The balance of responsibility for better health care delivery: media, ministry and citizens

Wayne D. Murray MD Fri, Nov 30, 2012

More open dialogue is required and expected on the medical services that we all depend on. The Ministry of Health being the more significant part of the machinery for delivery of health care, would naturally receive the greater percentage of critique. It is not an easy task when any one entity has such a great responsibility with obvious limitations of resources. The days of “we deliver and you receive” are far gone or should be.{{more}}

There seems to be too little interest or debate on our health care system and its ability to service our needs. St. Vincent and the Grenadines is a country with more than its fair share of respected professionals in the field of medicine both locally and internationally, and therefore one must question why there is a rather hushed state that exists on this matter, seeing that a vast resource of expertise exists. It is one thing for a random person in the population to question quality of health care, but it is more of a stamp of authority when an expert in the field raises the issue. Medical professionals in the state are failing the population by not contributing to the feeling of many about our state facilities. We cannot depend on farmers and store clerks to raise issues in an area where they are not likely to put forth a strong argument due to unfamiliarity with the practices in medicine. We cannot also be waiting on entities like the European Union and USAID to make provisions in their budget for us to then realize that we have needs in these areas, but rather we who experience the shortcomings must be the driving force.

Neighbouring countries like Barbados, Jamaica and Trinidad who have far superior medical facilities than ours have continuous debate of deficiencies in their medical system or similar issues. The media also plays a very important role in keeping the health ministries on their toes with investigative articles that show the weaknesses in the ministry’s armour in handling health issues. In order to not be caught “slacking”, the ministries are forced to be pro-active in giving information on its mode of action with reference to any challenges at hand. When an important piece of machinery is not operational for some time in hospital facilities in Jamaica, the Observer newspaper has that information informing the population. In our own situation, you can have someone travel from extremes of the island to our main medical facility to be told that a certain piece of equipment has not been functional for many days.

There are also too many persons not accepting that we have significant progress to make in our medical delivery services. It is poor judgment to say that our medical facilities are adequate or above par. We are not and that is why so many persons leave the state for medical care. It is one thing to travel for highly specialized care, but another to travel because non-functioning facilities et cetera. We are not talking about economically advanced persons who just don’t want to be looking in to the eyes of their urologist or gynaecologist every time they head to town due the small population, but rather people who are told by the local experts that they have to travel for better care.

A case in particular is the Dengue Fever outbreak that all these islands have been experiencing for the past months. Naturally, we are having our own share of Dengue Fever, but one would believe that we are not, because everyone seems to be silent except the persons who make their individual grumble when they or their family member is diagnosed or even worse referred to the hospital for management. That is when you hear their perception of the hospital. When they are healthy and well and it is not their own family requiring the medical services they have no concern. Having good local medical facilities is equal importance to having good health insurance. Most recently we hear of reports from the Dominica Ministry of Health about Dengue confirmed cases (100) and then Leptospirosis and hence warning the population about the presence of the diseases. Barbados released figures of approximately 300 confirmed cases of Dengue Fever. We must question our own statistics on Dengue Fever and the readiness of the population in terms of reporting and seeking medical assessment. It is the duty of the Ministry of Health to inform the population of our state of readiness and not wait until a few deaths to scramble to pick-up the pieces.

There are two situations that must never be ignored and that is the parallels of people recognizing their needs and others recognizing the needs of people. You cannot wait for people to recognize what your needs are, but rather you have to know what you need and make it a priority. Health care is a priority and must be a regular feature in our media to ensure that policy makers make it a priority. With the same pen that journalists write articles about new clinics being commissioned or new personnel and equipment they should also write about inadequate services or facilities. It must not be a situation whereby because someone raises the point of a deficiency that they are ungrateful or being hard on the Ministry, but rather it ensures that the knowledge of that need in documented and noted. It is akin to a balance sheet where expenditure and income is set side by side for easy analysis.

The situation that exists presently in our population is that of a person who only thinks about food when they are hungry. A good health care service and facility is one that is already in action before each individual and immediate need. It is when one is well that the interest in health care facilities must me a priority as opposed to when one is dying. The same way that you cannot be thinking about buying life insurance the day you think you would die is the same way that you cannot be questioning the available medical facilities when you terminally ill.

The truth is that the more secrets the Ministry keeps about its ability to deliver its service will be the more negative criticism it receives from persons expecting more of it. What I would advise the Ministry of Health to do is to be more pro-active in giving information to the public. If the latter is done, it can help nullify a lot of “tongue lashing” it gets that stems from misinformation and over expectations. The classical example of the latter is a lady being diagnosed with Cancer of the Cervix and blaming the Ministry of Health for not having a local Oncologist when indeed that lady refused to do annual pap-smears provided by her local public clinic. The latter is true for multiple medical situations that arises from persons not using ‘free’ excellent services provided by the public healthcare system.

We have a long way to go in realizing a healthcare delivery system that serves us adequately. To believe that we don’t have a problem is equally part of the problem. To believe that we require someone else to see our problem and solve it for us is really wishful thinking. I don’t blame the healthcare delivery system or the government totally, but rather much blame must be placed on the silence of people who require the service. If something is not broken, then it requires no fixing. It is only when the population demands significant improvement in the system would there would be definitive action to provide it.

The healthcare situation is akin a perfectly shaped sword that is not sharpened. For effective healthcare delivery both the Ministry of Health and the population must be in more dialogue. The available media is a good means of both knowing where failure, needs and progress are being realized.