(Trinidad Guardian) While discharging his responsibilities as Minister of Health, Dr Fuad khan is counting the days when he would be quitting the cabinet position and return to his practice as one of the country’s few urologists. Dr Khan who says he is being emotionally pulled apart between his ministerial office and his duty to his patients, is putting systems in place so that his successor would be well placed to continue to run the affairs of the ministry in a satisfactory manner. One of the things he is doing in the meantime is to open up visiting hours at the nation’s public health institutions instead of this being done at appointed designated hours.
Q: Dr Khan many moons ago when he was Minister of Health Kamaluddin Mohammed told me that the Ministry of Health was like a mad house and if he couldn’t fix the problems in the health sector no other minister could do it. Are you up to that task today?
A: (Smiling at his Park Street, Port-of-Spain, office Wednesday afternoon) Well, maybe in the 70’s it was a mad house right? I was too young to find out. However, because of the work that he and others before me did I have inherited something that’s not a mad house. So I want to thank them for creating and putting the effort to reach where we are today.
You know that statement runs counter to the negative perception that many have of the public health sector in terms of prompt and adequate health care delivery?
Remember Clevon our health care system caters to a very large segment of the population; the private sector caters to a much smaller clientele who pay for their services and having to serve the majority of the population you will find that there will be snags in the public sector. I am not making a self-serving defense of the system but the facts must be faced. There are two things we must take into consideration, people don’t like to wait and two, they believe their illness is more urgent than somebody else’s but in the health system there is something called the triage system.
Which is?
This is determining the extent of their illness by a simple observation, so that some people might feel another person is getting in before them and so on. I am not saying the health sector is not without fault, it could be upgraded…
Being a medical professional yourself what are some of the major problems facing the public health system?
There is not much penalty for inefficient performance.
Are there any penalties at all?
The American system which I like to quote if you don’t produce you go. In our system however, sometimes you could lie down very quietly you don’t produce and ….
Get paid?
Yes and they get promoted. We tend to promote in this system people who they want to get rid off. In the other system people are promoted on merit, in our system you get promoted based on seniority so sometimes you don’t get the best person for the job.
How serious is what I deem indiscipline in the system…..how is this affecting the efficient delivery of health care?
(Furrowed brow) You see it is difficult to discipline people, and we have to look at other things too. If you have two or three doctors working in the emergency section and an urgent case should turn up they have to go and see about that case so that patients with less urgent problems would have to wait and I know that that could cause some frustration…
True but there have been cases where patients had to wait for very lengthy periods…five, six, eight hours…
I am not defending it but in the emergency system abroad the average waiting time is six to eight hours for non-urgent cases. But I have put a system at the Eric Williams Medical Sciences Complex and we will see how it works out, where patients will be put in a good room fairly comfortable, and will be told how long their waiting time would be. We are also opening a shuttle service to the St Joseph Health Centre so they could go there for the non-urgent cases where they will get a faster service using a red card. It is hoped that you should get attended to in one hour or even less than that time.
Dr Khan what about the situation where relatives of patients are not being told anything about the condition of their loved ones even when they ask?
(Leaning forward with one finger on his left cheek) And that is a serious problem of which I am working on and I have put in place what we call customer service representatives, ambassadors and so on. Their job is to liaise with the patients’ relatives telling them what exactly is taking place with respect to their treatment, every step of the way relatives will be told the status of their sick relatives. Another innovative step I will be introducing and I am using this interview to disclose it is that very soon relatives will be able to visit their ailing relatives at any time.
What do you hope to achieve with this new development?
Two things, one we will keep the staff on their toes so that there will be no restricted visiting hours where things will be done to make them (the staff) look good and patients’ relatives will always be on the wards of course not in a manner that will obstruct the staff from discharging their responsibility to the patients.
One of the inexplicable things I never could understand Minister Khan, is why bodies—particularly those involved in road fatalities—have to lie on the ground waiting very often for lengthy periods on the arrival of a District Medical Officer?
OK. I was a DMO so I could understand that feeling and when I found myself having to go on a scene I ensured that I got there in the quickest possible time because a body on the road is disrespectful etc. However based on the forensic part of it, a body that is lying on the road may not have been one which was involved in a road crash. We have to move forward because we cannot afford to have bodies lying down the roadside too long.
On another matter how is this organ transplant programme progressing?
