Healthcare System in Dominica: A Chaotic Mess
If anyone doubted that the healthcare system in Dominica is a structural mess, they need look no further than the recent situation involving Dr. Sam Christian's accident on island and his eventual evacuation to Martinique. While many of the Healthcare Providers do their utmost to practice and function in a very challenging environment, it was quite apparent that there were no protocols or guidelines on evacuation of critically persons to higher level of care outside of Dominica. In the most recent event, it was obvious that the hierarchical structure is in disarray mainly because the Ministry of Health itself is not doing its work. The blame should squarely lie with the Minister of Health and Cabinet. This aspect of Health Management should be a government-to-government function, with assistance from Health Care Providers. Why is it that the main player was the Manager of DBS, the nation station, whose function is unrelated to Health care services or Health Care delivery? Many stated that Mr. Joseph got involved due to his 'connections' in Martinique. What! Was this a news item? How did this person become the central coordinator of such a health matter? The Minister of Health should be relieved of his position for failure to ensure proper functioning of emergency services. Additionally, the Chief Medical Officer and Permanent Secretary in the Ministry of Health should tender their resignation or be removed in favor of more experienced and knowledgeable individuals.
A country has to be able to take care of its health emergencies either at home or abroad. If it cannot do that then they should close up shop and go home. A government has to provide emergency care for citizens. There must be protocols in place for evacuation that would look at cost, receiving hospitals and air transportation. Procedures should be established and standardized so that there are no preferences; care should be based on the disease or trauma and not the particular individual. The Dominican people should not find themselves in a situation where they have to heap praises on an Administration for doing what is expected. Why haven't the governing administration seen it fit to train or attract more doctors with expertise in certain procedures to reduce evacuation rates?
A well organized and functional healthcare system would know its capabilities. The type of case that are required to be evacuated and, to which hospital would be determined a priori, because all that would have been previously set up. For example, based on existing capacity, it would have been known that they could not handle a Level 1 Trauma such as the pelvic fracture sustained by Dr. Sam Christian. If there were established protocols and adequately budgeted resources in place, Dr. Sam would have been transferred that same evening to a Hospital that already was targeted through prior agreements. A hospital administrator would initiate the process, then Doctor A in Dominica would communicate with Doctor B in the receiving hospital; Doctor B would advise on trauma or critical care needs prior to transfer. There is no place for political operatives in managing critically ill persons; just follow your guidelines. Likewise, there would have been agreements established with air ambulance companies to minimize cost and 'red tape'.
It is painfully apparent that healthcare is not a priority for the current administration in Dominica; never mind all of their boast. This Labor Administration has been in power for the past 19 years and have not been able to make healthcare more accessible. They have made a mess of Dominica's Primary Healthcare System, previously the envy of many developing states. Some previously established, well-functioning clinics are a shell of their past. In other cases, they have built clinics that are understaffed and ill-equipped to relieve the burden of the Secondary Health Care system. The current Administration had such a lack of foresight that they allowed Ross University to leave Dominica due to lack people with strong management skills in the system. The loss of Ross University has left such a hole in the economy that the full impact has not yet been fully felt. Why is it that the Administration did not see it fit to assist this University in building its own hospital or develop the Portsmouth Hospital into a highly functioning Unit that could serve the Northern half of Dominica.
Even the most basic seems insurmountable. Why is it that ambulances in Dominica are so sparsely equipped. Are they equipped with AEDs? An 'Ambulance' is a specially equipped vehicle; it could be an airplane or ship, designed to carry injured persons to a hospital in order to receive life-preserving care It is disappointing to learn that the Ambulances in Dominica have nothing more than a stretcher. It is time to have paramedics / emergency medical technicians (EMT) who can manage persons in transition from the field to healthcare center. Paramedics would be able start iv, use defibrillators and administer basic agents (eg critical medications like those for asthmatics) that are life saving in many instances. Why does this Administration resist engaging Dominican healthcare professionals at home and abroad who could advise on the proper healthcare management? Is this an ego thing?
It is true that in-hospital care is expensive, especially when healthcare professionals have not received the training to handle some of the cases they encounter and, if patients have to be evacuated. Those instances should become few and far between if the System is consistently evaluated for improvement. One of the ways to ease such burden is to improve Primary Healthcare. It is obvious that the current governing Administration in Dominica does not understand the importance of boosting the island's Primary Care to relieve the pressure on its secondary care. The World Bank estimates that 90% off all health care could be met at the Primary Level. This is the first point of contact with the patient where there is opportunity for education and prevention to reduce need for more complex care. If the hope is to eventually offer Universal Health Care in Dominica this cannot be done without making Primary Healthcare a priority and the cornerstone of an excellent island-wide Health System.
What exactly is the healthcare strategy of the current Administration in Dominica? Build a National Hospital? They have been beating that drum since 2004 and have lost valuable time in which the Primary Health Care System could have been strengthened. They have been pre-occupied with monuments like the State Palace / Malice and building show pieces (Stadium, unnecessary bridge in Roseau) that are monuments to re-election rather than serving the population. Dominica's Healthcare system can be improved. It starts with a commitment to comprehensive Primary Care that will eventually free-up resources to develop and modernize Secondary and Tertiary Care in strategic areas like Grand Bay, Castle Bruce, Marigot and Portsmouth.