Goose and gander healthcare

It’s as if Minister Chandresh Sharma lives on another planet. “I want to impress upon the national community that T&T offers the best healthcare in the world, at the public institutions. Very few countries in the world, and I have been to some of the developed cities, what they obtain in our public hospitals is far extraordinary.” Only the “ruling class” seems to live on Minister Sharma’s planet, and as is the case, those in power get treated very differently from the “average Joe”” in the working class of T&T. So as he lives in the world of the ruling class, this type of healthcare is all Minister Sharma knows. If only all of us were so fortunate as to have a family member or friend in such positions of power we would all be getting the care that is “far extraordinary” to some developed cities! Providing that Minister Chandresh Sharma’s declared satisfaction with his experiences in the public hospitals is genuine, it seems that we are capable of providing quality care in T&T. Yet we do not, and the average Joe is left with experiences of neglect and stories of death, suffering and missed diagnoses. Since we have “the best healthcare in the world,” I wonder how Minister Sharma would explain Mr Manning’s departure to seek rehabilitative services in the United States at tax payer’s expense? 

 

According to Dr Petronella Manning-Alleyne, “...have not yet achieved Vision 20/20. We are not first world and even though we have the services here, there is no question that where he has gone, the services are far superior to what we can offer.” In a way Dr Manning-Alleyne is absolutely correct. In T&T there is no sub-acute inpatient/outpatient rehabilitation centre that can provide neurological patients such as those with brain injuries, spinal cord injuries, and strokes, among others, with comprehensive rehabilitation. Such treatment is multidisciplinary in nature, as conditions like strokes can affect the physical, cognitive and communicative aspects of function. A rehabilitation centre will usually therefore have a team, headed by a physician, typically a physiatrist (rehabilitation physician), and include physical therapists, occupational therapists, speech-language pathologists and psychologists along with social workers and case managers. The nature of neurological injuries is such that the rehabilitation process is very long and tedious and can take months to years. Patients in these centres undergo intensive therapy and must spend hours a day working with the different therapists. So Dr Manning-Alleyne is correct in saying that we do not have such superior services, but she needs to qualify that statement by adding “because we do not have the facilities.” We certainly have superior professionals who are able to treat Mr Manning just as well as any American; however there are no specialised public rehabilitation facilities in which they can work as a multidisciplinary team with specialist physicians, and co-treat as unified rehabilitation professionals, where the patient is the centre of the team.  Dr Manning’s statement is misleading because it gives one the impression that we are incapable of providing such care, but the fact of the matter is that we are very capable.

 

So if there are so many rehabilitation professionals in T&T, why is there no focused rehabilitation hospital? Think about it. The average stroke patient who has lost his speech and function on one side of his body needs physiotherapy to improve his gross motor skills, occupational therapy to work on his cognition and fine motor tasks and activities of daily living, and speech therapy to help him improve his communication and swallowing. Not to mention possible psychological counseling to help him deal with this life-altering event.

This team must have frequent meetings with the managing physician and with the patient and his family. The patient’s days revolve around therapy aimed at regaining/modifying his function so that he can limit disability. It is a tremendously time-intensive rehabilitation and therefore very expensive. What a pity that US$91,000 of tax-payers’ money is so easily spent on one person to cover just air ambulance expenses, rather than using it to develop a local facility where he, and the people of T&T, could receive the necessary treatment.

In a private facility, the average Joe would be unable to afford the astronomical costs that would be incurred for hours of therapy each day for months. Therefore such a facility would have to be government subsidised. However, most of the public and private professionals who can offer such “superior” treatment cannot stomach the inevitable corruption, the political nonsense and substandard maintenance and mismanagement that they would have to deal with in order to establish and run a public rehabilitation hospital.

Because of this, and what seems to be disappointing priorities in the poor distribution of funds, there is no such thing in T&T. And there will continue to be no such thing as long as we continue to slap ourselves in the face by giving preferential treatment to those in “power.” We put our officials in power and they are dependent on us. As long as we are suckered by “Visions,” big, tall, empty glass buildings, extravagant allowances for air ambulances and foreign health care, and instructions for preferential treatment of government officials in hospitals, then ministers will continue to live on their “ruling class” planets and we will continue to have substandard care.Those in power need to feel, not see or hear, what they are doing to the citizens in order to effect change. What is not good for the goose, is allowed to be good for the gander. We make we bed, so we go lie in it.