Jamaican Medicine: From Independence to the present

To say that healthcare in Jamaica has come a long way from our colonial days is an understatement. To say how far behind we are where our true potential lies is an embarrassment. Nevertheless, Jamaicans enjoy one of the highest life expectancies among developing countries.

Our infant and maternal mortality rates are among the lowest, and we are dying of lifestyle diseases rather than infectious diseases. Jamaica currently ranks highly in setting up a business. One metric used, the distance to frontier, may be applied in assessing the current state of our healthcare system.

It is easy to show how life expectancy and health development indices have improved over the last 57 years, but how far are we from the groundbreaking treatments, the frontiers of healthcare in the 21st century?

THE EARLY DAYS

The British left us with a few hospitals and clinics to cater to the population of 1.7 million. Only 14 years before was the University College of the West Indies chartered with a medical faculty to train doctors locally. Training opportunities for doctors and nurses were limited and the majority of the population depended on herbal medicine and traditional healers for their common maladies. Vaccination coverage was only improving thanks to the endowment of the Rockefeller Foundation, but infectious diseases such as malaria, dengue, polio, yaws, dysentery and pneumonia plagued the populace.

Kingston slum dwellers lived in filthy conditions without basic public health standards of proper sewage disposal and access to clean water. In remote rural areas, access to the few, poorly staffed hospitals and health centres resulted in untold deaths. These were the challenges faced by the nation following the lowering of the Union Jack.

Primary care was of primary importance given the state of living conditions and the infectious disease outbreaks plaguing the country.

In addressing that challenge, public health inspectors were trained in large numbers and sent out across the island to educate and enforce public health regulations. Destruction of mosquito breeding sites, vaccination drives to ensure the immunisation of the majority of children, and the fostering of hygienic practices in food preparation led to vast improvements in the incidence infectious diseases.

The midwifery and community health aid programmes brought trained practitioners to the rural communities that previously had limited access to health education and proper maternal care.

The investments paid off. Within 20 years of self-rule, Jamaicans were living six years longer, fewer women died during childbirth, and fewer children died. Jamaicans were healthier being independent. Today, 80 per 100,000 women die in or around childbirth. For some countries, this is more than 600.

Health statistics show that this trend continues today and Jamaicans can expect to live to age 76 on average, comparable to countries such as Brazil and Hungary. Many infectious diseases are unknown to present-day doctors. But new threats evolved. The world over, development has led to the advent of chronic non-communicable diseases as the leading cause of sickness and death.

The challenge of these diseases is that the more successfully they are treated, the longer the patients live to develop more complex complications. People no longer die from blood-sugar levels being so high they die within hours. They die from a life of fairly high blood-sugar levels resulting in kidney, blood vessel or heart damage leading to renal failure, strokes and heart attacks years later.

Cancers are more common now and are not cured like the infectious diseases with a one-week course of medication. It is how we deal with these threats in the modern world that is a true measure of the merit of our healthcare system.

Chronic underfunding in the public health system, coupled with high costs in the private health system, has created an apartheid healthcare system in Jamaica where once you have the means you can obtain First-World care locally, but if you are forced to use the public health system, the treatment you receive will be decades behind the frontiers of medicine.

This gap is widening as more specialists hone their craft and expensive treatment modalities are deployed in the private sector, while public hospitals grapple with basic shortages and long waiting times for basic services.

The difference is stark. If you get a stroke or heart attack, a tiny tube can be inserted into the blocked blood vessels in your brain or heart, clearing the clot and restoring blood flow before the damage becomes devastating.

In the public hospitals, you are given oxygen and a prayer that the stroke does not get too bad, or blood thinners and hope the heart continues to work. One expert estimates that 80-90 per cent of limb amputations done in the public hospitals could be prevented if patients had access to the advanced endovascular techniques available locally.

Bariatric surgery offers a cure or improvement in diabetics, hypertensives and morbidly obese patients, but only to private patients. Virtually any abdominal, chest and joint surgery can be performed via keyhole surgery in the private setting, but on the few occasions when they are performed in public hospitals, it makes the news.

There may be better radiological investigations available to public patients now but after you have a diagnosis, what era of treatment will they receive?

We have come a long way in developing our healthcare system. But we have so much farther to go before our public health sector catches up with our private health sector. Only then should we be proud of our accomplishments.

- Contributed by Dr Alfred Dawes