Mandeville Hospital under pressure

What began as a temporary emergency response to Hurricane Melissa has evolved into a sustained healthcare crisis at Mandeville Regional Hospital, where patient numbers now far exceed capacity and exhausted staff struggle daily to keep pace.

Though nearly all patients relocated from the hurricane-ravaged Black River Hospital have since been discharged, Mandeville has become the default lifeline for much of southern Jamaica, absorbing a relentless post-storm influx that shows no signs of easing.

Of the 65 patients relocated to the Mandeville Regional Hospital from the hurricane-ravaged Black River Hospital in St Elizabeth, only two social cases remained last week. Yet the hospital – regarded as the main referral centre for the Southern Regional Health Authority – continues to face a growing influx of patients months after Hurricane Melissa’s mayhem.

A trek through the main clinic and Accident and Emergency areas at Mandeville Regional made clear the fragility of life last Thursday. In one section, scores of Jamaicans, seemingly more able, sat solemnly awaiting their names to be called. In another, the more desperate cases in A&E – mainly elderly patients – lay in pain, breathing shallowly and moaning.

Tears streamed down the cheeks of one elderly woman lying on a bed in A&E as doctors milled about, juggling limited resources and staff. It was another busy day, though not as chaotic as others, they admitted, explaining that, since the hurricane, patients have been streaming in from neighbouring Trelawny and as far away as St Ann, Westmoreland, St Mary and Clarendon.

With repairs still under way to damaged sections of the hospital and floodwaters at the front – which submerged cars during the hurricane – now subsided, hundreds of patients visit the facility daily.

Officially, the hospital has a capacity of 226 bed spaces. In 2024, the average daily admission was roughly 275 patients, explained Alwyn Miller, the hospital’s chief executive officer (CEO).

In 2025 before the storm, that average rose to 300/ Immediately after, it was around 340, while, since January this year, the average daily admission stands at 362, Miller said, outlining special arrangements made to accommodate the additional burden.

And those figures, he noted, reflect admissions only. They do not include about 200 daily visits for motor vehicle and motorcycle accidents, injuries sustained during home repairs, and complications from chronic non-communicable diseases.

“There are people who just walk into the hospital because that is the culture of Jamaicans. If they are sick, they think about going to the hospital first; not a health centre,” said Miller.

“Just after the hurricane, our clinics were rescheduled and we did some modification and used our out-patient department to house some of those patients. We put a tent on the inside of our Accident & Emergency [Department] waiting area with beds and stretchers in there and we have been putting some of our patients inside that tent,” remarked Miller.

“Because Black River [Hospital] is now in a state of recovery, and they still have challenges, we have found that patients east of Black River – anywhere from Lacovia to Santa Cruz and Balaclava – all of those patients come straight to Mandeville. They don’t even worry about going to Black River,” he explained. “So we are, in essence, accommodating the population from these two parishes, in addition to others.”

Miller said the hospital has 840 staff members, including 167 doctors and 270 nurses, many of whom work long hours into the night to ensure operations continue. At least six doctors are on each shift, but infrastructural challenges at the already overcrowded hospital remain severe.

Less serious cases are diverted to peripheral hospitals in neighbouring parishes, though many patients bypass those facilities and nearby health centres altogether. While many present with flu-like symptoms, Miller downplayed alarm, citing the colder season and noting that the hospital no longer tests for COVID-19 because of expected herd immunity.

Health Minister Christopher Tufton said Friday that contractors are repairing hospitals hardest hit by the hurricane, including those in Falmouth, Black River, Sav-la-Mar, Montego Bay and St Ann’s Bay. He acknowledged that the ongoing work has contributed to overcrowding.

“Mandeville Hospital is suffering from that, and, in addition, there is also the flu season,” said Tufton. “So what we have is a lot of persons who have upper respiratory illnesses, which is adding to the numbers. In a sense, there is a ‘double-whammy’ contributing to the situation.

“If it is not essential for you to go to A&E, go to your health centre or a private physician if you can afford it. Otherwise, you are going to be triaged when you get to A&E and the life-saving requirements will be dealt with first,” he said, noting that repairs should be completed at some facilities in coming weeks.

“But we continue to monitor the situation,” he said, adding that he fully understands the fatigue of the staff and patients.

Last week, one woman in A&E complained she had been waiting for hours to see a doctor, but Miller said a lengthy wait may be expected as all persons must be triaged to determine those in most need. He noted that the heavy influx of people with non-communicable diseases could be stymied if they, particularly the elderly, adhere to taking their medication - and on time.

It is a challenge rife in many rural communities, explained Lena Allen, community health aid assigned to St Elizabeth. Checking on people with non-communicable diseases such as hypertension and diabetes has been a constant part of her job since the hurricane passed.

“After the hurricane, it has been really bad because some people’s homes are still not in good order. There is mosquito infestation, rat infestation and, in some communities, some people are also still traumatised,” she said, hinting at the many mental and physical factors that often exacerbate the illnesses.

“Some people really don’t take their medication, especially the elderly. The caregivers will tell you that they have to trick them, crush the medication in order for them to take it, but some still don’t take it. So, sometimes they can be really difficult, and that can then lead to further problems,” she said, as one elderly woman groaned in pain on a stretcher nearby.

Pregnant mothers in St Elizabeth are also another concern, as many have been missing clinic appointments because of various social constraints brought on by the storm. Allen said it is her job to provide health information and other support for those in some of the most remote districts.

Dr Jhenelle Hew, senior resident at the hospital’s A&E, explained that dealing with the influx has been a struggle for staff, despite their resolve and allegiance for caring for the sick.

“Before Melissa, we would try to accommodate the simpler complaints in the ER, although, technically, those should be handled at the health centre. But, given the stress of Melissa, our department being short-staffed and overcrowded, we have to redirect more of those to the health centres,” she explained.

“Just like everybody else, we have to expect that they can become tired and need their vacation break, and they also get sick as well,” she said. “The staff is overworked and burnt out, but we work as a family and are trying our best – even though it may be taxing on us.

“You have doctors who get two days off, but they come in and work on their days off, working a double, 16-hour shift, so they do get fatigued,” she said, noting that she, too, has been working on all of her days off in recent weeks.

corey.robinson@gleanerjm.com