The first time I saw Trinidadian doctors at work, I thought to myself, “How arrogant!” It was at the Port-of- Spain General Hospital (PoSGH). I was being taken around by a friend of my family, who worked in the laundry. She was an old woman, almost ready to retire and, I suppose, not very important to the two doctors she pointed out to me, because they slowly continued walking past, ignoring her attempt at introducing me.
I probably did not look very impressive. I did not wear the uniform of a local doctor: white short-sleeved shirtjacks, dark blue pants, with shiny laced-up shoes and a stethoscope around the neck. I was not in a suit, which would have identified me as a “Very Important Person.” I was in corduroy jeans, short-sleeved shirt and loafers, which was what we wore to work in the hospital where I was completing my residency. It was also half past one in the afternoon, and lunch must have been foremost in their minds. Yet, the hospital seemed uncannily quiet to me, accustomed as I was to hectic 24-hour workdays and the constant activity of a well-run hospital. Why were these people going home at 1 pm?
Some years later, when I joined the PoSGH, I came across this same attitude in some of the medical staff. I had suggested that we invite some artists to paint pictures on the walls of the children’s wards and to donate a few books for the children to read and had been told by a senior consultant, “Why? They don’t have that at home?” Although a few of the paediatricians disagreed, it was an attitude prevalent at the time.
To me, coming as I did from a foreign work ethic, both as a medical student in Venezuela, and then as a medical graduate in Baltimore, where the Professor of Paediatrics was on first-name terms with the lady who cleaned up after him on the ward and the nurses were professionals whose advice was not only asked, but heeded by the doctors, this arrogance seemed to stem from an obsession that most Trinidadian doctors had. They were trying to behave the way they imagined English doctors would behave.
It seemed to me that Trinidadian doctors were trying to form their own identity but were being influenced by foreigners. This was very clear in the older generation of doctors, to whom anything English was sacrosanct. Instead of dealing with our people, our patients, in our own unique way, we were imitating the bad habits of the old-time English colonial doctor or nurse and creating class barriers, where there should have been none.
Over the years, however, whether under the influence of a rising nationalism or the disappearance of the older doctors, the attitude, at least in the Paediatrics Department at the PoSGH, mellowed. In its place arose a genuine feeling that we were there for the good of our children and that whilst practising good paediatrics, we had to do things our way.
I bring this up in view of last Saturday’s column in the Guardian by Dr Joel Teelucksingh, titled The Cancer of Neglect, where he relates the story of an elderly woman with breast cancer who died and the difficulties she had obtaining healthcare: from a biopsy that took months to confirm cancer, to the unreliability of medications, to a consultation with a senior doctor who simply never turned up but was available in his private office.
Dr Teelucksingh says, “The label, “Free Healthcare” tells us little unless we ask what patients must buy to complete their care.”
This once again suggests that there still is, in health, an elitist attitude that the mass of the population should make do with levels of care which are not good enough for the important and the well-to-do. I, too, once again sense this. Not since my first days at the PoSGH in the mid-seventies have I seen such arrogance among doctors at the top levels of the Ministry of Health, now implemented by doctors and administrators at the regional health authorities. It’s as if we are heading back to colonial times, where there were two standards of healthcare: the private nursing homes for the elite and the public hospitals for the ordinary folk, where you take what they give you because you have to and “if you don’t like it, leave!”
