The rev­e­la­tion that hav­ing spent $70 mil­lion on a Car­diac Catheter­i­za­tion Lab­o­ra­to­ry for the To­ba­go Gen­er­al Hos­pi­tal, the lab re­mains shut to na­tion­als, is an­oth­er ex­am­ple of the fun­da­men­tal chal­lenge fac­ing the coun­try, that of a lack of plan­ning, ex­e­cu­tion and ac­count­abil­i­ty.

Not on­ly has the mon­ey been spend on plant and equip­ment but the lack of ac­cess for the peo­ple of To­ba­go means sim­ply, if you get a heart at­tack you are more like­ly to die than if this lab was func­tion­al.

Do not take it from me, but rather from car­di­ol­o­gist Dr Ronald Hen­ry, who in an in­ter­view with my col­league Ky­ron Reg­is not­ed that the old way of do­ing things, where med­i­cine is giv­en to pa­tients with heart at­tacks and the out­come is await­ed, con­tributes to the loss of lives and ul­ti­mate­ly the loss of pro­duc­tive mem­bers of the labour force.

He said as a re­sult of this type of treat­ment, peo­ple do not on­ly stay away from work longer, but many of them nev­er re­turn to work, be­cause even if they sur­vive they have parts that are weak­ened per­ma­nent­ly.

The car­di­ol­o­gist ar­gued that a prop­er­ly man­aged Pri­ma­ry PCI (Per­cu­ta­neous Coro­nary In­ter­ven­tion) re­ferred to as PP­CI Pro­gram would as­sist in avoid­ing these cir­cum­stances. The Cath Lab is cru­cial for this to hap­pen.

The truth is that the Cath Lab was built and equipped but nev­er staffed and re­mains a prover­bial white ele­phant.

This, in a coun­try where the Min­istry of Health iden­ti­fies Is­chemic Heart Dis­ease as the lead­ing cause of death.

Quite of­ten the chal­lenge fac­ing T&T is not one of mon­ey but of plan­ning and se­ri­ous­ness.

How else do you ex­plain a sit­u­a­tion where we are paving roads every five years and lit­er­al­ly with­in weeks it is be­ing dug up or pot­holes de­vel­op? Look at the West­ern Main Road from West­mor­ings to Cha­gara­mas. It was repaved at a cost to tax­pay­ers and great in­con­ve­nience to res­i­dents. This was done with­in the last four years. To­day, when you dri­ve on it you are seek­ing to avoid huge pot­holes. The Diego Mar­tin Main Road was paved on the eve of the gen­er­al elec­tions and al­ready is de­vel­op­ing pot­holes. So when the Min­is­ter of Fi­nance comes and talks about the bud­getary short­fall bear in mind that his gov­ern­ment and those that pre­ced­ed it had no in­ter­est in the struc­tur­al change that will en­sure the coun­try gets val­ue for mon­ey and a pop­u­la­tion seem­ing pow­er­less or not in­ter­est­ed in pro­tect­ing its tax dol­lars.

The Min­is­ter of Health Ter­rence Deyals­ingh and Prime Min­is­ter Dr Kei­th Row­ley boast­ed on the cam­paign trail that the coun­try had a world class health care sys­tem, sec­ond to none. That they could have said that with a straight face when Min­is­ter Deyals­ingh knows that the Port of Spain Gen­er­al Hos­pi­tal can on­ly do chest xrays and emer­gency CT scans have to be sent to Er­ic Williams Med­ical Sci­ences Com­plex and non-emer­gen­cies to San­gre Grande Re­gion­al Hos­pi­tal while there in no MRI ma­chine at POS­GH is as­tound­ing.

Sure­ly the Min­is­ter of Health knows the hor­ror sto­ries of the health sec­tor from peo­ple wait­ing days for a bed to con­sul­tants who vis­it the hos­pi­tal at best for a cou­ple hours a week. Yet the Min­is­ter and the Prime Min­is­ter could still feel em­bold­ened to tell the coun­try that we have a world class health sys­tem.

For sure we spend a lot of mon­ey on health care but its a lack of sys­tems, a lack of ac­count­abil­i­ty and a lack of plan­ning in­clud­ing main­te­nance of equip­ment that al­lows us to be in a con­stant state of un­der-per­for­mance.

Since the gen­er­al elec­tion I have spent time in this col­umn ar­gu­ing that the coun­try lacks suf­fi­cient fo­cus to achieve its full po­ten­tial and at all lev­els we are pre­pared to get by, know­ing that the next en­er­gy boom is around the cor­ner and it will al­low us to have an­oth­er cy­cle of the good times.

Well that en­er­gy boom is un­like­ly and with the glob­al fo­cus on cli­mate change, the main source of rev­enue for the coun­try comes from a sun­set in­dus­try.

As I have said time and again, that does not mean we should not work hard on get­ting things right in the sec­tor but we must view it as a bridge to a new fu­ture and not in and of it­self the fu­ture.

The white ele­phant in To­ba­go, the con­stant spend­ing on paving roads that do not last, the poor gov­er­nance and scan­dals at CEEP­EP are all linked to a coun­try that con­tin­ues to waste re­sources and not see that if it is to achieve its po­ten­tial it has to change course.

When Min­is­ter Im­bert takes to floor in just un­der a month, no one should ex­pect any­thing trans­for­ma­tive. He has al­ready sig­nalled that it will a bud­get talk­ing about trans­ac­tion­al is­sues. For ex­am­ple, the de­ci­sion to re­move VAT and oth­er tax­es on com­put­ers, as wel­comed as it is, what is the strat­e­gy be­hind it? It is to be­come a more dig­i­tal so­ci­ety? How does that re­late to broad­band and in­ter­net ca­pac­i­ty? Is there a 5G strat­e­gy? Are we talk­ing about the use of da­ta and big da­ta and the adop­tion of tech­nol­o­gy. How does that re­late to the ease of do­ing busi­ness and the digi­ti­sa­tion thrust and how will digi­ti­sa­tion im­pact health care, where we still have records that are writ­ten and lost?

So yes, re­move the tax­es, but let us hear what the vi­sion is, com­mu­ni­cate that vi­sion to the coun­try and get buy-in.

Much has been made about spend­ing $500 mil­lion on agri­cul­ture but what is this go­ing to be linked to? Is it that we are try­ing to be self suf­fi­cient or is it that we are try­ing to make an in­dus­try out of it? What role will digi­ti­sa­tion play? How will we get a tourism sec­tor that can take pro­duce from farm­ers and give them an­oth­er sus­tain­able mar­ket. How do we en­sure that lo­cal pro­duce is linked to school feed­ing pro­grammes? In oth­er words where is the plan­ning?

For far too long gov­ern­ments have on­ly talked about projects, so build­ing new hos­pi­tal or high­way or paving a road are all projects. Lit­tle is said about the re­al changes need­ed. Re­form is hard work but if we don’t do it, if we don’t plan be­yond build­ing a Cath Lab we will end up hav­ing spent mon­ey and be no bet­ter off for it.