Visualising improvements in ophthalmology

It’s astonishing that someone seeking public-sector cataract surgery at the ophthalmology department at the Eric Williams Medical Sciences Complex (EWMSC) last week would have been given an appointment in 2016. It’s intolerable that more than 5,000 people have been waiting for three years for an operation that’s mainly performed on the elderly.

Declaring himself “upset and disappointed” by the collapse in service at the EWMSC’s ophthalmology department, Minister of Health Fuad Khan announced that he was considering shutting down the service at the facility and moving the patients to San Fernando and Sangre Grande, declaring the service at these alternate ophthalmology departments to be a comparison of “chalk and cheese.”

Minister Khan described the doctors working in the EWMSC department as “inefficient,” and hinted that he was aware of the reasons for the deficiencies, but declined to share his suspicions with the media. Whatever his reasons for skirting the matter, Dr Khan who has had difficulty setting aside his commitment to his profession to fully address his responsibilities in Cabinet, must prove himself willing to set aside the protocols of the medical club, to more visibly embrace his obligations to the taxpaying public.

An intricate scheme revealed to the Guardian alleges that patients of the ophthalmology department at Mt Hope, unwilling to wait for a mid-decade appointment would be offered names of doctors in private practice who are able to schedule the surgery much sooner. These doctors were said to be already practicing at Mt Hope.

Patients unable to pay for the costly private operation would be supplied with letters emphasising the urgent need for the surgery, moving the case out of the Mt Hope facility to the private-sector doctor, with all costs underwritten by the State. It’s compelling that these issues were raised at an event announcing a memorandum of understanding to bring ophthalmology training provided by the University of Utah to the San Fernando General Hospital.

The institutional partnership will improve training in the speciality and transfer knowledge on corneal transplantation, small-incision cataract surgery, macular retina and paediatric ophthalmology. As a first step in dealing with the humiliating backlog of cases, the minister announced that anyone with a case scheduled for anytime beyond June 2012 should visit the Ministry of Health, either on the Web or in person, to be referred to an officially-sanctioned third-party supplier of surgical services. These ministry partners would be constrained to provide the surgery at a cost of no more than $6,500.

The ministry will also be moving to address what was described as “supply-chain problem,” which has reduced the stock of lens. used in the surgery. The Health Minister is correct to focus on systematic changes that address the backlog of thousands of cataract cases awaiting public-sector surgeries.

These are elderly patients for whom years of impaired vision will bring significant challenges. Helping them to see again would represent a meaningful enhancement in their quality of life and capacity to take care of themselves. The underlying issues that created the problem in the first place should also be dealt with some dispatch.

In addition to dealing with any deliberate abuse of the public health system that may apply in this particular situation, Minister Khan must demonstrate a willingness to make poor performance unwelcome in local hospitals during his watch.
Dr Shehenaz Mohammed, president of the Medical Professional Association, suggested that long delayed audits of clinical performance would go some distance toward separating quality doctors from underperformers lurking within the public health sector.

Performance measurement is part of all private-sector management processes. Applying such evaluations would serve to bring welcome improvements in a profession in which the quality of care can make the difference between life and death.