The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Bahamas needs a $670m capital investment to “bring our healthcare facilities into the 21st century and up to par with the first world”, a Cabinet minister revealed yesterday.

Dr Duane Sands, minister of health, confirmed to Tribune Business that the government’s vision for an “ideal system to care” for the Bahamian people involves replacing both Princess Margaret Hospital (PMH) and Freeport’s Rand Memorial Hospital through a combined spend exceeding half a billion dollars.

He disclosed that the government had been asked to think big, and lay out a design “as if money was no object”, ahead of next week’s “pledge conference” that aims to raise millions of dollars in private sector donations to finance Hurricane Dorian reconstruction efforts.

Government documents, released ahead of the January 13 event, detail the scale of The Bahamas’ needs wish list in multiple areas including healthcare, housing, the environment, infrastructure and the micro, small and medium-sized enterprise (MSME) sector.

They peg the costs of replacing PMH and the Rand Memorial Hospital at $500m and $120m, respectively, requiring a combined investment of $620m. The third, and final, healthcare project detailed in papers seen by Tribune Business involves a $50m investment to construct and “repurpose” health clinics across Abaco and the cays in Dorian’s wake.

Dr Sands conceded he has “no idea” whether the pledging conference will raise sums that get even remotely close to these targets, but added that its organisers had encouraged the government to lay out its ideals as if there were no limitations on what can be achieved.

“We were asked to look at what would be truly impactful,” he told Tribune Business. “If we’re going to make an ask, the question would be: Are you going to limp into the next year or truly generate resilience moving forward?

“Given the fact we have been asked to think even more liberally about the future in terms of the pledging conference, there’s a basic concept of what it would take to bring our healthcare facilities into the 21st century and bring them up to par with any facility in South Florida or the first world. That’s what translates into $500m [for PMH].

“What we’ve been asked to do, if money was no object, is to design or consider the health system that would be ideal to care for the population... In terms of need, it is very clear that if we were to do this entirely on our own based on the cash flow of the Government of The Bahamas, or the borrowing of the Government of The Bahamas, there’s a limit to how far we can get in the short term.”

Dr Sands said the decision on whether to rebuild or upgrade PMH was “for the future”, but added that “a number of components” must be addressed to ensure it can fulfill its role as The Bahamas’ acute healthcare facility “for another 20 to 40 years”.

“We have costed out the next phase, which is the emergency room, maternal child health and imaging, and the price tag we’ve got for that is between $200-$250m,” he told Tribune Business.

“We already have pretty advanced ideas about maternal child health. Bear in mind we made that a manifesto commitment in 2017. We have pretty clear renderings, costings etc, and programming considerations.”

The Government’s pledge conference papers said Dorian’s devastation of healthcare facilities on Abaco and Grand Bahama had “exacerbated” the pressures on an already-overworked and overcrowded PMH, further straining “shortages in critical services areas” and adding to already-long patient waiting times.

Dr Sands, giving a deeper insight into these challenges, told Tribune Business: “To give you an idea, this weekend we had 28 patients in the emergency room admitted with no beds. You clearly have an incredible demand on PMH right now because the Rand is nowhere near at capacity notwithstanding the incredible benefit of Samaritan’s Purse [field hospital].

“We’ve not been able to provide elective procedures, surgical procedures and diagnostic procedures. A lot of that falls on to PMH and, with people coming from Abaco for treatment, the load on PMH is tremendous.

“We have also had to use staff from New Providence to cover the Family Islands, Grand Bahama and Abaco, in order to give resident professionals there a break. That exacerbates the challenge. The demand on PMH is huge.”

The most recent Ingraham administration had sought to redevelop PMH in stages, with its near-$100m investment in the facility’s Critical Care Block designed to prioritise the treatment of ‘life and death’ conditions as the first phase.

However, the Government’s post-Dorian paper said redevelopment plans for The Bahamas’ primary tertiary care facility have been mulled since 1985. “As the major tertiary facility for the nation, the Princess Margaret Hospital has received the brunt of the patient load as a result of this catastrophic event,” it added, referring to the Category Five storm.

