The Tribune

MINISTER of Health Dr Duane Sands has been brutally frank and forthright in assessing the state of public medical care in The Bahamas. He has warned us the system is failing us. In one nearly 4,000-word treatise in January in reply to breaking news stories about a shortage of beds leaving people lying in the halls at what is supposed to be the nation’s flagship healthcare provider, Princess Margaret Hospital (PMH), he spelled out just about everything that was wrong from inadequate equipment to roofs that have been leaking for years but he neglected one critical factor – the filthy conditions at that facility.

“Our healthcare system is in deep trouble,” the Minister of Health stated. “Across the country, collapsing infrastructure, broken and or obsolete equipment, inadequate provision of staff; particularly, nurses, doctors and allied health personnel, have led to a situation in which access to healthcare services and patient dignity; particularly in Accident and Emergency (A&E) and the Maternity Ward, are compromised daily.

“Our community clinics – the frontline in the battle for health – are in the net, rendered functionally ineffective despite the services provided and we are watching the current health profile of DM, obesity, HIV, infant mortality, cardiovascular disease, etc. take a dismal toll. These shortcomings have been widely acknowledged and there have been many instances in which our public healthcare system has been brought under negative public scrutiny.”

He pointed to what he called “dreadful conditions” in A&E at PMH, spelled out eight specific categories of near-desperate needs and he detailed the difficulty with a deficit of millions in funding, some $9m in the first quarter ending September 2017.

We give Dr Sands kudos for his honesty and for calling attention to what too many people ignore. But we do not know how in that open and frank treatise he overlooked the filthy conditions at PMH. There is no excuse anyone can make for the scum and dirt along baseboards, the grime of fingerprints on doors and scuff marks on walls. The hospital is so dirty that we are surprised the Ministry of Health - which is quick to close down a restaurant if it finds rodents and unsafe conditions - does not order PMH closed for a general cleaning.

It is the only hospital we have ever visited where we could walk the halls for extended periods of time on the weekends, in particular, and not see a single cleaning cart or a person mopping, wiping, scrubbing.

Sophisticated medical equipment is hugely expensive. The Breathe Easy campaign raised $392,063 to buy seven ventilators and three incubators for the neonatal intensive care unit. Private sources also raised $164,000 for eight new dialysis machines. With women in The Bahamas suffering from the highest rate of breast cancer in the world, a disease that will strike nearly one in every four women in this country, PMH was limping along with a ten-year-old obsolete mammogram machine. Again, private sources had to come to the rescue.

Equipment is so inadequate that surgeons, including the Minister of Health who is also a world-class heart surgeon, were bringing their own equipment to the job. “23 years ago, I started using my own vascular instruments in the PHA. Every year since I have heard… we are getting some this year… still waiting,” wrote Dr Sands in that now famous January tell-all state of the system speech.

Ophthalmologist Dr Jonathan Rodgers, upon his return from Canada, began taking his own equipment to PMH. He left it in the hospital’s care for a while before removing it because there was no care, only abuse. That was more than 20 years ago and it appears conditions have got even worse.

Healthcare is expensive, cleaning is not. While more realistic funding must be found for diagnostic and treatment equipment, infrastructure, proper staffing and other needs, the search for rags, mops and safe, non-toxic cleaning goods and a practice of keeping the country’s premier healthcare facility clean must begin in earnest immediately. At the same time, the emphasis on prevention of disease by better diet and lifestyle choices should become a part of every school curriculum and should be supported by a widespread campaign that focuses on facts of the health and life consequences of poor diet choices, including too much processed and fast food.

With the current Prime Minister and the Minister of Health both being leading medical professionals the opportunity for improvement has never been better.