PUBLIC Health Minister Dr. George Norton has come up with a novel way of sanctioning those healthcare professionals found culpable in the death or injury of patients in the public healthcare system. He believes that reducing their emoluments would be an effective way of ensuring that they take their jobs more seriously.
Expressing his dissatisfaction with the manner in which serious matters are dealt with by some healthcare professionals in the public health sector, he used as a case in point the new-born baby boy who reportedly fell off a bed last week in the Maternity Ward of the Georgetown Public Hospital Corporation (GPHC).

A HUMAN ERROR
“The baby can’t roll off the bed! The baby can’t wriggle off the bed! That is a human error that we are investigating,” he said.
“If criminal negligence is found, so be it; you will go to the police. I say this, being a healthcare worker myself,” he told the Guyana Chronicle on Tuesday.
While he has ordered an investigation into the incident at reference, Dr. Norton said he strongly believes that the explanation provided by the healthcare professionals he spoke with at the hospital is unacceptable.
“The first thing you hear is that it was an Apgar of 10; baby was born strong. I don’t care how much! It could be an Apgar of 20, if such existed; the baby can’t roll off that bed! It is a human error; it has to be negligence!” the minister said passionately.
An Apgar score, which can range from zero to ten, is a medical way of assessing the health of a newborn baby.
Noting that Acting Chief Medical Officer, Dr. Morris Edwards has been tasked with investigating the incident, Dr Norton said: “We will leave no stone unturned.”
And though he could not say for certain when that report would be ready, he does not set too much store by them.
“Reports are chronicled in such a way that only the reports look good,” he said. “It doesn’t give you the true picture of what is taking place.”

PUNITIVE MEASURES
Though the Minister recognises that the Public Service Law does not permit the reduction of an employee’s salary when they are found guilty of acts of negligence, he believes that emoluments must be reduced as a punitive measure. No one should be allowed to operate as if it’s business as usual, the Public Health Minister stressed.
“It must not happen again! If the Public Service Law says you cannot touch the people’s salaries when they are at fault, then it must be changed,” Dr Norton posited. “Because, if you are going to keep an ectopic pregnancy misdiagnosed for hours in the Accident and Emergency (A&E) department, causing the mother to die, then I don’t think sending you back to the institution in order for you to regain your knowledge without interfering with your emolument is right.”
He said that as a punitive measure, “the salary scale should be affected; and then people would realise that we mean business.
“It might not be in accordance with Public Service rules and so on, but Public Service rules can’t bring back a maternal death. We have got to be prepared to do this; if not, we will end up worse. And the year isn’t even finished as yet!”
Dr. Norton believes that if drastic measures are not taken against defaulters, cases of negligence will continue to spiral out of control. This, he said, is not something he is prepared to have happen under his watch.
“These are things I berated while I was in opposition. I did it then; and I would do it again.”
MORTALITY RATES
And while he is the first to admit that the country’s maternal mortality rate is not going to change dramatically, he noted that the core problem is the lack of proper systemic care.
“Our maternal mortality and infantile mortality rate is a reflection of our health system,” he said. “And it starts from our first tier: Our community health workers; it starts from there.”
More emphasis must be placed on Community Health Workers, Dr. Norton said. “I think that our strength lies in our Community Health Workers; simply because it is our first tier.” He acknowledged that many community health workers have limitations while noting that they have come a long way. Many of the Community Health Workers have received formal training; an initiative of the former administration.
“I hate to go to a health hut where a midwife and a community worker have to deliver the baby on a regular bed, as opposed to a birthing bed, especially when I see birthing beds scattered in certain institutions. Hats off to whomever started it; we recognise the value in our community health workers, but we have got to do better than that.”
The Minister believes that while the GPHC may take a lot of flak for maternal deaths, oftentimes it is the pregnant women who do not heed the calls of the healthcare professionals.
“We have had situations where doctors said to the patient, ‘Please do not get pregnant; your heart can’t take it.’ And the next thing you know, she comes pregnant,” he said.
“We have got to start at that level,” he said. “You see, many a time, we take the blame fair and square; that is happening at the GPHC. Why? Because, so many times, they (the women) reach there so late. By the time they get there, there isn’t anything that can be done.”

CHANGE OF CULTURE
Accordingly, the Minister believes that there is a need for a change in culture to be effected. Pregnancy, he said, must be seen as a “fragile” period.
“While we would very often say it is a natural process, we have suffered too much just to regard it as a natural process,” Dr Norton said. “We have got to start looking at our pregnant mothers as something fragile; something that is supposed to be there in a glass case.”
As such, pregnant women need to be sent off from work earlier, and need to remain on maternity leave longer. He believes, too, that after delivery, mothers should be entitled to six months maternity leave; something he is pushing to effect.
“We say, ‘Oh, you must breast feed for six months.’ But then, you are only giving three months maternal leave. Do the math!”
Citing the 2014 report, titled, ‘Trends in Maternal Mortality Estimates 1990 to 2013’, Dr. Norton said statistics show that Guyana was poorly ranked. As a result, he said there must be several changes in the country’s health care system.
The collaborative report produced by the World Health Organisation (WHO), UNICEF, the United Nations Population Fund (UNFPA), the World Bank and the United Nations Population Division demonstrated that many countries were not on the path to achieving Millennium Development Goal 5 which calls for the reduction of maternal mortality ratio by three quarters between 1990 and 2015. Guyana was ranked as one of five countries in the Americas with the highest maternal mortality rate.

By Ariana Gordon