–Medical Extension Officers remain important stakeholders in the health system 44 years on

The MEDEX (Medical Extension Officers) Programme has existed for 44 years, and Guyana’s Medex Programme has produced a total of 319 MEDEX who function as mid-level managers primarily in the rural, riverine and hinterland areas.

However, currently there are only 57 Medex within the public health system.
Such medical professionals are trained in nursing and some amount in medicine. They can handle most of the primary and routine care provided by physicians.
In an interview with this publication Chief Medex (Ag) Carleen Howard-Mohabir said that Medex plays an integral role in the development of the Primary Healthcare System in Guyana through embracing and cultivating all policies and procedures in both rural and urban areas.

“Our labour almost goes unnoticed to those who are ill-informed of our roles and our significance to the system. We are multifaceted as we function as a substitute for the doctor, pharmacy assistant and midwife. Additionally, some have branched off into various specialties,” the acting Chief Medex noted.

Noting that the MEDEX programme is governed by the Legislative Medex Act of Guyana 1978, which was founded by Dick Smith, who started the International Medex programme, Ms. Howard-Mohabir said she approached the Ministry of Health to facilitate the training of local mid-level health care practitioners to serve the citizens living in remote areas of the country.
Adding that the need was great as there was no School of Medicine in Guyana, the Chief Medex said all medical doctors were trained in Cuba, and access to medical services was limited in remote and coastal tribal areas.

She explained that indigenous Amerindians were most at risk among the diverse Guyanese population. Their susceptibility to dehydration, diarrhoea and malnutrition was markedly increased due to the inaccessibility of healthcare services.

Over the past four decades, she explained that Guyana’s Medex Programme curriculum changed since the initial batches were trained in dentistry. This was eventually made into a separate training programme.

The first batch of 22 MEDEX graduated on October 18, 1978 and was immediately dispatched to health centre and district hospitals in remote areas of Guyana. The training programme was and is still accredited by the University of Guyana.

Since then, Chief Medex (ag) Howard-Mohabir said the programme was further developed as a direct response to the limited number of qualified Medical Doctors at all health facilities countrywide.

In 2000, Guyana was sacrificing its existing nursing workforce to be trained as MEDEX, which created additional gaps within the system.
As a result, she explained that in 2006 the first batch of eight students from “The New-Pathway” underwent a 42-month training programme where 26 completed successful training in 2010.

The New Pathway programme included components such as nursing and midwifery before completing the Medex phase, which includes managing and treating Chronic and Non-Communicable diseases while conceptualizing the pathophysiology and other essential elements. This avenue allowed school leavers with a minimum of five CXC subjects or more with Mathematics, English and one Science subject with grades 1-3 for entry into the programme.

Currently, she said two training batches of medex students are being trained simultaneously; Medex Sarah Daniels co-ordinates that programme.
In 2024, twenty-seven students will complete their training; in 2025, thirty-six students will complete the course. These persons are from regions one to 10.
This will increase the availability of MEDEX at health facilities as the quality of care and the number of available services to clients in the respective villages and regions will improve.

“Some of our major contributions are reduction of maternal and child mortality and morbidity with key involvement in other programmes such as Vector Control, HIV/AIDs, Tuberculosis, Mental Health, Visual Inspection with Acetic Acid Clinics (VIA), Chronic Disease, Port Health and other relevant departments. . Inter-sectorial collaboration is pivotal as the community is our client,” Chief Medex (Ag) Carleen Howard-Mohabir said.

She continued: “We continue to explore the genesis of the community health problems while we conduct health education and promotion on positive health-seeking behaviour example, planned pregnancies, recommended intervals between pregnancies, modifiable practices related to diet, exercise, smoking, and alcohol abuse. In addition, some MEDEX function in the capacity as Regional Maternal and Child Health Supervisors,” the Chief Medex emphasised.

In recognition of MEDEX to the health care system of Guyana, the Ministry of Health has acknowledged and recognised the contributions made by Medex.
“As the Chief Medex, I am elated to be a successful graduate of the first batch of New Pathway, after which I underwent a Diploma in Management, Bachelor of Science in Public Health Nursing. Currently, I am reading for my Masters in Public Policy and Administration. Clinically, in 2011, I functioned as a Health Centre Manager.

From 2013 to 2015, I served as the Regional Maternal and Child Health Supervisor for Region nine, after which I returned to Georgetown and managed Central Georgetown Health Centres. In May of 2022, I assumed duties of the Chief Medex,” Mrs Carleen Howard-Mohabir told this publication.

Below are some of the MEDEX who contributed to reducing mortality and morbidity amongst pregnant women and other members within the community.
For Ms. Holly Edghilo Gill, her career started in March 1992 at the Georgetown School of Nursing. She was appointed Nursing Assistant in 1994, appointed a midwife in 2000 and appointed MEDEX in 2006.

