The Tribune

LAST week’s front page shocker that Princess Margaret Hospital had such a critical bed shortage it was cancelling all elective surgery indefinitely should have come as no surprise. Nor should the following day’s story about a shortage of nurses, nor the ensuing social media posts and rants about shortage of care, equipment and attention to life-threatening cases piling into an overworked and overwhelmed accident and emergency (A&E) department. Everyone who has ever been to PMH, let alone sought treatment at the country’s largest and busiest hospital, is painfully aware of its broken infrastructure, its shortages and the crippling demands the public places on it. And anyone who has ever spent time wandering its halls where patients lie on cots outside rooms because wards are full will marvel at the kindness of some nurses and staff, recoil at the miserable attitude of others and wonder in awe and disbelief that the institution somehow works, people get treated, many get better.

Worst overall is A&E where we know of one case just last week of a patient sent with an Urgent notice from a doctor requiring immediate attention for a heart attack. Eleven hours later, the heart attack victim went home, unseen, probably saved by the heavy aspirin dose the original physician gave him.

If PMH were a patient, the diagnosis would be frightening. The institution suffers from nearly every poor condition that would reduce a patient’s chances for survival. PMH is bloated with patients and a system that is antiquated and cumbersome, yet it is starved for funding and unfit for the job it holds. And just like those patients, there is a cure but it is harsh medicine, hard to swallow.

The prescription to fix PMH is expensive and uncomfortable. It involves a serious shaking up of how it is managed with departments operating in silos, no reasonable and realistic vision for the facility as a whole and without funding needed to play catch up before advancing. Good health care is costly. Both Canada and Britain, often cited as examples of countries with excellent health care, spend about 10% of their GDP on health care. The Bahamas spends more but gets less return because we are already so far behind and the un-health of our population drives up incidence for care and for crises. And Director of Health Dr. Glen Beneby told a Tribune reporter that as much as $100 million or 25-30% of the funds allocated were wasted. Switzerland, which generally ranks between first and third worldwide for the quality and population coverage of its health care, has compulsory private health care insurance. Results are impressive. The population is among the healthiest in the world with an obesity rate of about 10% while obesity in The Bahamas hovers close to 80% and is linked to a myriad of diseases.

So none of what has made headlines and heads shake all week with health care should have caught us off guard. As Minister of Health Dr. Duane Sands said, “For decades we have suffered from an inability to properly budget and allocate sufficient finances for medicine, medical and surgical supplies, equipment, staff and infrastructure upgrade and maintenance.”

Essential expenses go unfunded, many of them pertaining to something the patient never sees – maintenance of equipment. Preventative maintenance of Public Hospitals Authority equipment is estimated at $3 million, $460,000 for the Critical Care Block at PMH alone. But year after year, the funding falls short of the need. The glaring consequences are everywhere, from broken chairs in A&E at PMH to once expensive machines that sit idle, like a CT scan in radiology, in such poor condition that there is no sense trying to repair them.

Despite ongoing problems that can no longer be ignored or downplayed in the light of bold headlines prompting sudden outrage, there is some reason for hope. That optimism lies in the courage and determination of the current minister of health who has done something few Cabinet ministers have ever done. He has stood up and said in a loud and clear voice, “Houston, we have a problem.” He acknowledged the shortages and shortcomings of a public healthcare system that has been overstressed and underfunded for years. He is not glossing over anything. In a 10-page epoch issued yesterday in response to a social media post, he was brutally and painfully honest. Some equipment at PMH is in such bad condition, he said, that 23 years ago he began using his own vascular equipment to treat cardiac cases. Another doctor we know brought his own ophthalmology equipment. It is only through the hard work of the Princess Margaret Hospital Foundation and donors like this newspaper with the support of a generous public that prematurely born infants now have proper incubators instead of used, decrepit infant cribs.

You cannot save lives by holding a hospital together with duct tape, Bandaids and promises.

If you are serious about health care, you have to do one of two things. Either fund it adequately through public coffers, even if it requires an emergency tax, or allow an organized group of medical professionals to lease the facility in whole or in part, holding them accountable by mutually agreed measures. Examples of successful privately managed hospitals abound.

And the debate over public vs private is not likely to be solved in The Bahamas any time soon, though there is certainly cause to believe that the smaller clinics in islands like Exuma and Abaco would best be managed by private concerns. There is also a third alternative, which involves private management with public funds to ensure that no one is left untreated because of financial incapability to pay.

Whatever we do, we have to move fast. The story has broken and it is not going away.