By Terry Noel
According to American historian and philosopher Will Durant, “the health of nations is more important than the wealth of nations”. Unfortunately though, in rural Grenada this is not the case since patients should expect some difficulty and long waiting periods in receiving medical attention at the (Mirabeau) Princess Alice Hospital, while government, and in particular the Ministry of Health, pays little or no attention to improving and enhancing the management structure under which the hospital currently operates.
In fact, while special attention is given to the General Hospital in St George’s, the Princess Alice Hospital, which is responsible for providing healthcare services to the people from the rural areas, is left to operate as a big clinic or an old hospital museum. As a result, doctors and nurses work under severe stress and pressure in an already pressurized environment in order to meet the needs of the frequent patients who are seeking medical care and attention. Moreover, the Princess Alice Hospital has outstretched its capacity to perform the duty and function it was designed to do, since it is seriously understaffed and outmoded. In fact, almost every department at the PAH is outdated. Worse yet, the PAH provides its services to a wide cross-section of the population, since it is the only other hospital available on the mainland, apart from the General Hospital in St George’s. For example, it provides its services to at least four parishes: St Andrew, St Patrick, St David, and to some extent St John, since the people from the Clozier community in St John usually take their patients there because it is easier and faster to travel through the Belvedere or Windsor Forest Road in order to get medical attention; especially when it is an emergency situation.
In fact, the disparity is so severe, that a single ward in the General Hospital is better equipped, structured and managed than the entire PAH. Interestingly, while a single ward at the General Hospital generally has its own registrar or registrars, three consultants/specialists, three house officers (junior doctors) and three interns (doctors in training) which basically consist of a total of approximately nine doctors to look after the patients interests, in comparison, the entire PAH has no interns and consultant, which can be dangerous to any patient’s wellbeing, since the duty of the house officer is to review the prognosis of the patient, while the consultant’s duty is to overlook and review all the work done by all the doctors and make changes where necessary, to prevent confusion or mistakes from happening. This is vital and important, because where different doctors attend to the same patient on different shifts, there can be confusion at times. Unfortunately, the entire PAH is equipped with a mere six house officers. In fact, only recently, the hospital was faced with a dilemma where one of the house officers went on vacation leave, while at the same time, the two Cuban doctors (house officers) were removed and sent to work at Carriacou, leaving only three doctors at the facility to attend to patients. One could only imagine the stress and pressure these three doctors had to endure, since they would have been heavily overworked; not to mention the psychological and physical strain on these doctors to perform their duties. Subsequently, the situation contributed to two of the three house officers (doctors) acquiring sick leave, leaving only a single doctor to do the bulk of the work. As a result, doctors at the PAH have little or no choice other than to transport a vast majority of patients to the General Hospital. So in reality, the PAH has become nothing more than a transhipment point, since the PAH isn’t equipped to handle some of the most basic things. Even the transporting of patients to the General Hospital itself has its challenges, since only one ambulance was available to the PAH. However, after numerous complaints, another ambulance and a van were given to the PAH.
Moreover, according to some medical practitioners, there is no consensus or protocol as to how to manage a patient in Grenada. For example, there is no protocol as to how to manage a diabetic patient. Therefore, a diabetic patient at the General Hospital can be managed differently to a diabetic patient at the PAH. So imagine new doctors coming into the system, having no guideline or protocol to follow. This can only lead to problems and confusion. This in itself is a dangerous practice, since in recent times, Cuban doctors were brought here to assist in the hospitals, and were left unsupervised with no protocol to adhere to. Worse yet, the Cuban doctors knew very little or no English, and no translator was provided to them to assist in communication. They had to rely on computers for translation.
Moreover, there is also a shortage of human resources in regard to the auxiliary staff at the PAH, while at the same time, nurses are being exported to Trinidad and Tobago, and others who have finished their nursing degrees and programs have left home without being hired, simply because of the government’s implementation of a stringent Structural Adjustment Programme that endorses a hiring freeze among civil servants. Where the health of any country should be paramount and should be prioritized, such a programme should never be included or interfere with the health system. For instance, at the PAH, the casualty department consists of just only one nurse on a normal shift. Interestingly, casualty is normally the busiest department of any hospital, so one could only imagine how stressful the job can be on a normal basis. The nurse assigned to the casualty department now has to perform different tasks at the same time. Firstly, this single nurse would have to triage the patient while the doctor is waiting on the nurse and the patient. Secondly, she would have to attend to the door to the emergency room where patients are constantly checking in for treatment. Thirdly, she has to do stale dressings since there is a prescribed day in the week for that type of dressings. That should be handled at the district level, but management insists that it should remain at the PAH. Therefore, the patient in triage and the patients waiting for attendance now have to wait longer for medical attention while this is done. Fourthly, she has to carry out the doctor’s order, such as medications, etc. This is the nation’s health which should be the top priority of the state, since we are asking tourists and investors to invest and visit our shores.
