-public healthcare system currently has 62

FOR many hinterland and riverine communities that are starved of vital healthcare workers because they are too sparsely populated for there to be permanent physicians, a medex, at times, can be the difference between life and death for those residents.

Introduced in Guyana in 1977, this month the profession celebrates 44 years of existence.

Short for Medical Extension, the medex profession is a version of the physician’s assistant programme that was created in 1968 by global health leader, and former Deputy Director of the Peace Corps, Dr. Richard Smith. He had created the programme at the University of Washington before developing similar programmes at seven other US universities.

The programme was eventually rolled out worldwide, particularly in developing countries with medically underserved areas. Though they are not doctors, medex are mid-level medical professionals given some amount of training in nursing and medicine and can handle most of the basic and routine care provided by physicians.

“The medex is like [an] all-rounder. it’s a mixture of nursing and medicine. It’s kind of an in-between programme,” said Coordinator of the Medex Training Programme, Sarah Daniels, who has been in the profession for over 13 years.

She shared her experiences and spoke about some of the challenges those in the profession are encountering, during a recent interview with the Guyana Chronicle.

While she is proud of how far the profession has come, Daniels believes that it is not given the kind of recognition deserving of the level of work and dedication that these “selfless” individuals give.

“Sometimes it’s like we don’t exist even though we have some very, very good medex out there. I have been to facilities around Guyana and, looking at some of the conditions we have to work with, we really try to put our all out there but we are not recognised,” she noted.

Though there are only 62 practising medex in the public healthcare system today, they play a vital role and help to fill a crucial void in the public healthcare systems in remote communities.

“In those facilities you have limited resources and not enough personnel. So, you have to work the best way possible that you could with the situations that arise,” she said.

“I recall one time, while working in Leguan, I treated a teenager who got a fishing hook caught through his lip. Another time a guy came with alligator bites, with huge lacerations and you had to make your best assessment. But working in those areas helps one to build more confidence and learn to make informed decisions,” Daniels added.

In recalling some of the experiences that have aided her professional growth, she said she was exposed to a lot and worked in many communities across the country.

“Being a medex I had the chance to work in all parts of the country in different capacities and I considered it an honour to work out there with my people, see how they live the different lifestyles and cultures,” she told this publication.

Originally from Vergenoegen in Region Three (Essequibo Islands-West Demerara), Daniels was already a midwife when she commenced training to become a medex. A love for patients was what led her in that direction.

Daniel’s face lit up as she spoke about her passion and love for the profession.

“I like clinical medicine, dealing with patients, and elderly people. One of the greatest things you can do is talk and sit with your patients rather than just write them a prescription and not paying much attention to how they are feeling. It brings joy to learn about them and they decide to trust you so much,” she said.

In Guyana, one can become a medex by first qualifying as a midwife and then undertaking an 18-month medex programme. However, with the current shortage of midwifes in the public healthcare system, interested individuals can alternatively do a four-year programme which requires at least five CSEC subjects to qualify for entry.

This programme involves one year of training in nursing, one year of training in midwifery, and two years of training in clinical medicine. At the end, graduates are awarded an Associate Degree in Medex, with the programme affiliated to the University of Guyana.

The training programme is free of cost; however, it is offered only through the Ministry of Health and graduates are required to serve in the public healthcare system for at least five years after graduating.

This month a new batch of 35 students will be entering the programme, while there are also some 29 students currently in training.

According to Daniels, the current number does not meet the demand needed across Guyana.

“I don’t think we have enough or will ever have enough because as we train more people, others are retiring, migrating and upgrading so we will always have a shortage,” she said.

Though expansion of the programme has been curtailed due to limited facilities, Daniels looks forward to the day when facilities are available and the programme can be upgraded to a degree programme so that graduates would have avenues to further their education.