South Africa

Abstract

Upwards of 50% of patients are refused admission to our unit, because of a lack of resources to deal with the patient load. Furthermore, because of the acute conditions of the patients admitted, mortality rates are often around 40%. The total budget for the hospital is in the region of US$26 million. This is a 750-bed hospital with several outlying clinics. The intensive care unit (ICU) consists of 8 beds; there are approximately 500 cases per year. The budget of this ICU is substantially lower than that of an American ICU, where the cost of managing 100 consecutive patients can run more than US$26 million, of which more than 50% is spent on survivors.¹ It is unconscionable that in a country where human immunodeficiency virus (HIV) infection is epidemic, such funds are used for those whose chance of survival is remote. It is not only a problem in ICUs. Resources are such that, for example, patients no longer regarded as candidates for kidney transplantation are removed from the dialysis program. It is clear that choices must be made among patients, and there is little to be gained by emotional debates around the fact that a given patient may survive, for such can be said of any patient no matter how sick.