The announcement last Friday that an agreement had been signed that would see a team of medical specialists from Mount Sinai Health System in New York, USA, arrive in Guyana this week to conduct training exercises at the George-town Public Hospital (GPH) was welcome news. It was revealed that the team includes specialists in the areas of oncology, cardiovascular medicine, endocrinology, primary and preventative care among others. Of course, most of these specialty medicine areas require years of post-medical school training, which cannot be completed in short stints, such as the current one being funded jointly by the government and Hess Corporation. Nevertheless, it’s a start.
Additionally, for what must be the umpteenth time, preventing diabetes, hypertension, cardiovascular illness, cancers and other chronic non-communicable diseases (CNCDs) was touted as part of a ‘new’ national healthcare initiative. Dr Frank Anthony, who made that proclamation while talking up the clinical excellence and better patient care among other things that are expected to follow the specialists’ visit, is only the latest health minister in a long line to promise this. Whether he will have any more success than his predecessors is left to be seen.
What is certain is that only training medical professionals at the GPH will not actualise clinical excellence in the national system. One hopes plans are in the pipeline to extend the instruction to all of the hospitals in the public healthcare system. Further, certain aspects, like the end-to-end diabetes screening and care as referred to by Mount Sinai’s Executive Vice President and Chief Clinical Officer Dr Jeremy Boal, as well as steps to prevent other CNCDs should be widely disseminated to all cottage hospitals, health centres and clinics.
Furthermore, there should be much more emphasis on preventive medicine, which includes biostatistics, epidemiology, mental health, occupational health, and health promotion from a public health standpoint. One hopes that medical students are being steered in this direction. The saying, ‘prevention is better than the cure’ is ever apt.
Of course, key to making this work is ensuring that healthcare workers are properly compensated so that they are motivated to stay. So far, this does not appear to form part of the equation. Given that the leaching of staff from the healthcare system is continuing unabated, there is every chance that those who are trained now could leave shortly, taking that knowledge with them. The high attrition rate in the public health sector is among the reasons for its less than stellar performance – to put it mildly.
President Irfaan Ali, who delivered the feature address at the signing ceremony, which was held at State House, was quoted as saying that the ultimate goal was to position Guyana as a destination of choice for health care services. “There will be an entire system overhaul…,” he told those gathered. “You can have the best service but if you don’t have the system or platform to provide that service you would be wasting time.” He should have gone further to acknowledge that if the human resources were not available to run the system, then you might as well not have it at all. Our leaders often appear to be operating with tunnel vision.
In January, when he read this year’s national budget, Minister of Finance Dr Ashni Singh had announced government’s plans for “a major expansion in public healthcare facilities”. According to his speech, $12.4 billion had been earmarked for the design and construction of a state-of-the-art paediatric and maternal hospital, the upgrading of the West Demerara and Bartica hospitals, and the construction of six modern hospitals at Anna Regina, Tuschen, Diamond, Enmore, Bath and Number 75 Village, Corentyne. Additionally, $220 million had been set aside to retrofit and equip the Festival City Polyclinic to provide x-ray, dental, laboratory and rehabilitation services, while another $1 billion had been allocated to upgrade health centres across all the regions of Guyana.
Needless to say, while these projections sound good in speeches, putting them into practice is usually not that simple. Again, a major concern will be the staffing of these new and upgraded facilities with medical professionals who not only know what they are doing, but are motivated enough to do it correctly. A cursory look at the hospitals in the country – both public and private – will reveal that there is an overwhelming number of foreign medical practitioners and technical staff. Communication is sometimes an issue. Is this state of affairs meant to continue indefinitely?
Meanwhile, maybe Dr Anthony would like to explain why, after all this time, the provision of a Magnetic Resonance Imaging (MRI) machine is not a priority for the GPH, which is the country’s premier medical facility. To date, this service is only afforded at a private hospital and for years, the average Guyanese trying to access the so-called free healthcare available in this country have had to beg or fundraise if ascertaining their diagnosis required MRI screening. A state-of-the-art MRI machine costs between US$1 million and US$3 million today and the 14-week training for technicians, a mere fraction of that. Perhaps this is something the government might want to consider sooner rather than later.
