Dear editor,
HAVE you ever been an in-patient in hospital? Have you ever had a loved one in hospital? I have, and I can tell you that both are quite distressing. I chose a career in the health profession, where I have had the privilege of meeting some wonderful patients, to try to make a difference. What I found with most of my patients is that in most instances, a reassuring smile and a gentle hug would suffice. Sometimes these, the basics as they are known, are forgotten with all of the complex machines that are at our disposal.

During the PPP’s 23 years in government, I had made several observations that were quite concerning. Two and three patients sharing a bed on the maternity ward; beds without sheets and pillows. No patients’ privacy. Patients’ deaths not routinely investigated unless it reaches the media. Poor communications by healthcare professionals. Patients travelling many miles to get basic medical tests among other ills.

I struggled to be silent. I was not silent. When this government came into power in 2015, I continued my criticism. President David Granger and Prime Minister Moses Nagamottoo, two men I greatly admire, did not escape my criticisms. Guyana Times, the PPP-aligned newspapers, got hold of one of my letters and chose to score cheap political points by interviewing the then Junior Minister of Public Health Dr. Karen Cummings. All that I have stated above can be easily verified.

I state the above because I know what I am about to write, the PPP scribes will rush to misrepresent me as a government supporter blowing the Government’s trumpet. On looking at my stated record of objectivity, they will struggle to defend such a position. A few nights ago, I listened to an interview on Benschop Radio given by the Honourable Minister of Public Health Volda Lawrence. The interview was intellectually stimulating and very eye-opening. The interviewer was very informed and asked very difficult and searching questions. The interviewee was also very informed, amiable, and articulate. But what was amazing was her grasp of medical concepts, taking into consideration that she is an accountant by profession.

The interview started with the normal getting-to-know-you question. Our Minister of Public Health volunteered that she was conceived in Linden, but born in Georgetown. A very light and humanly touch for which the interviewer, Mr. Benschop, in jest, constantly reminded the Honourable Minister. The Hon. Minister then set the scene of the status of the health service when APNU-AFC came into power in 2015. The negative observations I alluded to were still present. The Hon. Minister then went on to outline other concerning observations at the New Amsterdam Hospital. The mortuary being in close proximity to the kitchen where patients’ meals are prepared. The smell of decomposing bodies pervasive in the kitchen. The drain for the mortuary passes through the middle of the kitchen. The doctors’ sleeping area was a boxed off area of four white sheets and a bed. The hospital beds and hospital environs was in a deplorable state. These conditions were not unique to New Amsterdam Hospital, but was a common pattern throughout Guyana.

The minister then went on to outline what this present government was able to achieve. Through collaboration with Food for the Poor, Government funding and other agencies, hospital beds were procured, hence patients no longer need to share beds in the maternity wards; something that was prevalent during PPP’s 23 years in power. Some may see this as minor, but this is major. The closest analogy I can think of is having to travel by plane and spending eight hours sitting and sleeping next to a complete stranger. It is not easy. Now add two newborns to that mix. Two adults and two babies on a single bed. How the PPP could have allowed that to continue for 23 years is unbelievable. As alluded to earlier, being an inpatient in hospital is very distressing. Why burden these distressed patients with inadequate and poor sleeping arrangements?

The second take-away point was the reduction in maternal mortality. To achieve this, the ministry worked along with PAHO, private and public consultants. The Hon. Minister of Public Health had this to say, “We recognized, and we admitted to the issues that we have, especially those related to maternal mortality and the maternal health system.” In my opinion, this, namely, candour and probity, was unheard of in Guyana under the PPP. Unless there is honesty in recognising that a problem exists, be prepared to explore the causes of that problem, then it would be impossible to solve it. Great Leadership by the Hon. Minister.
The Hon. Minister also had this say, “When there were many maternal deaths, we did not play the blame game; instead, in addition to assistance from PAHO, we put together the Maternal Mortality Review (MMR) Committee. They have been reviewing all the Standard Operating Procedures (SOPs), and visiting all the medical facilities where deliveries are done.” Again, this highlighted three important medical concepts: First is to investigate but not to blame. By having such a culture would encourage health professionals to be honest. The fact is that most errors in medicine are institutional and not individual. Secondly, investigating a death provides the opportunity to learn, not only at GPHC, but throughout the country. Finally, by reviewing of all the SOPs allows the medical investigators to scrutinise individual steps in the patient’s pathway of care. In so doing, flaws or deficiencies in a specific step may be identified and modified, with a view to reducing any chance of the error reoccurring. Again, brilliant leadership by the Hon. Minister. It was a massive disaster by the PPP to practise 19th Century medicine in the 21st Century, failing to understand these basic concepts.

The Minister also spoke of investigating “near misses”. A “near miss” is an event that might have resulted in harm, but the problem did not reach the patient because of timely intervention by healthcare providers or the patient or family, or due to good fortune. It is very important to investigate this since in all likelihood a medical error had occurred. Even though the patient did not come to harm, the error had the potential to have caused that hence it needs to be identified, remedied and information disseminated. The Minister also spoke of the use of specialist maternity suits which are available in the hinterland. These are used when pregnant patients may be having a bleeding complication in pregnancy, in the remote hinterland areas and a doctor may not be readily available. As a result the patients were this maternity suit to stabilise them until the doctor is available to take over the care and provide definitive treatment.

A chronic shortage of health care professionals has always been a problem in Guyana especially in the hinterland regions. Addressing this problem required innovative thinking and action. To address this shortage locals in the area were trained as Community Health Workers (CHW). They main role was to assist with delivery. Working in conjunction with this is the building of maternity homes at the hospitals in the hinterland. These homes will serve to house mothers who live many miles away from the hospital and also those who may have a complicated pregnancy. What is obvious from the above is that the decrease in maternal mortality rate was not by chance. Rather it was due to active intervention by this Government to resuscitate a dying healthcare service that they inheriting from the PPP. What is significant is that these changes were achieved in a fraction of 23yrs.

Also the Hon. Minister addressed other aspects of medicine where steps were taking. She spoke of bringing healthcare to the patients and reducing the patient need to travel long distances for healthcare. This is all a part of patient centred care. A patient who may require a basic scan test but had to travel tens of miles to have this done.

Now that is not necessary since these test are now available at their local hospitals, which reduce the burden on GPHC and improve patients’ and relatives satisfaction. Also over the past four years, there were physical development of many health centres and Regional Hospitals. Recently a doctors’ quarter was completely renovated.

Recognising that healthcare professionals communications was an area of concern, communication skills training is being given to health professionals at GPHC with a view to extend it nationally. This is critical in improving patients and relatives experiences. Finally, the Ministry of Public health is a part of the UNAIDS 90-90-90. Thus far the Ministry has been able to achieve the first 90 and is scoring in the mid 80’s for the two 90’s with a view to completing the triple 90 in 2020.

It was reassuring to hear the Hon. Minister clearly stating that there is much more to be done. Twenty three years of mismanagement by the PPP has resulted in complete destruction of the health service. It is impossible to remedy this in four years. The solution to this problem is to have sound leadership from the top. The solution involves probity by all healthcare professionals. The solution requires candour by all healthcare professionals. For the first time with the leadership of APNU-AFC Government, I can confidently state that healthcare in Guyana is going in the right direction. These are baby steps but they are going in the direction of progress. Well done Madam Minister and her team. With your leadership, I can see that our healthcare will become the envy of the Caribbean. We are some distance from that but having a vision, passion and dream is where it starts.

Regards,
Dr. Mark Devonish MBBS MSc Med. Ed