Thursday, August 2, 2007

Painful Practice

Medicine has long been regarded as a noble profession and its practitioners respected as men and women of honour and integrity. Lately, however, it seems as though doctors have become the target and reason for everything that is wrong with our health system. The myth, perpetrated by none other than the Minister of Health himself, that the reason for poor healthcare in this country is as a result of incompetent, lazy and selfish doctors has caught steam with the general public, justifiably frustrated by the worsening manner in which health care has been delivered under this administration.

Minister Rahael cannot continue to use isolated incidents involving a few doctors to paint the entire profession with a brush that taints all. This is especially true when dealing with a profession, such as medicine, where reputation is essential in obtaining the trust and respect of your patients. If we are to use his yardstick, then we will be justified in painting all politicians as corrupt, including Mr. Rahael, himself, who came under scrutiny recently over the establishment of a nationwide pharmacy chain linked to his immediate family.

There has been a slew of controversies within the last five years that has led one to conclude that the government is determined to deal with doctors in a confrontational manner, unbecoming of the profession. Whether that has been over salaries, working conditions, questionable hiring and firing practices by the Ministry or the claim by those in government that the entire medical profession is sympathetic to the cause of a political party opposed to them, it is clear that doctors and medical students in this country have had to deal with more than their fair share of mauvais langue from the powers who claim to have the health of the nation as a primary concern.

It has become almost cliché to say that basic amenities have not been addressed even after the expenditure of close to $200 billion dollars in the last six years. There has not been the construction of a single general hospital. Instead, there has been the premature abortion of one in Tobago, while the rest of the nation contends with three under-staffed, poorly-equipped institutions that continue to run only on the dedication of their staff and the grace of God.

Surely, Mr. Rahael must be accountable to the nation when it comes to answering questions regarding the reasons why there are not enough dialysis machines or functioning Intensive Care Units (both adult and neonatal) or proper quarters for doctors and nurses at our hospitals. Are doctors responsible for the purchase of these machines? And then there is the question of drugs. Why are the pharmacies at the hospitals always woefully short of some medication at one point or another? Is it that there is a vested interest in forcing the public to go buy these drugs at private establishments, such as the one owned by his son?

Then there is the issue of admission criteria at the University of the West Indies, Medical Faculty. Why has this suddenly become an issue and why is race being considered as a factor? Is the government suggesting that the doctors produced over the last 20 odd years from Mt. Hope have failed the nation when it comes to providing adequate care? If so, then are there proper statistics or research to back that claim? Where is the current research that shows that a single ethnic group is being favored over another for admission into the medical school? And who exactly is in charge of making decisions regarding health in this country? Is it the Ministry of Health and their experts or is it the Ministry of Science, Technology and Tertiary Education? Under whose jurisdiction does the University fall and how can, with one fell swoop, the Government mandate change without proper research and consultation? And, if admission criteria need to be changed, then when does it take effect? If it takes effect immediately, then doesn’t that place, at a significant disadvantage, those students currently entering 6th and 7th years of secondary school who would have taken certain subjects on the premise that that was the acceptable criteria?

As if all that was not enough to frustrate even the most experienced of professional, there is the issue of hiring and firing practices by the current Minister and his cohorts. There was the claim that there was a shortage of doctors in the system and therefore the need to hire foreign doctors to meet the needs of the populace. Again, was any research conducted to determine the extent of the shortfall and therefore the number of doctors required to fill the void? Was consideration given to the fact that approximately 120 doctors graduate every year from Mt. Hope, so that contracts given to foreign doctors should be on a diminishing basis to account for the incoming new doctors?

There was the recent firing of two nurses at the Mt. Hope Maternity Hospital after an incident where a newborn was burned with a hot water bottle. By all accounts, published in the press, this directive came from the Minister himself. Apart from wondering whether the Minister has better things to do than to micromanage the hospitals, isn’t there something to be said about having a proper inquiry into the circumstances surrounding this horrific incident? As professionals, who would have spent a significant amount of time and expense training to become nurses, aren’t they entitled to a hearing where they would have been allowed to give their side of the story? Perhaps a hot water bottle was used to keep the newborn warm because the incompetent administration of the hospital and by extension, the Minister, were unaware that there were an inadequate number of incubators at the hospital and that the baby would have died, had he not been kept warm. But these stories never come to light. It’s easier to fire the nurses because it’s good Public Relations. The rabid population calls for blood and the Minister obliges, disregarding totally, the rights of any he may have trampled on.

In addition, we now hear of the firing of 30 recently graduated, local doctors from the hospitals. Is it that the chronic shortage is now over? If so, then why are our wards still heavily populated with foreign labour? If the excuse is that the doctors were not under contract, then perhaps the disingenuous perpetrators of that excuse would like to see all those doctors currently not under contract justifiably walk off the job, since they have no right to be on the wards. The exodus would be astounding and then the Minister would have yet another opportunity to posture himself on national television and accuse doctors of endangering the lives of their patients.

Mr. Minister, the system is broken badly and getting worse. Serious change needs to be made with respect to the proper administration of Health in Trinidad and Tobago. The report of Gladys Gafoor following the Commission of Inquiry into the Health Sector should be made public and its recommendations heeded. Instead of antagonizing the very people who have to provide health services to this nation (doctors, nurses, attendants, drivers etc) why don’t you expend more time and implore your Prime Minister to spend more money to properly upgrade the woeful facilities that currently exist?

You have had six years in government. Can you honestly face the nation and tell its citizens that the system, not incidental accomplishments, but the system as a whole is better off now, even after the most prosperous economic times that this country has seen? What is our life expectancy now, compared to five years ago? What is the infant mortality rate now compared to five years ago? How has the health system been able to cope with the rise in lifestyle diseases such as diabetes and cancer? How has our economy and productivity suffered because of inadequate or improper health care? If these questions cannot be answered at the drop of a hat, Mr. Minister, it is you and your government that has failed the people of this country when it comes to providing health care.

There are surely many other things that can be done to address the state of our hospitals than finding scapegoats in the very individuals who keep the sinking ship of health barely afloat by their dedication and compassion for their patients, rather than vindictive discrimination or the love of money. It wasn’t doctors that got whopping increases in salaries since you took office in 2001. I hear the Salaries Review Commission is meeting again soon. No doubt at least 67 parliamentarians will be better off following their recommendations. What about the rest of us?

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