“Not Us!” by Dr Patrick Martin MD

Not Us!

Patrick Martin, MD

July 13, 2018

 A picture is worth a thousand words. The unprofessional and inhuman display of first responder “care” recently captured on video is not us! Criticism and correction are deserved. But, the baby must not be thrown out with the bathwater.

Medical errors occur in St. Kitts and Nevis but far less than in the USA. According to the US National Institutes of Health (NIH), medical errors there constitute “the third leading cause of death”. In St. Kitts and Nevis, the top 5 causes of death are Heart Disease, Stroke, Cancer, Diabetic Complications and Homicide – accounting for 4 out of 5 deaths.

Every crisis, emergency, risk or tragedy is an opportunity to improve. However, opportunity has to be discerned; improvement inspired, resourced and steered by a competent leadership and management. Therein lies the rub.

A Ministry of Health is an accountable organization legally mandated to safeguard the health of the population. When there is a crisis, a solitary officer cannot be made the mother of all scapegoats. One hand cannot clap. Singling out is inherently reactive, defensive, punitive, and unwelcoming of system-wide scrutiny.

The national health system has a proud record of achievement dating back to the 1950s. Measures of strength such as high life expectancy and low infant mortality are already on par with so-called developed countries. Our vaccination rate is a global best; so too is the elimination of mother-to-child transmission of HIV and syphilis.

Excellence must become universal. Areas past due for improvement include health communications, customer service, inventory management, physical plant appearance, pay for value versus volume, and objective performance assessment, among other service and working condition issues.

Weaknesses and medical errors are systemic much more than they are individual. System fixes are doable in short order.  Boasting of MRI, CT-Scan, and Oncology Clinic – essential, though they are – is secondary to the fact that gunshots send staff diving for cover.

The litany of existing shortcomings are not the primary doing of EMTs and other frontline staff.  They do not cause bullet holes to adorn glass windows and a blood trail leading to the emergency rooms. Ordinary staff did not sneak people across the border and into the hospital for an unethical experiment. The fact that hospitals are half-empty yet short-staffed with nurses is not the fault of the EMS. The EMS is not responsible for government collecting a mere 10% of the EC$ 34 million in fees paid in the government hospitals.

A fundamental point is this: Leadership and senior management have been weakened by a calculated campaign hashtag “#competentofficercleansing”.

There is good talent in this small country who can become functionaries prepared to speak truth to power and inspire performance in the rank and file. The “management of the Ministry of Health” knows there are good people in its employ. Some paid their own way to upgrade their skills – no thanks, no reimbursement. Some work their shift without a break while their colleagues enjoy unwarranted sick leave. Some are bypassed for training and promotion then suffer under the burden of inept favorites.

The video left us stunned, speechless and hurt – spare a thought for the family and friends. The inescapable and urgent health leadership task is to get on with the business of restoring citizen and visitor confidence as well as worker morale. Such can start in 24 hours because the issues and corrective measures are well-known.

Healthcare is about people serving people. If only there is the political will and testicular fortitude; care-recipients and care-providers would be treated with dignity and respect, first and foremost.

Indignity is an under-resourced health system. Disrespect includes the addiction to hurling insults, throwing surgical implements and seeking to apply disciplinary action without due process. These symptoms of shambolic leadership stem from an overlord and elitist mindset.

The Federation is blessed with competent healthcare workers. Their only motivation is to delivery high quality care to Jah people. They are inherently and demonstrable good because the Federation is a healthy place to live and invest. Substandard performance is not us!

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