Furthermore, the PAH. has no nurse’s hostel where nurses can reside depending on their work schedule. Since the destruction of the nurse’s hostel by Hurricane Ivan in 2004, it was never rebuilt or refurbished. Similarly, the doctor’s main residence on the facility was never rebuilt and is still in ruins after the passage of Hurricane Ivan.
Additionally, after the matron position there isn’t anyone assigned to supervise the nurses, so there is a gap between the matron and the nurses, and although there are nurses at the facility who are qualified to fit the position, such portfolio was never given to those qualified for the job, so nurses are usually unsupervised. Furthermore, the PAH still operates with a non-functional X-Ray department, so in essence, all X-Rays have to be done at the General Hospital. Also, there are no basic labs available where basic rudimentary tests can be done to diagnose patients. Therefore, patients have to wait long periods for results from the General Hospital which can be done by a simple test; in some instances timing is key to diagnose in order to treat the patient. Besides, the hospital isn’t equipped with the information technology which will allow the PAH to access test results through some form of computerized system from the General Hospital.
Moreover, the therapy department is non-functional and there is no physiotherapist employed to rehabilitate patients at the PAH. Where patients have to undergo some form of physiotherapy for recovery, they now have to travel to the General Hospital, or left on their own at home with no professional guidance, when there are qualified trained physiotherapists available in the country that the government refuses to employ. For example, depending on the type of injury one sustains, some form of physical therapy must be prescribed or administered, for proper recovery and healing. Similarly, in the case of a stroke or heart attack which the vast majority of our senior citizens suffer, such system is most needed. Likewise, there is no dietician at the PAH. Again, depending on the diagnosis, the dietician is key to prescribing the types of food necessary for healing, which is totally out of the doctor’s domain. However, although some of these facilities had once existed at the PAH, these have been non-functional for many years with apparently no effort by government to remedy the problem. While these facilities and professionals are available at the General Hospital, unfortunately it is not the same at the PAH. So instead of progressing, we have regressed over the years. Sadly, this is all the healthcare that the government of Grenada could offer to the people of St Andrew, St Patrick, and St David.
Unfortunately though, it is important to note that there is a serious disconnect between country and town in Grenada. In fact, we still operate in a backward medieval state where city takes precedence over country. So in essence, there is the “town and country” mentality which our sociologists fail to adequately address. They instead hasten to address other issues such as politics. In fact, one of the main reasons for the controller’s neglect of the PAH is because of its location being in the rural St Andrew area. Strangely though, the St Andrew people have not yet realized the seriousness with this disconnect between city and rural, and overwhelmingly voted for a political party that further compounded the divisive problem. So in essence, they are voting against their own self-interest, since the NNP developmental focus is heavily based on centralization rather than decentralization. Interestingly, the Member of Parliament for the area whose interest should be addressing and correcting these pertinent issues appears to be silent on the matter. Therefore, MPs appear to be in the position just for the sake of enjoying the position, and not because they are genuinely passionate and intent on making genuine change that will benefit the people they so represent.
However, it is important to note, that for both Mr Dominic Paul, the owner and founder of SpiceIsle Imaging Center, and Mr Hildebrand James, former director of the Government Information Service (GIS), the very first contact for medical help after drowning was at the PAH. According to observers on the scene, Mr James was resuscitated at the beach and was conscious on his way to the hospital. A single nurse having to do different things at once at the causality department would not have done him any justice. Having more nurses at the causality department might have made all the difference in saving Mr James’ life. Both men have contributed immensely to the development of this country. Therefore, it is important that the parliamentary representatives in the area and government address these pertinent issues, so as to give the people of the rural communities of Grenada, Carriacou and Petite Martinique, the respect and benefit they deserve. Does it have to take the Prime Minister or some senior member of parliament to fall ill while attending a function in the area and have to be rushed to the PAH for medical attention, for government to seriously address these important issues?
The question is, what is it that the PAH is actually offering the rural population as a so-called hospital in terms of healthcare, and why is there such a great disparity between what is available or provided for the people of St Andrew, St Patrick and St David?
There is so much to be done!
Terry Noel has a BA in History with Political Science from the University of the West Indies, Cave Hill Campus, Barbados, and he is a former vice-president of the Historical Society UWI, Cave Hill, Barbados