What we are doing is a lot of live donor transplant… people giving their relatives the organs and what we are trying to build is organ harvesting. Right now we have two or three doctors in Barcelona training in this system and we need to have a culture of organ donations. We have to have a mindset that says when you die we should donate certain organs if they are good as a humanitarian gesture. Some people have a mindset which says; “Look I want to go to the hereafter with all my systems intact… suppose I reach up there (pointing to the ceiling) and you know…” (Laughs) No it sounds funny, eh? Everything rotting when you done…let somebody use them, you know? But we need to change our mindset we need to think out of the box…
No pun intended?
(Throws back his head and bursts out laughing) That was a good one I did not think about that…
Are you still…
(Raphael pauses while contemplating the question a few seconds) Hit me straight, hit me straight Clevon, do not “brakse”. I am a person who likes to get it straight, once you have to think about the question you not giving it to me straight (rocks back in his swivel chair)
OK Dr Khan are you still torn between leaving your lucrative practice and…
(Anticipating the question) The answer is yes. Yes. I am being ripped apart with it but I know I have a duty to the country, I know I could do this job real good. I am a good urological surgeon we don’t have many of them…about three or four of us in the country.
Do you think it is fair to people like you who feel they could do both jobs; serve as a government minister and still maintain your private practice…and are not being allowed to multi-task as it were?
(A serious countenance) I personally think and I mean no disrespect to anybody; anyone who could multi-task should be able to do it in their free time because at the end of the day it depends on the individual. If however any complications arise then they would have to pay the penalty for it. I believe we have to look at those laws once again. It needs to be changed and so as not to upset the apple cart I accepted this cabinet position but I am putting things in place…I have given myself a time frame…
Time frame for what?
By giving yourself a time period you do things very fast because at the end of the day my patients have been asking me to come back.
In effect you have given yourself a time frame when you would be quitting the Cabinet?
Yes. I will put things in place so that anybody can run this ministry after I have left. I am not going to lie to you or to the population; I do miss my practice (soft tone of voice) I miss my patients, I miss my urology. I like the ministry but at the end of the day I am a skilled urologist so people call me every day. My patients are calling each and every day…. up to this morning one of them called so it is really pulling me emotionally apart.
Financial consideration has anything to do with your decision?
Yes. Well that is part of it of course. This ministry job pays you less than… when you finish paying tax you taking less than $35,000 a month and you signing paper for people who get $65,000 a month. I am not ashamed to say that and as an urologist you make much more than that. I am not ashamed to say yes I do miss my financial remuneration. But this is my choice to serve for now.
Exactly does this time frame expire?
(Leaning forward with one hand on his right hip) Clevon, I am not telling you that one, if I do I would create…look… let me do it according to my time frame. I know exactly how fast I have to run… (Smiles)
Moving on. On this question of donor harvesting do you think human trafficking in that regard… kidnapping of people to obtain body parts of course illegally is a serious issue in TT?
I am glad you asked that question Clevon because when I was on the election campaign trail that was one of my subjects; that we are not paying proper attention to human trafficking as it relates to Trinidad and Tobago, there are several people I know who have disappeared without a trace. There is trafficking for prostitution, for human organs or any other reason and I am glad that Minister Sandy is introducing very soon a better system of communication within the national security where the kidnappers cannot log into our system. I cannot wait to see it come on board. It is a serious problem here.
I know that you have been pushing a healthy lifestyle project as part of the ministry’s efforts combating certain lifestyle diseases…
Yes. I was told yesterday by a doctor at the paediatric hospital that a very large number of children between the ages of five and ten years old were not only obese but had cholesterol levels more than 200. So I feel justified in attacking the fast food outlets to do something about excessive fats in their products. This is frightening the level of cholesterol in these young children.
Dr Khan it is generally accepted that the delivery of health care in the public sector is not exactly as it should be. How soon do you believe that people can have full confidence in this sector?
I am doing it; I am doing it very slowly. It is a mammoth task and this action includes the coming into fruition of the National Health Insurance Policy (takes out a copy from a pile on his desk)…
This basically seeks to do what?
It is a basic policy and programme for all health institutions in Trinidad and Tobago public and in the private sectors. I am also in the process of implementing an accreditation system where all these institutions would have to adhere to the policies contained in this document and if they fail to do so they would lose their license.
Finally Dr Khan what assurance can you give the nation that an incident like the recent one in which young Akeel Simon died in the arms of his mother after an ambulance refused to pick them up on the street would never happen again?
I am giving you this guarantee now that next week it won’t happen again. Give me until next Wednesday when I will be sending out a policy directive on that. The people are our customers and ambulances and all the institutions are service providers and they must treat everyone with the compassion and respect they deserve.
