Garth Rattray | Hospital dilemma

Every now and then, members of the public hospital medical staff experience such frustration and distress that they go public with their concerns for their patients. Such was the situation as highlighted in a Jamaica Observer, Tuesday, August 13, 2019 piece by Kimone Francis titled ‘Hospital hell’.

Francis writes: “Junior doctors in the public health system have shared multiple horror stories of the conditions in which they work and which, they say, are putting the lives of patients at risk.”

Just recently, two very good friends of mine became emergency admissions at the University Hospital of the West Indies (a partly publicly funded institution). In both instances, the medical staff were competent, but the availability of working equipment and operating theatre time forced both to transfer out. The consequences of remaining there would have been grave.

Long appointment times

Many public hospital patients receive inordinately long appointment times for investigations and/or therapy/operations. Even when the suspicion is cancer, the appointments may be many months, a year, or even farther away. Sometimes patients with serious heart disease die waiting on help from the public system.

Some patients can’t afford possibly expensive investigations needed before returning to the clinic. These tests are sometimes for suspected cancer or for the staging of established cancer to determine intervention strategies. Many need surgical implants but can’t afford them, and they suffer immensely only because they are poor.

Several blood tests can’t be done because of lack of reagents. Dressings are often inadequate, and so, too, are essentials like gloves and needles and gauze, not to mention the breakdown of ageing and overworked equipment.

Jamaica needs at least twice the current number of hospital beds if we are to come anywhere close to good patient care. I know that the health and wellness ministry is severely restricted, by funding, in its ability to ensure proper patient care. However, I see several blatant problems that cry out for solutions.

I’ve been calling for the reintroduction of public hospital and clinic fees for all patients. Currently, the insurance companies are breaking their own rules and allowing patients with health insurance to access them at public institutions, while uninsured patients pay nothing. However, I believe that all patients should be billed and encouraged to pay what they can afford.

When user fees were abolished on April 1, 2008, purely for political reasons, nearly $2 billion was lost annually. A high financial and healthcare price indeed, just to win an election.

The May 2013 Caribbean Policy Research Institute publication, No User Fee Policy In Public Hospitals In Jamaica, revealed this finding: “… The abolition of user fees has resulted in a loss of financial resources for the sector, negatively affecting pharmaceutical and medical supply stocks, staffing, waiting times, space, service delivery and processing time.” Yet, the powers that be allow this situation to continue. Fear of public disfavour is causing their tenacious adherence to this very harmful policy.

We need interministerial cooperation in order to improve healthcare delivery. Trauma from crashes and violence inundate several public health facilities. We must increase efforts at road safety and reduce criminality. We also need to remove all forms of taxes on healthcare items. Currently, several health products attract government fees of one sort or the other. This is disgraceful.

According to medical ethics, staff should refuse to work under conditions that force them to compromise patient care. They helplessly watch as patients suffer and perhaps even die needlessly. If this were a developed country, there would be a continuous deluge of litigation.

However, the medical staff are ethically and legally absolved because they are doing their best under very adverse circumstances. I congratulate them but also encourage them to agitate for change.

Garth A. Rattray is a medical doctor with a family practice. Email feedback to columns@gleanerjm.com and garthrattray@gmail.com.