Dr. Irving Pascal
Dr. Irving Pascal

I was initially disappointed when I missed the 11am appointment to a hearing with the newly formed National Health Commission. I had welcomed this long overdue Commission needed to address the health status of the nation. I felt vindicated for the ire I had evoked in Parliament four years ago when I had dared to request an inquiry into the management and leadership of the health system in Dominica. However, a closer read of the invitation letter evoked some reflections that lead me to predict that this Commission will achieve little but will surely give credence the old cliché "that doing the same thing and expecting a different result is insanity".

My skepticism starts with this paragraph from the letter dated May 12th 2018 inviting me to a hearing with the Commission: I quote "The proposed Commission will function as a policy advisory body which will assess the status of the provision of health services, health care, health facilities and resources in the Commonwealth of Dominica and submit recommendations for improvement having regard to the declared priorities for the health sector as stated by the Government of the Commonwealth of Dominica, for a more climate resilient health sector."

First, given the widespread knowledge of the appalling state of affairs in the nation's health sector there is enough factual information available to task any Commission to begin its work by ensuring the implementation of existing recommendations.
This Commission from the outset, however, will have no authority to ensure implementation of any recommendation, old or new. This could have been easily rectified by ensuring that the two individuals holding positions in the Ministry of Health with the legal and administrative responsibilities (Permanent Secretary and Chief Medical officer) to advise the Minister and the Cabinet and implement recommendations are on the Commission. Neither of them is but, interestingly, several members of the Commission have occupied one of these positions in prior incarnations. I don't consider this an oversight by the Government who I would think is the convener of the Commission; neither do I believe that the "reincarnated" members of the Commission with more than 100 years of administrative experience between them are oblivious to this apparent folly. My skepticism is giving way to morbid pessimism. What is really going to change?

Secondly, the Commission did not respond to my request for a list of the declared priorities of the government for a climate resilient health sector as stated in its function. This, to me, speaks volumes as to the seriousness with which this important endeavor is being undertaken. I had indicated that this information would enhance my preparation and contribution at the scheduled hearing.

Thirdly, as far as I am aware several present and former senior health care practitioners have not received invitations to a hearing with the Commission. The feedback that I have also suggests that hearings have served primarily as a complaints board for some who attended. Furthermore, there is no open day for either concerned "non-invited" health care workers or the wider public to ensure wide stakeholder participation.

I am not optimistic when such a Commission whose mandate is to increase "climate resiliency" in our health system would be at this stage preoccupied with collecting known complaints of deficiencies in the Health System. There is a WHO document "Operational Framework for Building Climate Resilient Health Systems. Switzerland: World Health Organization 2015" that speaks eloquently as to what we should be doing with regards to improving the resilience in our health care system. The longer we take to act within the guidelines of this framework the less "resilience" there is in the health care system.

I think it is therefore understandable if I consider the Commission's real mandate to be another futile cynical attempt to diffuse the growing disenchantment and disaffection in the health sector by affording health care workers an opportunity to naively vent to those with no real authority to improve their situation or the health status of the country.

Like the Commission I have no authority to ensure implementation of any recommendation I have made. A Marshall Plan for better health care provision in the country is needed. However, in pursuing this it would serve us well to be guided by the fact that it is the patients who ultimately suffer when the final word on "the practice of medicine" does not originate from your best and most knowledgeable medical practitioners. Worst yet should "the practice of medicine" be subject to the toxic influence of those who really don't have a clue as to "the purpose and function of medicine."

May the Spirit of my Ancestors be Pleased.

Dr Irving "Eipigh"Pascal MBBS, FRCS.