Fiji's Colonial War Memorial Hospital is facing a dual crisis of extreme emergency overcrowding and a surge in complex HIV cases linked to drug use.

AT one of Fiji’s busiest emergency departments, the pressures of overcrowding, limited staffing and a growing burden of HIV linked to drug use are colliding, according to a clinical presentation by Dr Shiva Shankar.. Speaking at the Fiji Medical Association (FMA) mini conference about work at the Colonial War Memorial Hospital emergency department, he said the department is operating far beyond safe capacity.. “The very first step of fixing something is to identify that it

is broken,” he told the conference participants, before describing a system in which other departments are often told, “we’re currently dead blocked, and please keep the patient there for some time until we sort our cases.” He said the department’s bed occupancy rate is “actually 146% on any given week,” well above the 85 per cent occupancy level generally recommended for emergency care.. Shankar framed the problem as more than overcrowding, and the emergency unit

is increasingly seeing young adults with HIV, many of them arriving late and already seriously unwell.. Citing a retrospective emergency department study discussed in the presentation, he said the unit identified 137 new HIV and AIDS cases over 18 months and saw a 34 per cent increase in the final six months.. He said most patients were men and many were between 20 and 29 years old, a pattern he described as alarming because it

affects the country’s productive age group.. The clinical picture, he said, is often complex: fever, chronic cough, weight loss, muscle and joint pain, brain abscesses, tuberculosis, skin infections and bloodstream infections.. “The majority of them, about 95% of the cases that presented to us, we had to admit,” he said, adding that many require long hospital stays, prolonged antibiotics and care from multiple departments, including intensive care, neurosurgery, internal medicine, tuberculosis and rehabilitation teams.. He

also tied the rise in severe cases to injecting drug use and trauma, describing cases of IV site infections, immunocompromised patients with brain abscesses, and violent drug-related injuries that demand major surgical and trauma resources.. In one case, he said, a patient died in theatre after a severe stabbing injury, underscoring how quickly drug-related harm can become fatal.. “There has to be a financial, a social and a political commitment to make things happen.. Band-Aids

don’t fix bullet holes.”

Dr. Shiva Shankar, Fiji healthcare, emergency department overcrowding, HIV surge, hospital capacity, public health, medical crisis