Wed | Dec 7, 2016

Doctors, nurses on call - Hope for a brighter future in ailing health sector

Published:Sunday | December 21, 2014 | 12:00 AM
Minister of Health Dr Fenton Ferguson
Doctors in action. - File
In an example of the problems facing local hospitals, this young woman uses a bench for her bed while being given IV fluid after being admitted to the St Ann's Bay Hospital. - File
Nurses protesting outside the Kingston Public Hospital in downtown Kingston after a nurse at the institution was attacked by a mentally ill patient. - File
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Dr Alfred Dawes, Contributor

This year will go down as the one that Jamaicans fully realised what those in the sector have been saying for years - the health care system is in shambles.

Despite the gains made by the administration and front-line workers, the one thing that stood out is the chikungunya disaster. The epidemic and its exposure of the gaping holes in the health-care system, such as lack of staffing, infrastructure and effective lines of communication, led to frustration and outrage, sometimes violently directed towards the very workers propping up the system.

Albeit, there were positive trends in health in Jamaica in 2014 and we should celebrate our accomplishments and not focus entirely on the negatives.

Public health got a tremendous boost with the bold moves of Minister of Health Dr Fenton Ferguson pushing through anti-smoking legislature despite tremendous resistance.

This led to a major decline in cigarette sales across the island as fewer persons lit up. The immediate shortfall in taxes from tobacco sales will undoubtedly be insignificant compared to the long-term savings in expenditure to treat the multitude of smoking-associated diseases.

Many lauded the broad-backed minister and some thought he could do no wrong. This was cemented in the opening of several Public Health Centres of Excellence in his continued push to improve primary care. It seemed we were finally on our way to achieving universal health care.

Jamaica has been lagging behind its Caribbean and Central American neighbours in the field of advanced surgery for some time now. The gap was significantly narrowed in 2014 as surgical teams introduced several new cutting-edge procedures to the island.

Of note were the historic procedures in vascular surgery for chest trauma and minimally invasive spinal surgery at the University Hospital. Not to be outdone, the Kingston Public Hospital general surgery and combined ear, nose and throat and neurosurgery teams also introduced complicated operations in the form of the Sugarbaker procedure for cancer and the removal of a tumour from the brain and middle ear of a patient.

The fledgling field of bariatric surgery leaped forward with the first laparoscopic gastric bypass and intragastric balloon placement being done with excellent weight-loss results. In the face of numerous challenges health-care workers continued to push the envelope in the development of the sector, despite their work being overshadowed by the negativity surrounding them.

The world changed in December 2013. A two-year-old toddler died from Ebola in a remote village in Guinea, and a traveller brought the chikungunya virus to the small Eastern Caribbean country of St Martin. Chikungunya was virtually unknown in the West and the virus quickly spread through the virgin population that had no immunity.

Jamaica had been officially preparing
for the outbreak for two years and the minister had warned of its
inevitable arrival in his sectoral debate presentation in April 2014.
However, the expected arrival of chikungunya was a national disaster
akin to an unforeseen Category 5 hurricane.

The
Ministry of Health appeared shifty in its reporting of the number of
cases of chikunguyna as it stuck with reporting confirmed cases and the
grossly under-notified suspected cases. By the time the ministry stopped
playing the numbers game, its credibility had suffered a major blow.
Persons felt that officials were hiding the truth and this led to
conspiracy theories flourishing.

The embattled
minister could not convince the population of the need for personal
responsibility in vector control as he was constantly kept on the
defensive as to the extent of the outbreak. Politics, of course, came
into play as the virus ravished the country leaving hundreds of
thousands hobbling and contributing to a number of
deaths.

Damaged reputation

This
'chikun-gate' crisis seriously damaged the minister's reputation, with
scores calling for his resignation.

As thousands
sought medical attention at the already overburdened health centres and
hospitals, the system faced a near total
collapse.

Inadequate infrastructure, lack of resources
and crippling staff shortages led to prolonged waiting times. Among the
greatest tragedies of the epidemic were persons who lost their lives
waiting for medical attention.

Sensational stories of
persons dying in the emergency rooms were reported, but persons who died
on the wards or had worse outcomes because of the delays in getting
definitive treatment were overlooked.

As frustration
with the long waiting time grew, some hooligans resorted to threats and
at times physical attacks on health- care workers. In fact, some
emergency departments were turned into war zones. Chikungunya had been a
stress test that showed the glaring inadequacies in the health system.
And when we thought it couldn't get any worse, Ebola showed up in
Dallas, Texas.

This Ebola outbreak started with a
Guinean toddler in a remote frontier village.

Within
months that isolated case morphed into the largest and deadliest
outbreak of the disease the world had ever seen. More than 16,000
persons became infected in eight countries with nearly 6,000 dead since
the start of the epidemic. The outbreak was largely ignored by the world
until it spread to Nigeria. Although quickly confined to 20 cases with
eight deaths, there were jitters across the world where doomsday
scenarios were envisioned should the virus hit a major
metropolis.

The world panicked when a Liberian
national was diagnosed with the deadly virus in a Dallas hospital. Even
worse were the bumbling efforts of the United States to control the
outbreak as there were two cases of local transmission of the
virus.

With Ebola suddenly close to our shores, and
already reeling from the chikungunya epidemic, Jamaicans became panicky.
Distrustful of the Ministry of Health and questioning the levels of
preparedness for a possible Ebola outbreak, there was a palpable fear
across the nation.

Demoralised health-care workers
threatening to abandon their posts should the virus hit did little to
comfort the masses. Rumours of Ebola cases sprang up across the country,
each associated with a fiasco that underscored our level of
unpreparedness.

In the end, we got reassurance with
more organised, multisectoral national responses to chikungunya and
Ebola. Crucial to this was the invaluable assistance of our old ally,
Cuba. With promises of logistics, training and manpower support, the
Cubans strengthened our preparations significantly. The worst of the
Ebola epidemic has likely passed and with a stronger prevention
programme in place, Jamaicans can rest easier.

As
difficult as the year was for the health sector, there is hope for 2015.
The election of new Nurses' Association of Jamaica and Jamaica Medical
Doctors Association presidents, as well as a new chief medical officer
and permanent secretary, who have all expressed their willingness to
work together for the improvement of the sector holds
promise.

Add this group to a minister of health whose
legacy now hinges not on his prior accomplishments, but his ability to
reform an ailing sector, and we just might have healthier days ahead.
The greater involvement of the private sector and civic groups in the
national chikungunya and Ebola responses sets a welcome precedent for
future collaborations with the ministry.

Hopefully,
this gathers momentum and we all continue to chip in for the betterment
of the system, as a healthier nation is a more productive and happier
nation.

Dr Alfred Dawes is the president of the
Jamaica Medical Doctors' Association. Email feedback to
editorial@glanerjm.com.