Of health care, recessions and lack of supplies

EDITORIAL

Caribbean Medical News would not wish to cause alarm or in any way suggest that Ministries across the Caribbean are negligent in any way should they fall short of supplies from time to time. As people in the medical profession at various levels, we are familiar with stories of over-crowded emergency rooms and the occasional shortage of medication, quickly fixed by fast-acting officials in the Ministries of Health the world over.

What is happening in then in Barbados may be somewhat alarming but it is not unusual. Not only did the recession delay hospital care and prescription drug purchases for more than two years in a row according to an Obama report published in Health Journal Affairs but Federal spending increased by an alarming 40 per cent.

“U.S. health spending grew more slowly in 2009 and 2010, more  than at any other time in the 51 years the government has been collecting such data”, said Anne B. Martin, an economist in the office of the actuary at the Department of Health and Human Services.  So while the recession reduced spending by consumers, employers and state and local governments, the federal government picked up the slack.

This however seems not to be the case in Barbados entirely. (Barbados’ health care system operates much like the NHS of the UK). However, in this case and according to reports in their press, the Barbados  Association of Medical Practitioners has said that “only emergency surgeries” will be done in the face of crucial shortages of supplies from gauze to sutures to equipment like ventilators or MRIs. A day later, the Ministry of Health said that they would be allocating more funds to the hospital to get critical supplies.

The Minister promised an additional $22 million dollars to deal with this shortage amidst an already somewhat chaotic situation of QEH owing various distributors for critical medicines. In addition CEO Dexter James had said that the paid-for dialysis treatment for private care users would also increase.

The polyclinics have had an increase in patient arrivals as have the public pharmacies but there has been no increase in the number of staff attending the patients and public pharmacies do not always have the medications required.  Dr Clyde Cave of the QEH had also recently said in the press that while he welcomed 30 interns that doctors may have to look outside of Barbados for jobs in the future.

Unlike the US where in 2010, the study said, hospitals reported a decline in admissions and slower growth in emergency room visits and outpatient visits, there is an increase in visits (especially in the asthma bay) for public medical attention at the island’s polyclinics in Barbados. Public healthcare has largely been paid by the taxpayers of Barbados for several years and there are views that this may soon come to a halt or those who can pay may be forced to do so.

Private pharmacies are reeling from a drop in sales as much as 35% according to the President of the Association there, while doctors are also reporting that one-third of their practice has declined according to BAMP.

So is the Queen Elizabeth Hospital in crisis? The Prime Minister of the Island, The Hon. Freundel Stuart, QC says “no”. These situations tend to bring with them the political haggling that is all too common when the focus ought to be patient care. The Opposition in Barbados insists that there is a problem and that the hospital is in crisis.

We as medical professionals would like to throw our support behind BAMP and also behind the Government of Barbados in seeking solutions to what must be pressing and urgent problems. Rather than politicize an issue, we would want to support the efforts of all involved in ensuring quality and urgent health care to all who need it from those needing elective surgery to those in the midst of emergency surgery.

Doctors often prescribe drugs during office visits thus any decline in visits will slow spending on medication. The island is in a prolonged recession with the International Monetary Fund at its doors and this is not unlike many other Caribbean countries including Jamaica.

What therefore is more critical is whether patients are getting care and whether they are getting the necessary medication. At a time when NCDs are increasing even among the younger population, access to quality health care that is affordable and available is key.

These issues are not issues that affect Barbados alone. Big metropolitan cities have gone through similar situations but perhaps with less publicity. There are times when medications are out of stock or there are shortages, a visit to the FDA webpage will illustrate the same. There are times when doctors see less patients but when the issue is one of access based on the ability to pay, combined with issues of short staff and short medication, we are inclined to say that this is a tad more than a storm in a teacup. However, the situation can be managed.

We are confident that like any other island hospital or one in a metropolis facing financial issues, Barbados, renowned for its excellent patient care, will be back on its feet under the management of its current Board with non-adversarial discussion and participation with the BAMP, distributors and all coming together to do what is best for the patient.

We wish Barbados well.

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