swabs of cultures. No infection control audit could possibly be conducted. Large open garbage bins near the wash basins and latrines are overturned by scavenging dogs that seem to have unhindered access.

Hence, putrefying food remnants, discarded dressings, vomit bags and fruit peels are strewn on the wet floors, where leaking taps, blocked and overflowing wash basins spill to the floor. No colour-coded waste containers are evident. It seems as if bodily fluids, festering dressings and used medical supplies are all disposed in one lot.

Mice regularly scoot across the aisles with no apparent inhibitions. Antibiotics seem to be administered almost normatively, regardless of consequences to individuals’ condition or immune capabilities. Ventilation to reduce airborne infections consist of one or two fans operated at random from a loose and caving fabric ceiling with multiple layers of darkened dust and cobwebs that seem to have been untouched for years.

Patients are routinely transferred from beds to other beds or positions under other patients’ beds in grossly overcrowded conditions with some patients sitting on visitor stools while they wait for a chance to lie down. The whole operation of the ward seems to undermine the basic respect that any human being is owed as citizens by the state.

Those responsible for perpetuation of this despicable state should be forced to endure these conditions first-hand so that otherwise wasted public funds can be utilised more compassionately and considerately.