By Klao Bell, Senior Staff ReporterMATRONS HAVE had to juggle many balls to keep infirmaries running. From driving sick patients to hospital, to soliciting food and funds from the community, the matron is expected to keep the dysfunctional institutions open ... with little.
This has been identified as one of the fundamental weaknesses in existing system of managing infirmaries. According to the report by a task force within the Office of the Prime Minister on the state of the island's infirmaries: "The system and structure of management of an infirmary rest in the hands of one person and therefore its efficiency is dependent on the capability and capacity of that individual to oversee the various components of daily operations while planning and strategising for development of the institution."
Despite work conditions, which breach government regulations, matrons insist that they love their jobs because of the fulfilment of working with the poor.
Matron Ivy Williams has been at the Manchester Infirmary for 17 years. She lives on site and is on call round the clock. As she took the news team on a tour, she walked through the facility touching, bantering and joking with her patients. She seemed to know all of them by their first names.
"I definitely have a heart for the poor. Having worked with them for so long we become family," Matron Williams said.
The reports on the condition of infirmaries state that staff dedication is one of the strengths which keep the highly dysfunctional organisations running, even though staff operates under arduous circumstances which put their own health and welfare at risk.
However, the reports also show that although matrons are usually registered nurses, the majority of the staff is untrained and ill-equipped to properly care for residents, who are usually elderly, mentally ill, bed-ridden or amputees.
LOW STAFF-RESIDENTS RATIO
The 2002 report of the task force on infirmaries, prepared by the Programme Co-ordinating and Monitoring Unit, found that the staff to residents ratio was way below Ministry of Health's standards which require four patients to one staff member.
"The study revealed that the care providing staff to patient ratio ranges from a low of 15:1 to a high of 88:1. It is unlikely that residents can be cared for adequately with this level of staffing. The situation lends itself to stress and fatigue, thus affecting the quality of care that can be delivered," the report stated. At the St. James Infirmary, which had 88 residents in 2002, there were 10 care-providing staff members and 88 patients which meant a ratio of nine patients to one staff member.
The infirmaries, however, operate on three shifts, with the 2 p.m. to 10 p.m. and the 10 p.m. to 6 p.m. shifts being most unpopular. As a result, fewer staff members work, and in St. James, there was only one staff member for each of those shifts.
At the St. Catherine Infirmary, which has the highest number of patients, the situation is just as bad. There are 24 ward assistants with seven wards and 143 patients to care for. That means a ratio of 29 residents to one worker during the day shifts and 18 patients to one worker during the night.
"Some years ago people were laid off but were never replaced. We need at least two more persons per ward because as it is, it's often one person to a ward and with mostly bed-ridden people, it's quite a burden on one person," explained Matron Hilda Richards.
On the other hand, the Golden Age Home in Kingston, which is seen as a model institution, has a better managed arrangement. The Home is funded mainly by the Government but is run by an administrator who reports to a board of directors.
The Home has a different structure from other infirmaries which have a matron in charge, who reports to the Inspector of Poor and secretary/manager of the Parish Council.
There are 350 residents and 103 staff members. The home also benefits from the support of the influx of interns from the nursing schools around Kingston. An opportunity not enjoyed by rural infirmaries.
"I am totally satisfied with the staff. Given the resources the staff are doing their best. You find there is genuine love for the people they work for. Sometimes, you even find staff using their own resources to assist the clients, even though they don't earn a lot of money," said Dr. Denise Eldemire-Shearer, chairperson for Board of Supervision which oversees infirmaries.
