The future of health care – Part 1

by Dr Jerrol Thompson

Today, all nations worldwide battle with the growing challenges and demands of modern health care (access, affordability, quality and its coverage) and health’s critical importance in a nation’s development. Some nations have tackled a few of these challenges, but very few have mastered all. Both political parties, ULP and NDP, have stated plans to build a new hospital; however, modern health care is far more than just a new hospital, so let us examine ULP’s approach to health care.{{more}}

In the overarching process of building SVG, the ULP Government has focused on the whole man, the whole woman and the whole citizen. It has created the much applauded Education Revolution; a Housing Revolution (inclusive of the most extensive land distribution and ownership programme in our history, so turning dead capital into live capital); an extensive Social Safety-Net programme for the elderly, physically challenged and children; a reduction in extreme poverty from 27 per cent to 2.9 per cent and a UN award winning reduction in undernourishment by over 50 per cent to a level below 5 per cent. The ULP has shepherded major telecommunications advances and the construction of critical infrastructure such as the AIA, Rabacca Bridge, highways, bridges, river defenses and combatting coastal erosion such as the Layou waterfront. It has fashioned an innovative foreign policy, a cultural revival and more. The achievements of the ULP are not centered in only one sector, but spread across the board and easily repeated by every citizen. It can be argued that all these sectors are themselves linked and integrated in some way with health. However, the focus on discussing the popular achievements in education, housing, telecommunications, and major infrastructure does not diminish the achievements in other sectors, such as that of health care, where accomplishments have been numerous. So what are these major ULP health care achievements?

I recall in the 90’s returning to St Vincent and the Grenadines as a physician and I was shocked by the state of Vincentian health care from Chateaubelair to Kingstown to Union Island. NDP’s failed renovation of the Kingstown General Hospital, a poorly designed Casualty, diversion of the highway leaving a flood prone storm drain running straight through the hospital and a column in the middle of the drain was testimony of a health care disaster in play under the NDP. The attitude of the 17-year NDP Government was captured in an Yvonne Francis Gibson’s statement. “We did not need things like CAT-Scans.” So, let us re-examine these critical health problems inherited by the ULP in 2001.

1. A crippling shortage of nursing staff and expert medical specialists (doctors).

2. Inadequate promotion of public health, nutrition, wellness and poverty alleviation.

3. Very long waiting times at Casualty for urgent care.

4. Poor quality rural hospital services, clinics and dilapidated specialized facilities, like the Mental Hospital.

5. Perennial periodic shortages of medications and some supplies.

6. A lack of modern diagnostic equipment.

7. Insufficient promotion of preventive medicine and curbing chronic non-communicable diseases

8. Severe delays for surgical care

9. Inability to provide advanced highly specialized care and new services for kidney disease, cardiology and for the elderly, forcing expensive overseas travel for those who could afford it.

10. Combatting the ever-growing and potentially overwhelming health care financing cost.

No doubt all these problems could not be tackled overnight, nor could they be handled by simply building a new hospital. Rather it required a comprehensive step-wise approach, (A Health and Wellness Revolution).

1. Very early, one major achievement was a targetted, rapid increase of the number of nurses and nursing assistants trained, with increased salaries, such that now after 14 years over 881 nursing students, 138 nursing assistant students and 138 midwives have received training. Those successful have eliminated the severe shortages of the 90’s, and employment opportunities provided for nurses in SVG and eight other countries. In 2001, 239 nursing positions were in the estimates; today, there are 345 positions, an increase of 31 per cent. The medical doctors’ staff also jumped 32 per cent from 62 to 91 and now boast new specialists such as: two nephrologist, two urologists, four ophthalmologists, two pathologists, one pulmonologist, epidemiologist, infectious diseases, dermatology, gastroenterology, pediatric retinology, and pediatric surgeon, etc, and now a full time oncologist (cancer doctor). The impact of public private partnerships with the four new medical schools, now provide visiting neurosurgeons, neurologists, etc, and offers a huge and impressive pipeline of other specialists. In addition, the economic importance of 1,200 medical students in SVG is vital [i.e. four times the number as St George’s University]. One of the latest specialists is a new health disaster coordinator, evidence of the ULP’s focus on disaster health issues and climate change.

2. The Public’s Health: The promotion of this nation’s public health and the tremendous gains made in this area is too often overlooked. Active household water connections went from 60 per cent (2,500 active connections in 2001) to 98 per cent (3,600 connections in 2014) a massive 31 per cent increase. New facilities at Dalaware, and Jennings and the introduction of giant water storage tanks at Rose Hall, Belle Isles, Layou, Mamoon, Majorca, Akers, Perseverance and Fancy have ensured an adequate clean water supply on the mainland.

The introduction of national garbage collection services in October 2001, inclusive of North Leeward and North Windward, has reduced the old practice of dumping in rivers and ravines, where rats and burning were commonplace. Government has had an extensive, successful programme providing sanitary toilets and elimination of pit latrines and built a new septic lagoon at Diamond. It has facilitated plastic bottle recycling, which helps keep our environment clean, while providing an income for many. Other efforts, like a 100 per cent immunization rate and reduced maternal and infant death, have lifted our public health to one of the best in the region. One of the more reassuring health indicators is the hundreds of persons, morning and evenings, walking for wellness and improved fitness. SVG has now launched the first Zero Hunger Plan in the Caribbean, such that by 2020 no one will again go to sleep hungry. These public health achievements may well be some of our greatest accomplishments, especially when one recalls Eustace’s statement in 2000 that he did not know there was so much poverty in SVG.

(We will continued our discussion of the 10 critical health problems inherited from the NDP and how they were tackled by the ULP in the Weekend edition of November 20, 2015).