The Chil­dren’s Hos­pi­tal and by ex­ten­sion, the Er­ic Williams Med­ical Sci­ences Com­plex (EWM­SC), was opened on Jan­u­ary 2, 1991 by the trans­fer of a 12-year-old with leukaemia from the open chil­dren’s wards at the Port-of-Spain Gen­er­al Hos­pi­tal (PoS­GH) to a high-risk iso­la­tion room. Oth­er pa­tients fol­lowed, a small A&E was de­vel­oped and a full com­ple­ment of clin­i­cal ser­vices de­vel­oped in con­junc­tion with ra­di­ol­o­gy, phar­ma­cy and pathol­o­gy de­part­ments.

Some ten years lat­er, the Mil­ton Mac­dougall De­part­ment of Pae­di­atrics, ie the five pae­di­atric wards at the PoS­GH, mi­nus the Neona­tal In­ten­sive Care Ser­vice, was scorn­ful­ly trans­ferred to the EWM­SC and has been there since, fight­ing up with what are op­ti­misti­cal­ly called ‘hos­pi­tal ad­min­is­tra­tors’.

Since my ar­ti­cle a month ago crit­i­cis­ing the han­dling of chil­dren with de­vel­op­men­tal prob­lems at the EWM­SC and the care of chil­dren in the health cen­tres, I have come to a bet­ter un­der­stand­ing of the ad­min­is­tra­tive prob­lems fac­ing doc­tors in the pub­lic health ser­vice.

The prob­lem, as I sus­pect­ed, is not with the doc­tors. They play a small part. The prob­lem is the ad­min­is­tra­tion.

Dur­ing the con­ver­sa­tions I had with var­i­ous pro­fes­sion­als, it was com­mon to hear state­ments like, “We try our best with lim­it­ed re­sources. Most of us are dis­heart­ened. We are lim­it­ed by ad­min­is­tra­tion but we make it work. There is a lack of un­der­stand­ing by our ad­min­is­tra­tors in terms of re­spect­ing what we do. We will keep try­ing, that is our pas­sion. There have been some im­prove­ments. We now have pae­di­atric neu­rol­o­gy, nephrol­o­gy and car­di­ol­o­gy but be­lieve it or not, each of the­ses spe­cial­ists had to crawl and beg to get a job and they have a skele­tal sup­port­ing staff.”

“Crawl and beg” hos­pi­tal ad­min­is­tra­tors to get a job to take care of the chil­dren of T&T?

The sit­u­a­tion re child de­vel­op­ment ser­vices was worse than I had imag­ined. There are on­ly two child de­vel­op­ment spe­cial­ists in EWM­SC and one in Cou­va. They have a wait­ing list of one to two years and no sup­port­ing staff, doc­tors or af­fil­i­at­ed pro­fes­sion­als like child psy­chol­o­gists, oc­cu­pa­tion­al ther­a­pists, au­di­ol­o­gists or phys­io­ther­a­pists.

As I have con­tin­u­ous­ly writ­ten in this col­umn for the last 25 years, there is no speech ther­a­py avail­able in the pub­lic ser­vice. Re­peat­ed re­quests have been made over the years at EWM­SC for a speech ther­a­pist. Last year, a ther­a­pist was of­fered an in­sult­ing re­mu­ner­a­tion of less than one-tenth of her stan­dard fee.

For months there were ru­mours of a re­cent­ly opened Child De­vel­op­ment Clin­ic in the Ari­ma Health fa­cil­i­ty but sur­pris­ing­ly, con­sul­tants at EWMJSC were un­able to make re­fer­rals. That had to be done by clerks with­out med­ical in­put, un­der “or­ders from ad­min­is­tra­tion”. Of­fi­cial con­fir­ma­tion of the Ari­ma ser­vice ar­rived last week. Will doc­tors be al­lowed to re­fer their pa­tients or will clerks de­cide that?

To com­pli­cate mat­ters, it turns out that there is an en­tire area at the EWM­SC des­ig­nat­ed for kids with de­vel­op­men­tal and be­hav­iour­al dis­or­ders that is not op­er­a­tional de­spite re­peat­ed meet­ings with the ad­min­is­tra­tion.

The sit­u­a­tion in the health cen­tres is equal­ly bizarre. Ef­forts have been made for years to get pae­di­a­tri­cians in­to the health cen­tres. Ad­min­is­tra­tion has been ag­gres­sive­ly op­pos­ing this sug­ges­tion. The idea was to have pae­di­a­tri­cians vis­it each health cen­tre every week. Chil­dren would re­ceive an an­nu­al med­ical re­view and there would be week­ly teach­ing ses­sions with the DMOs and nurs­es. Com­pli­cat­ed pa­tients would be re­ferred to the sub­spe­cial­ist at EWM­SC. Ad­min­is­tra­tors blocked the plan.

Health cen­tres al­so re­fused to see chil­dren with sta­ble seizure dis­or­ders or chil­dren with cere­bral pal­sy. The sug­ges­tion was to have health cen­tres pe­ri­od­i­cal­ly see chil­dren whose con­di­tions were sta­ble with overview and re­view at EWM­SC. This would free up need­ed space at EWM­SC. Ad­min­is­tra­tion again re­fused. Pa­tients have to trav­el to EWM­SC for a rou­tine clin­ic fol­low-up and for month­ly pre­scrip­tion re­fills. These are par­ents who have to take a day off from their jobs, of­ten rent a car to go to the hos­pi­tal be­cause taxis will not take a child with cere­bral pal­sy, who makes ‘fun­ny ‘ nois­es or wears a di­a­per or drools. It would be so much eas­i­er if they could be man­aged near­er to their homes in the neigh­bour­hood health cen­tre.

Per­haps the most poignant state­ment made was, “Some of us work ex­treme­ly hard for our pa­tients. Even to get a con­sul­tant post in the pub­lic sys­tem was a roller­coast­er, de­spite sac­ri­fic­ing our fam­i­ly and per­son­al lives to do bet­ter for our pa­tients, to train more, to learn more. But we love our job. We ad­vo­cate for our kids with what­ev­er we have. We try to find loop­holes in the sys­tem for them to ac­cess care.”

The next time you com­plain about the care your child re­ceives in the pub­lic health sys­tem, re­mem­ber the pae­di­a­tri­cians fight­ing up to “find loop­holes in the sys­tem”.