Health Care without Resources
The male nurse was looking for a vein in my hand. Lying in the hospital theatre in a gown under yellow neon lights, being prepped for a very minor surgery by a celebrated surgeon in a private institution, I felt enormously lucky and guilty, knowing what I do about healthcare in this country. The mind meanders as one is being sedated.
Darts here and there. It settled on one phrase by a writer friend: “When you write or speak, check your privilege.” So, I thought of the people who even as I lay there, in expert hands, standing in line patiently for their turn to get chemotherapy, sitting for hours on uncomfortable chairs in the POS General Hospital, in the San Fernando hospital, in health clinics throughout the country.
Being ill and in the hands of people you hope will relieve discomfort or add months or years to your life is the ultimate in human frailty. Thankfully, the minor surgery went well, and I was hugely grateful not just to the surgeon but the medical fraternity in this country. But I was one of the lucky ones.
Some months back, I reached out to doctors in this country by asking questions about the state of public healthcare in this country. Here are responses from two. I have deliberately left in the duplicate responses because it means it’s representative of what’s out there.
Doctor one: “The state of public healthcare is hanging by a thread. The buildings are there but the efficiency is crippled due to lack of resources including staff, equipment and medication.
The patient load is too heavy for the hospitals and health centres to manage. “Health professionals cannot practise the level of care we are trained when basic tools and medications are simply not available. For us, it’s a constant battle between untrained foreigners, including nurses, waiting for porters/medicines/beds/theatre times/CT/MRI machines to be fixed and impatient patients.
We are overworked due to being understaffed. We are working at a pay that has not increased since 2006. “The Health Minister has made our plight worse. By trying to win over the country, he has lost sight of the tools required by health professionals to make the system work. By refusing to give a pay rise and not improving the conditions, he does not make it easy for locals to want to work in the system. Instead, he brings in Cuban doctors who firstly, are not up to par, and secondly, most patients cannot understand them, so the local staff have to take on double work while the Cubans get paid a much higher salary for less work and hours.”
Doctor two: “• Limited or no medical equipment. We are impelled to improvise to provide care. Basic items vital to every hospital are often not available. Antibiotics, painkillers, sedatives run out frequently. Often we are forced to use whatever is available. This means we waste money on expensive antibiotics in situations where far cheaper drugs would be appropriate.
• Poor maintenance of equipment, especially radiology (MRI, CT). In San Fernando General Hospital (SFGH) radiology equipment is notorious for ‘breaking down.’ The first thing we have to do before we send a patient for a scan is inquire if the relevant machine is working. This wastes time in already-overbooked clinics and prolongs patients’ waiting times. Recently, the RHA has been sending patients privately to do certain scans if they can’t get it within three months, but the cost of this is much greater compared to the cost of simply maintaining the machines.
• Inadequate staff. The patient: doctor/nurse ratio is ridiculous. This could be because the administration appears unwilling to hire more staff, or staff leaving because they are fed up with the poor salary and lack of residency programmes/places.
• Poor attitude and work ethic of health professionals including clerks, attendants and nurses. Doctors are regularly told that the clerk stayed home, so we cannot get a patient’s file, therefore vital information is missed completely. Or the clerks do not file the notes properly and chunks of it go missing. Or attendants are absent. If we need to bring a patient for a scan, the doctor has to do it. Nurses can be quite good, but many are lazy and have no accountability for procedures/drugs that they are supposed to do/give. This means that the doctors themselves have to pick up the slack for many departments, which we are not compensated.
• Poor salary considering the effort and sacrifices made daily: Up till May 2015, we have been working on a 2009 salary. Negotiations have been intensive and finally, we were given compensation from the CPO, but not what was deserved. Compared to the minimum of five per cent increase per year that other public servants received, doctors got approximately three per cent increase. Even though the job makes us travelling officers, the MVT exemption was removed. All exams, CME (continuing medical education) etc is paid from our own pocket.
• Limited scope for residency programmes: Few specialty programmes are available within the country, and places are very difficult to secure.” So one day on, in recovery, I am able to remember the relief I felt at being treated when the need arose. I am sad and ashamed that basic healthcare in this oil-rich country remains a privilege and is not an issue that is being debated in the upcoming election.