First appeared in The Tribune here…
BAHAMIANS have generally felt that the powers that be do not truly have a healthcare agenda and, frankly, do not care about the public healthcare system. If one was to visit the Princess Margaret Hospital or some of the polyclinics on any given day or night, one would encounter throngs of frustrated Bahamians, irritated by the “don’t care” attitudes of medical personnel, angry about the slothfulness of staff in catering to their needs and exasperated by what appears to be an overall lack of user-friendliness in accessing decent healthcare without either having to bleed out in the waiting room, display their anger through uncontrollable outbursts, call a physician who they might know or are connected to some politician. That is the horrendous state of public healthcare and yet when the single largest investment in the history of healthcare in the Bahamas is made — that is, in the public sphere — the potential that would’ve been realized with the introduction of the critical care block will likely not be achieved as a design-built step-down unit has been excluded from the block in preference to glossy office spaces.
Indeed, any poll of Bahamians and medical professionals alike would yield the opinion that the vast majority of them believe that the public healthcare system must be fundamentally revamped and/or completely rebuilt.
Relative to the vitally important step-down unit — which I understand was supposed to be situated on the second floor of the newly constructed critical care block — its intent, in hospitals across the globe, is to serve as an intermediate, semi-critical unit in which patients who are no longer critically ill (that is, in the Intensive Care Unit), who may be on a monitor or generally interactive, but who aren’t well enough to go to the medical-surgical units. One should also note that not all patients who come out of ICU must go to a step-down unit or a general ward as some of them have a marked improvement in their conditions, so much so, that they could be discharged.
Cardiovascular Surgeon Dr Duane Sands told me:
“I don’t know what the premise is in changing from the step-down unit, but there’s a concept that is well held which is that the accommodations of administration are, and must be, significantly better than the accommodations for patients or the professionals who must care for patients. There’s a real disconnect as to what priorities are! The question Bahamians should be asking is how should their scarce healthcare dollars be spent — is it better spent on clinical equipment, critical care space or air conditioned offices? A step-down unit would allow for the treatment of seriously ill patients who need more than open or general ward care. So, the exclusion of such a unit, for whatever reason, is an error in healthcare planning. This will need to be revisited in the near future.”
Indeed, the evolution of the critical care block from one initially intended to better care for critically ill patients to one that would partially offer facilities for patients and partially offer posh, high-rise offices for hospital big-wigs is demonstrative of what the Public Hospital Authority (PHA) and the powers that be view as priority! As Dr Sands said, “The view that is widely held in the administration of healthcare is that ‘if it wasn’t for them doctors and them nurses, we (the administrators) would be fine taking care of patients.’”
“They do not listen. And so, despite the single largest investment in healthcare, the potential of the new critical care block could possibly be lost and never come to fruition. Up to Thursday (November 14th), surgeons—who will be the primary users of this space (critical care block)—have not had a chance to view the facility. As a matter of fact, I still haven’t seen inside and they simply won’t let you in. We would have to go on a tour and they have not allowed us to go on this tour—bear in mind that it’s November! The viewing of the critical care block is by appointment only and we have not been given an appointment. “
When one looks at the critical care block and thinks about how a vital floor—originally dedicated to medical care—was designated to serve as office spaces for the hospital’s administration (who, obviously, must already have offices in their current capacities), we Bahamians find ourselves yet again disappointed with another promise that has not been delivered.
According to reliable sources, the critical care block is behind schedule and the funding — which was recently raised by the PHA’s recent public offering, is delayed. Frankly, though the share offering was oversubscribed, the PHA had to publicly seek funding as it is virtually insolvent. Moreover, the opening of the critical care block is further delayed since the staffing levels are not yet adequate to meet the needs of the new block. By all accounts, as it stands, the anticipated move-in date has been indefinitely postponed.
In summing up his take on the delayed critical care block and the PHA, Dr Sands said:
“The PHA is a tool of devolution and, despite the efforts of those involved, it has not been set free to function as originally conceived. It continues to be micromanaged by the MOH and is therefore another layer of bureaucracy. It is metaphoric of the inability of politicians to avoid meddling in the so-called quasi-government entity. It is far too enticing to be able to manage so many jobs, so much money and so many resources that the politicians simply can’t let go! For this same reason, political interference in the PHA will forever keep it on the brink of fiscal insolvency, just like the Mortgage Corporation, Bahamasair, BEC and Water and Sewerage.”
I couldn’t agree more.