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Raffique Shah


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Hospitals of horror

By Raffique Shah
March 27, 2011

If doctors in the public health care system feel that they are being unfairly targeted by Government and the public, they need to pause, collectively inhale, and look into the mirror. They should also weed out those in their ranks who have given this once noble profession a bad reputation. Indeed, many senior doctors who have long moved on into lucrative private practice must also shoulder some blame for the ills that bedevil the public health sector today.

I have long maintained that, for all its shortcomings, most of which are beyond the control of staff, our public health system is not as woeful as many people make it out to be. Mercifully for me, as a now senior citizen (if that "status" is marked only by age), I have not had to depend on doctors to maintain my health. When one realises that the basics for staying relatively healthy lie in one's own hands, or more accurately one's feet and lifestyle, doctors become a secondary port of call.

I should add that my personal doctor and a few others I've had cause to visit from time to time, have all been very professional, very courteous. I have not always heeded their advice or recommendations. In other words, I am somewhat of a maverick: I believe I should always be in charge of me.

On occasions when I've had to use the public health system, I have found the staff, both nurses and doctors, all of them quite young, equally professional. But most times they are under stress, what with hordes of patients waiting to see them, and equipment they need, or medication, unavailable. Sometimes the clinics at these institutions appear to be severely under-staffed. Frustration builds among both patients and staff, and in such scenario, hasty-but-fateful decisions or actions could result in things going fatally wrong.

Which is when professionalism, cool and calculated thinking, ought to kick in. Doctors, nurses and other medical personnel deal with life and death situations almost on a daily basis. Besides their grasp of medical procedures, young doctors also need to have leadership qualities that they employ when they face crises. Under immense pressure, they must make tough decisions. There may be no senior practitioner around. Their colleagues may panic. Sometimes the senior officer loses his nerve and it's left to a junior to fill that decision-making breach.

I shall not dwell further on this aspect of health delivery since I am not au courant with the training doctors go though at medical schools. I should hope, though, that those who determine the curricula at these institutions see the need to include leadership training for doctors. Every graduate of medical school should be able to take charge of life-and-death situations with authority. The last thing you need in an operating theatre is panic, should something go awry.

While our public health system is far better than what passes for such in countries more developed than ours, it is hampered by archaic regulations, poor remuneration packages, and near-primitive working conditions in some instances. With the exception of the Mount Hope Hospital and several district health facilities that were constructed over the past 20 years, most other institutions stink.

Take the San Fernando Hospital, which was built by the colonial authorities back in the early 1950s. Except for a new wing that took ages to come on stream, and maybe some modern equipment added from time to time, it looks decrepit. Neither patients nor staff can be comfortable there. Why are we surprised that fatalities occur at the institution, or at the Port of Spain Hospital, as frequently as they do?

Ten years ago, I spent three nights in San Fernando after I fractured five ribs in a bad bike fall. There was no room in the ward, so I slept in the corridor. When I used the toilets, I had to wade through water to get to WCs that had no seats! The doctor administered morphine on the first night to ease the excruciating pain I endured, not by choice, but because there were no other strong pain relief drugs in the dispensary.

I refused to take a second dose of morphine, opting instead to have my family buy a less dangerous tablet the doctor recommended. My colleagues sought to move me to a private institution, but I dismissed that idea. I wanted to experience what ordinary citizens in this country who cannot afford private health care do. Sheer guts took me through those three nights.

But good doctors, like good soldiers, learn to function in the most adverse conditions.

And this is where I have problems with doctors and other professional staff who, because their work environment is close to atrocious, vent their frustration on patients. If they must protest for better remuneration and working conditions, by all means do that. Confront the regional health authority. Attack the minister, the government. Cuss Patrick Manning for wasting money on structures we didn't need, even as hospitals remained low-priority or no-priority.

However, in pursuing these goals, doctors and other staff should never allow patients to suffer, or worse, to die. That is inexcusable. I hope the probe into the passing of Chrystal Ramsoomair triggers some dramatic changes not only at the San Fernando Hospital, but also at the other facilities that are crying out for attention.

It is the least we taxpayers expect. No one can resurrect Chrystal. But we can certainly restructure the health sector so that such tragedies can be avoided in the future.

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