Health and Freedom

Is this proposed expansion the best thing in hard economic terms?

I think so for several reasons. Firstly, the increased efficiency cannot be measured in hard cash, but other real cash benefits can be seen. The scheme would tend to attract back to the territory, a number of recently qualified doctors, thus eliminating some of the apparent waste that goes on now. It would also save the government, the greater portion of those sums of money which they now spend on sending cases abroad for treatment. It will also save the country the money in foreign exchange that private citizens spend on seeking medical advice abroad. This sum is not known, but it is, very likely, quite large.

In nursing, the same world shortage that exists in terms of medical staff applies. In Britain, there is great difficulty in recruiting girls except in the long established and famous nursing schools. Most of the ordinary hospitals in Britain are largely staffed by nurses recruited from abroad, and, in particular, from the West Indies. The situation in Britain is best illustrated by a recent event: a new hospital, advertising for nursing staff, so that it could begin functioning, received one reply; and that from a girl overseas. Nevertheless, there are more Barbadian girls in Britain doing nursing than there are in Barbados.

Why, then, is there a shortage of nurses in Barbados?

I think the answer lies in the fact that the terms and conditions of service are poor, and entirely unrelieved by any real social status in the community. Many girls who undergo training abroad would not consider entering the profession at home, except at the top level. Nurses in Barbados are asked to work at very low salaries. These salaries are often worse than those commanded by the most junior clerical jobs that require no training. Often they are placed in understaffed wards where the number of patients may be one third more than the capacity of the wards allows. There is grossly inadequate supervision of junior nurses, particularly at night. Under these conditions, nurses are frequently subject to abuse from other staff and abuse from their patients as well.

How are the problems to be tackled in this sector of the service? I think it must be remembered that the idea of service for the cornmunity under arduous conditions is an outmoded one, and that in this age, the standards required by all sections of the community have been raised. Therefore, efforts have to be made to make the training, accommodation, recreational and social facilities more attractive for the nursing staff’. Higher standards would not only be reflected in the increased numbers seeking recruitment, but also in recruitment from a larger cross section of the community.

In Barbados, we have on the whole, good nurses, although not enough of them, but their effectiveness is vastly diminished by the relations within the service itself, and by its relations with the medical staff. There is no dialogue between the senior nursing and the senior medical staff. This situation is founded on a profound degree of suspiciousness by the nursing staff about the feelings and motivations of the medical staff towards them. This is no doubt based, and with some good reason on past events, but this habit of mind and practice should now be consciously eradicated, for it has a marked detrimental effect on the efficiency of the hospital service. At present, decisions which affect both parties, are formulated in entirely separate cocoons, to reach an inevitable clash when revealed. There should be a constant awareness by both parties of the need for consultation on all problems, for they always reflect on patient welfare, which should be the primary concern of both parties.

If the defects in the service can be overcome, the hospital should become the focal point of the health service in the territory, the staff providing the impetus for better preventative medicine, as well as being the authorities in the curative aspects. This would mean ever increasing burden on the hospital service as more and more patients seek the improved standards of care. If the system becomes overloaded, it will eventually break down. The people have a valuable role to play, if this situation is to be avoided. They should try to use the hospital for its specialists and emergency services alone, and by showing their interest in the improvement of the services with voluntary contributions of their time as well as money for patient facilities. However, our community is not noted for its restraint in the face of a good freeness, and safeguards should be applied to prevent the overloading of the system. It means that certain definite restrictions will have to be put on the category of patient seeking hospital care. They must be restricted to emergencies and to those who are sent by other doctors for the specialist services of the hospital. This will also ensure that the valuable role that the general practitioner has to play in the community is not undermined by the hospital service, and may serve to destroy the mutual suspicion which can exist between the two services. It may be said that this view is untenable because the two services do not come of the same stem and so are not reciprocal, but it will always be remembered that the third party, the patient, will ensure the bridging of the gap.

for its specialists and emergency services alone, and by showing their interest in the improvement of the services with voluntary contributions of their time as well as money for patient facilities. However our community is not noted for its restraint in the face of a good freeness, and safeguards should be applied to prevent the overloading ol the system. It means that certain definite restrictions will have to be put on the category of patient seeking hospital care. They must be restricted to emergencies and to those who are sent by other doctors for the specialist services of the hospital. This will also ensure that the valuable role that the general practitioner has to play in the community is not undermined by the hospital service, and may serve to destroy the mutual suspicion which can exist between the two services. It may be said that this view is untenable because the two services do not come of the same stem and so are not reciprocal, but it will always be remembered that the third party, the patient, will ensure the bridging of the gap.

How are all our small emergent island territories to meet the demands that are so clearly needed in their health services? Of course the governments must beg, borrow and tax for the money. This is common practice; but there is another course of action open to us in this area. There can he areas of regional co-operation in medicine as there have been in other services without political union. In fact sickness is probably the one time that barriers are cut across without rancour. It must however be remembered in this idea that it is economically not feasible to scatter special services in many centres, for they feed one another, and this will mean the development of only 2 or 3 centres, and these will inevitably fall on those already well developed. Perhaps the proposed extension of medical teaching of the University College of the West Indies. into Trinidad and into Barbados, may provide the stimulus for integration of patient care, specialist services, and nursing training. This will naturally mean that there will be a good deal of political Interest ‘in the health services, but it will be spread wide instead of long restricted party lines. No matter how much we regret it, a service which is going to spend as much money as the health service must become invoked in politics, but unlike other government services the principal participants, the patients themselves, can play a vital role in how it is run and how good it is, if they are constantly on the lookout 10 improve it rather than to just take from it.

How are all our small emergent island territories to meet the demands that are so clearly needed in their health services? Of course, the governments must beg, borrow and tax for the money. This is common practice, but there is another course of action open to us in this area. There can be areas of regional co-operation in medicine as there have been in other services, without political union. In fact, sickness is probably the one time that barriers are cut across without rancour. It must however be remembered in this idea that it is economically not feasible to scatter special services in many centres, for they feed one another, and this will mean the development of only 2 or 3 centres, and these will inevitably fall on those already well-developed. Perhaps, the proposed extension of medical teaching of the University College of the West Indies into Trinidad and into Barbados, may provide the stimulus for integration of patient care, specialist services, and nursing training. This will naturally mean that there will be a good deal of political interest in the health services, but it will be spread wide instead of along restricted party lines. No matter how much we regret it, a service which is going to spend as much money as the health service must become involved in politics, but unlike other government services, the principal participants, the patients themselves, can play a vital role in how it is run and how good it is, if they are constantly on the lookout to improve it rather than to just take from it.

Patients must see the hospital not only as a service from which they take, but also as an example of collaborative effort, of communal living which improvement they contribute to, and whose excellence of standards they constantly demand.