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Ear nose and throat specialist Dr Irving Pascal
Ear nose and throat specialist Dr Irving Pascal

The World Health Organization defines quality of care as "the extent to which health care services provided to individuals and patient populations improve desired health outcomes. In order to achieve this, health care must be safe, effective, timely, equitable, and people centered." I still remember learning from in first year medical school lectures that "quality health care is that which is affordable, available, accessible, acceptable and accountable." Regardless of the definition quality health care only emanates from knowledgeable, compassionate, patient, kind, technically adept, trustworthy, experienced and morally sound health professionals who are great communicators, speak your language and understand your culture. Quality health care will never be the preserve of sitting politicians and hence the reason why political interference in the clinical care of patients is clear evidence that these politicians have priorities other than quality health care.

It is clear to me, that the callous denial to ordinary Dominicans of access to surgical services provide by Dr. Hazel Shillingford and myself within our respective specialties at PMH is the most recent example that quality health care cannot be a priority for this DLP administration. This is particularly immoral when substituted foreign specialists without the necessary language, cultural and clinical competencies are thrust without accountability unto the innocent unsuspecting public.

A close look at most of the health care policies of this DLP administration reveals a dismal failure to relieve the human suffering associated with the challenges of Health Care Financing, managing the complications of chronic non-communicable diseases (CNCD's) and the inability to rehabilitate Dominica's Primary Health Care system. This Labour Party administration's policies seem to benefit sitting politicians more than the suffering patient. Foremost among these policies is the failure to appoint health care professionals who are experienced, knowledgeable, trustworthy and competent to senior management positions in the Ministry of Health. The result of course is a bias towards the political imperative as opposed to improving clinical care and patient outcomes. This dictatorial and shortsighted approach to health care management was aptly exemplified in the way the decision to build a new national hospital was railroaded down the throats of these same managers. These managers had spent countless hours producing a ten year strategic plan that never even mentioned the building of the new national hospital far less its current premature form and non- resilient location.

A properly constituted Health Care Financing mechanism is the key to safe, timely, effective, efficient and equitable care. National Health Insurance promised 19 years ago hasn't seen the light of day. In the meantime financially strapped patients struggle to meet their health care needs. (Quality health care is not FREE!). Particularly inconsiderate and unethical are the demoralizing processes to which patients are subjected to finance urgent and elective medical care overseas. Too often these patients have to resort to radio telethons or a humiliatingly climb up the Financial Centre stairs on a Wednesday. On the other days of the week they are belittled walking around Roseau or a parliamentary representative's office with a begging bowl to finance their health care needs. Yes they do! Do we really care?

These suffering patients under this labor party regime are also denied the avenues to hold doctors (clinical and administrative) accountable for their failure to be kind, compassionate, technically adept, trustworthy and knowledgeable. Why? A revised medical act that would provide some succor and replace the old colonial medical act of the 18th century is sitting in draft form in the Attorney General's chambers for more than ten years. Furthermore a recommendation to improve the delivery of services at PMH thru the implementation of a Hospital Management Board continues to be shelved after more than fifteen years. This is despite the repeated requests of healthcare professionals who are all aware that the present management structure is the greatest threat to Quality Assurance and patient well being at PMH. Does this reflect an administration concerned with quality health care?

I was always taught that prevention is better than cure and preventative health care is unavoidably people centered. Preventative medicine is also the cornerstone of our once renowned Primary Healthcare System. There is not one policy under this administration of which I am aware that has lessened the despair and disarray in the Primary Care system. On the contrary the epic failure to provide adequate health services in the Marigot and Portsmouth health districts coupled with the colossal failure to maximize the expertise at Ross University in this regard reflects gross negligence and incompetence. It surely doesn't reflect any priority to provide quality health care services to our people.

All competent and experienced health care practitioners know that competent, experienced, well trained, culturally sensitive and fluent nurses are the 'back bone' of any quality health care system. This DLP regime's failure to ensure the necessary training to ensure competence and career mobility as well their lack of compassion and sensitivity to the plight of nurses will ensure the burial of quality health care in this country. Juxtapose this to the impending importation of thirty Cuban nurses to assist with a health system on life support when ten years ago this DLP administration boasted of training so many nurses that it could export. Guess what the lecturers then were Cuban.

My final example of the blatant lack of prioritizing Quality Health Care is reflected in what may be considered the poaching of health care professionals in a human resource strapped system just to satisfy narrow selfish partisan political aspirations. Neither the national investment in their training nor the simultaneous destruction of their professional medical careers seem to be considered. The most recent casualties of this cannibalistic political pursuit which ultimately undermines access to Quality Health Care are Dr. Kenneth Darroux, Dr. Martin Christmas and Nurse Justina Charles(from primary health care),Dr. Irving McIntyre(general practitioner from private practice),and Dr Adis King (recently trained physician specialist from PMH). In addition there is the simultaneous exclusion of the experience and expertise of Dr. Hazel Shillingford and myself from providing quality specialist services to patients at PMH. This is at best shortsighted but more realistically qualifies as administrative medico-legal negligence.

When I addressed similar issues on Quality Health Care in 2014, I requested that the senior health administrators who couldn't or wouldn't stop the deterioration in health services resign or be held accountable. On this occasion I advise our patient populations to question this administration who instead of ensuring Quality Health Care infect us with another unnamed 'malignant' disease that can only be treated by "X-Cision."

May the spirits of my ancestors be pleased.

Dr Irving "Eipigh" Pascal.


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