“This aging facility has long outgrown its clinical spaces and the ability to safely provide the level of service required to meet the healthcare needs of the nation. To this end, design/redevelopment plans dating back to 1985 have supported this need.

“Understandably, after the passage of Hurricane Dorian, the population shift from the affected islands to New Providence exacerbated the existing situation with respect to critical bed shortages and the need to expand clinical spaces,” it continued.

“Inpatient wards are overcrowded, particularly maternity, male surgical and children’s wards; shortages in critical services areas (dialysis, intensive care unit); and notable challenges within the Emergency Department include further overcrowding with accompanying long wait times, constrained workspaces and poor patient/work flows.”

As for Freeport’s Rand Memorial Hospital, the Government’s paper calls for it to be rebuilt “better and stronger”, and warns against making extensive investments in the current facility that suffered extensive flooding and other damages in Hurricane Dorian.

“Based on previous facility assessments, there is a critical need for a new facility and investments should not be channelled to attempt repairing the entire facility,” the document states. It warns that the Rand and surrounding land are “susceptible to future flooding”, meaning that an “inevitable repeat of service and staff disruption” will occur during another Dorian-storm.

“The age of the structure (50 years) guarantees high maintenance costs with limited opportunity for developing a smart, climate resilient facility,” the report added. “Ten years of expansion and modification has resulted in a mix of various HVAC and air conditioning systems delivering varying levels of performance and reliability.”

Besides the salt water damage to the Rand’s electrics and plumbing, the report added that “75 percent of the ductwork throughout the facility is fibre glass, which cannot be cleaned of mold. The existing campus cannot accommodate all inpatient and outpatient services, necessitating perpetual maintenance of annual rental contracts”.

Dr Sands said of this assessment: “I think we have all agreed that the existing Rand Hospital cannot be trusted to be the acute healthcare facility for Grand Bahama moving forward based on the fact it took a massive beating in the last hurricane.

“The new facility not only has to be resilient in terms of weather, but it has to provide services it does not provide today like cancer care, cardio care; things like that.” The minister added, though, that the Government had little choice but to sufficiently repair the existing Rand so that it can provide safe, essential medical services to the Bahamian people prior to the 2020 hurricane season.

He suggested that this required a balancing act where the Government invested what was required, but did not overspend and, in doing so, drain funding away from a potential new hospital construction.

The third, and final, project detailed by the Government’s paper is a “hub and spoke” model for Abaco’s 24-hour healthcare via a network of seven clinics where Marsh Harbour acts as the “parent”, or hub, for the likes of Hope Town, Man O’ War Cay and Guana Cay in central Abaco.

“Sandy Point Clinic in south Abaco is to serve as the parent facility for the Moore’s Island clinic, while Coopers Town Clinic will provide same for the Fox Town and Green Turtle clinics while also servicing the Treasure Cay community,” the paper said.

“This vision has not been fully realised in part due to resource constraints relative to infrastructure and equipment. While recognising the opportunity for redesign, repurposing and enhancement to improve resilience, the focus cannot be singularly on reconstruction but must also geared toward achievement of the medium and long-term vision for health care services across the Commonwealth of The Bahamas.

“Ongoing challenges such as inter-island/cay connectivity via information technology, as well as air, land and sea transport deficits, are all critical items for creating a resilient health care system in an archipelagic small island developing state such as The Bahamas,” it continued.

“Constructing resilient facilities is recognised by the Ministry as an area of specialty, and it is anticipated that assistance would be needed to ensure consideration is given to disaster risk reduction by rebuilding climate smart facilities, taking into consideration ongoing and evolving environmental factors.”

Dr Sands, meanwhile, admitted: “I want to be very clear that we have no idea what such a pledging conference will yield. We’ve done the preliminary work, and now it’s a matter of hosting the event. These are persons that do this for a living, have apparently done it quite well, and we shall see. They have suggested we do this inclusively as opposed to exclusively in terms of consideration.”

The Government is hosting the pledging conference in partnership with the United Nations Development Programme (UNDP), and with support from the governments of the United States and the United Kingdom.

It is designed to mobilise financial and technical support for recovery efforts from the private sector, high-net-worth individuals, other governments and donors who have expressed interest in assisting with the recovery.