Reflecting on a challenging time, Ms. Gill said “One out of many was in the month of June 2019. During this time, rain fell consistently, a pregnant woman was in labour around 1 o’clock in the morning and she was not co-operating well, she began to hemorrhage while she was 9 cm, and the baby was born with no complications. The bleeding for the mom worsened after the delivery of the placenta. On examination, she had two cervical lacerations. A medevac was not possible due to the weather. I prayed and with God’s guidance I managed to suture the lacerations and managed to control the bleeding. Three days later, the patient moved to GPHC.”

Meanwhile, for Medex, Sharon Hope, her medical career commenced on 1st June 2000 as a single-trained midwife, followed by completing the Medex Programme in 2006 and Bachelor of Science in Public Health Nursing in 2019.

“In my sixteen years as a Medex, my most memorable experience was in 2010, while escorting a pregnant woman with complete breech presentation to GPHC for delivery,” she said, explaining that in a complete “breech presentation,” the legs are tucked, and the foetus is in a crouching position which can result in complications or a Caesarean Section.

Medex Hope continued: “On our way, she started complaining of severe uterine contractions, I kept reassuring her. Furthermore, when we arrived at the Harbour Bridge it was closed and the mother said, ‘MEDEX, I feel the baby coming, I can’t bear it anymore, so I decided to check her. Hoping and praying not to see the buttocks protruding. Unfortunately it was sitting there. My first breech delivery was done on the Harbor Bridge with sweat streaming down my face. I gave God all the glory; the delivery was a success, and a bouncing baby boy was born without any complications or Caesarean Section,” she revealed.

As for Medex Josephine Murphy, she commenced her medical career in 1980, when she completed the Community Health Worker’s programme.
Because of her passion and need to receive additional skills, she became a Registered Nursing Assistant in 1987. As the community’s need increased, it created a gap in service delivery. This provided the need for a MEDEX which she concluded training for in 1996.

Medex Murphy served different communities in Region Seven, where she is currently stationed at Kurupung and Isseneru Health Post.
One memorable experience for Medex Josephine was in the year 2009, when she referred a 14-year-old mother for delivery.

While conducting follow-up visits in the community, the mother did not adhere to the referral. By this time, she had specific issues during labour. An emergency call for a Medevac was done. In the aircraft, the mother’s pain became intense and regular; and the baby was born over the Essequibo River, followed by the placenta.

When they were eventually on the ground, Medex Murpy recounted, “while in the ambulance proceeding to Georgetown Public Hospital, a car collided into the ambulance where I ended up at the side of the road, feet folded and with baby in my arms uninjured. “I must say I was in shock”. We all reached GPHC safely where continuity of care was done for the mother and baby,”

Meanwhile, Medex Liza Augustus started her career in 1996/1997 when she received training in first-aid from the Guyana Red Cross Society and community health worker’s programme, where she gained employment at RDC Region eight in 1998. One of the many pieces of training was in malaria microscopy.

“Being a health worker at that time was very challenging since there was no supervisor around for guidance, no family planning services and lots of pregnant women with deliveries being done at home by a relative or a nanny; malaria was the disease of the day along with acute diarrheal diseases,” she noted.

In 2000, a great opportunity arose for Miss Augustus to be trained as Medical Extension Officer, and by 2002, she was appointed MEDEX. Further, wanting to provide adequate care for the women in Kopinang, Mahdia District Hospital, Kato Cottage Hospital and Paramakatoi Health Centre., Medex Augustus became certified as a midwife.
Having these skills, maternal and child health services were improved. Climbing the ladder another round, she committed herself to the Public Health Nursing program, and in 2019, she earned her degree.

Medex Augustus continues to prove herself a worthy team player in the health sector. She worked at the Kopinang Health Centre and served the villages of Kopinang, Maikwak, Kaibarupai, Kamana and Waipa. She is currently the Health Visitor and supervisor for Region eight, based at the Maternal and Child Health Department of Mahdia District Hospital. She manages twenty-three health facilities within the region.

“A memorable experience I can recall is a multigravida mother (pregnant more than once) who was in an abusive relationship and was three months pregnant. One incident caused her to experience vaginal bleeding. She bled until she was white like chalk. At that time the facility was not equipped with any infusions. I could have only reassured and monitored the mother until the aircraft came to medivac her to Georgetown,” she recalled noting that the mother eventually received the necessary care.

In the case of Medex Sampson Bartholomew, he started to work as a Community Health Worker in 1994, trained as a Malaria Microscopist in 1999 and began working as a Medex in 2002.
“An outstanding personal experience was when I was working for seven years with Iwokrama as a medical personnel in dealing with tourists from different countries.

A memorable experience occurred when there was a motor vehicle accident where the driver who was involved almost lost his entire arm as it was clipped off during collision with him and a truck, he almost bled to death but he was saved by applying a tourniquet and pressure to the stomp of the amputated arm. The incident occurred fast and was confusing. An arrangement was made to take the person to Georgetown.

The funny thing was that two air-craft came. As I escorted the patient, we realized that one aircraft was carrying the arm separately and the patient’s life was in my hands. I thank God he arrived alive and received timely admission that to the hospital,” Medex Bartholomew recollected.