Tue | Jul 17, 2018

Alfred Dawes | Trauma having a significant impact on health care

Published:Wednesday | May 11, 2016 | 12:00 AM
Dr Alfred Dawes

When we look at health-care costs, we often focus on chronic diseases such as diabetes and hypertension, and infectious diseases such as the Chiks and Ziks. The impact of trauma on our health sector is often overlooked while it continues to wreak havoc on the sector.

Trauma cases account for a significant number of patients treated in hospitals, and the cost to the State is staggering.

In 2006, the estimated cost of hospital care for the treatment of injuries was US$33.4 million, or 20 per cent of the health budget. In 2010, ten-year data from the Jamaica Trauma Registry showed that trauma accounted for 20 per cent of surgical admissions, with close to 50 per cent being intentional.

For the period 2000-2009, information from the Jamaica Injury Surveillance Survey (JISS) revealed that 11 per cent of all accident and emergency visits were due to injuries. Road traffic accidents accounted for 17 per cent, unintentional injuries accounted for 45 per cent and intentional injuries accounted for 38 per cent of injuries.

The burden of trauma on the health sector is causing an already overburdened system to burst at the seams. Resources that could be used to treat other conditions are diverted to treat injuries, of which up to 90 per cent may be preventable.

Elective cases often get cancelled because trauma victims are rushed into theatre as a priority and consume blood products intended for elective surgery. The consequences are prolonged waiting times for patients whose elective procedures are cancelled.

The direct costs of treatment, including prolonged rehabilitation, is worsened by the fact that trauma primarily affects the younger, more productive members of society. The subsequent loss in productivity affects families, businesses, and the overall economy to the tune of an estimated US$1 billion per annum or approximately 7.2 per cent of Jamaica's gross domestic product. These numbers are not insignificant in a country with dreams of achieving First World status.




When it comes to the impact of crime, we often look at the social and economic costs. The direct effects on victims and their families is significant, and have a negative effect on the emotional state of an entire population living in fear that they or a loved one might be next.

The economic cost is staggering. Were Jamaica to reduce its crime levels to that of Costa Rica, the annual increase in Gross Domestic Product would be 5.4 percentage points.

However, few persons have thought about the cost to the health care system. In a country where your tax dollars are paying for the care of the victims, the burden of violent crime on the health sector must take centre stage in the discussions on how to curb the crime monster. In 2004, the direct medical costs of interpersonal violence were US$29.5 million and the indirect costs US$385 million.

Not only is crime directly affecting health-care costs, it is taking away money that could be spent on improving the service. According to the World Bank in its review, The Road to Sustained Growth in Jamaica, between 1988-89 and 2001-02, Jamaica's budgetary expenditure for health grew 23 per cent annually, whereas the budget for national security and justice grew by 62 per cent. We cannot improve health care when crime is sucking away much-needed funds from the health sector directly and indirectly.




Last year, 383 people lost their lives on our roads and already we are nine ahead of the same time period last year. Road deaths in Jamaica hover around 10 per 100,000, compared to developed countries, where the rate can be as low as three per 100,000. Road traffic accidents accounted for 17 per cent of injuries seen in emergency departments.

A significant increase in motorbike accidents is worrying. Compared with a person in a car, a bike rider is 20 times more likely to be killed for each kilometer traveled.

Factors that contribute to the high rate of crashes include older, poorly maintained vehicles that often carry many more people beyond their designed to capacity, lack of seat belt and helmet use, poor road surfaces and design, and the indiscipline and poor judgement of road users.

Vice-chairman of the National Road Safety Council Dr Lucien Jones estimates that up to two to three per cent of the GDP is cut by road traffic accidents. If Mr Lee-Chin wants to see five per cent growth in the economy, the road to his success may just lie on our roads.

The survivors of these accidents require surgery in many instances, and their prolonged rehabilitation comes at a significant cost. More often than not, hospital beds are occupied by accident victims awaiting surgery or undergoing prolonged treatment. This at a time when we are in dire need of bed spaces in our health facilities.

The impact of injuries on the health sector is not one that should be addressed solely by the Ministry of Health. By the time a patient gets to the hospital, the damage has literally been done. At that time, the costs are already high.




The best approach is to focus on primary prevention - preventing the injuries from occurring in the first place, and secondary invention - minimising the extent of the injuries during the event. This means effective public-awareness campaigns focusing on road safety, and conflict resolution. The enforcement of laws governing seat belt and helmet use will minimise the injuries sustained after a crash.

When it comes to the high rate of road traffic accidents, we cannot overlook the elephant in the room - corruption. Corruption not only leads to poor enforcement of traffic-safety regulations, but it also extends to the vehicle and driving licensing agency.

A study done by the Pan American Health Organization and the National Road Council of Jamaica in 2006 revealed that 71 per cent of the persons who obtained drivers licences without being examined met in accidents, while for those who obtained drivers licences legally, 40 per cent met in accidents. The corrupt practices of a few have a multiplying effect that becomes a disaster for families and our nation.

If we are to achieve sustainable growth and have a world-class health service, we must look at our country as a whole and address the different pieces of the puzzle.

Without addressing crime and trauma, we will continue to have anaemic growth and a stressed, underfunded health sector. To fix health, we must fix Jamaica.

- Dr Alfred Dawes is a general laparoscopic and weight loss surgeon at the Island Laparoscopy and Medical Care. Email info@islandlaparoscopy.com or yourhealth@gleanerjm.com.