The Tribune

By DR DUANE SANDS

FNM Chairman

There is often considerable debate over the delivery of health care in The Bahamas. Recently, there has been much discussion on the best means to transform and build the facilities required to improve the delivery of health care through the Princess Margaret Hospital, our main general hospital in the country.

Health care is connected to every other public policy issue in the country including, economic development and growth, reducing poverty, tackling one of the highest rates of obesity in the world and its various consequences, social development, and other areas of policy.

Getting health care policy right is essential. Poor decisions will have ramifications in health care and other areas of national life for decades. The decision by the current government to build what will be a stand-alone ward of PMH away from the main campus will be a colossal error. It is not prudent. It is unwise.

Bahamians should be clear. The government is not building a new general hospital. They are building a stand-alone facility with several services. This new facility will not address the major issue of adult A&E (Emergency Medicine,) general medicine or surgical care and ICU. Bluntly stated, this massive investment will not impact the biggest healthcare problems that plague Bahamians or that frustrate those seeking care.

Three governments, including FNM and PLP administrations, led respectively by Hubert Ingraham, Perry Christie and Dr. Hubert Minnis proposed the ongoing redevelopment of PMH on its current campus.

Each of these three governments made this decision for practical, financial, and health care reasons. They were guided by a variety of studies and experts. For example, the prestigious Aga Khan Foundation, a nonprofit international development agency with expertise in health care in developing countries undertook a study of PMH.

The firm advice was to rebuild PMH on current location over time, in discrete units - small, digestible “bites” which they suggested would be the most cost-effective, efficient, and manageable option.

The FNM began this transformation with the Critical Care Block. We proposed the second stage, a 96,000 square-foot multi-story medical, surgical, maternal and child health facility that would cost approximately $55 million.

The PLP cancelled this facility. Have they also abandoned the advice, vision, and concept of transforming the PMH campus?

There are a host of reasons why the Opposition believes that the government is making a terrible mistake. We believe that their poorly thought-out decision will cost the country dearly and will do considerable harm to the delivery of better health care.

The loan for the stand-alone facility is approximately $280 million dollars with a two percent interest rate over 20 years and there is no sustainable financing mechanism.

How much more will be needed to clean up the environmental problems at the site? How many millions will be needed to do roadworks to accommodate the heavy increase in vehicular traffic? Are there any other hidden costs?

Wouldn’t the final costs for the new facility going upwards to a staggering $350 million or more, for this single facility, be better invested in PMH?

The public health sector is already underfinanced by $30 to $40 million dollars annually. This new stand-alone facility will come with massive opportunity costs. It will prevent much needed improvements elsewhere.

The separation of services in our archipelago has already demonstrated the challenges of equipping, staffing, and maintaining separate facilities.

Our existing system is already so stretched that it cannot extract needed productivity from essential clinicians who cannot be replaced by lower-level staff. Essential equipment like scanners, echo machines, ventilators will have to be duplicated at even more cost.

The existing plan for acute care service was carefully planned and agreed years ago. The first $100 million was only completed nine years ago. It has already fallen into a state of disrepair because insufficient funds have been provided for maintenance.

We currently do not have adequate skilled staff to run the Critical Care Block, which means that currently, multiple ICU beds (25-50%) are closed. On any day multiple operating rooms cannot be used to provide care. Adding a new facility will worsen the problems.

The country has been unable to open multiple services at Exuma and Abaco over the past 12 years because of insufficient staff. Why would this new stand-alone facility be any different?

The Neonatal Intensive Care Unit at PMH is known to be one of the best in the region. It has never been filled to capacity. Why is the government now proposing to abandon it?

The greatest health care challenges include heart disease and violence/trauma. None of our acute care facilities have adequate diagnostic or therapeutic capacity to deal with cardiovascular disease or have the blood bank, operating rooms, emergency rooms, support staff, and rehabilitation staff capacity required for the better management of trauma patients.

Given that these are the major problems in healthcare, they should be our national priority. Again, the new facility will not address these issues.

Further, as many others have advised, the new facility, which is to be built on a contaminated site, will remove considerable acres of green space. From an environmental perspective alone, the government has embarked on the wrong course of action.

Among the greatest passions and deepest commitments of my life have been medicine and serving the Bahamian people. For the past thirty years, I have sought to honor this commitment by serving those in need of medical care, particularly in the field of heart care and surgery, and in trauma care in Accident & Emergency.

The principles that have guided me include the age-old maxim of, ‘First, do no harm” and care for all. I have attended to Bahamians of all political and other affiliations. Like many other colleagues, I have also dedicated my entire professional life to improving public health care.

I have had the privilege of serving on the frontlines of health care and as minister of health. I dearly and passionately believe that the proposed new facility will harm our ability to improve the delivery of health care. Like most of my medical colleagues, I believe we have a duty to sound the alarm on this.

The argument the Opposition is making on how to improve our health care facilities is a moral and ethical case beyond the narrow political and commercial views of some whose arguments may not serve the broader common or public good.

The Opposition rejects the bogus suggestion that because we oppose this stand-alone facility, we do not support improving health care. It is precisely because we want to dramatically improve health care that we insist the priority ought to be the transformation of PMH.

I believe in the politics of good public policy and hope. This is the quality of “political acumen” and medical acumen. We need to make the best decisions on behalf of every Bahamian, particularly the poor and the vulnerable.

Like a well-functioning human body, an integrated, centralized major national hospital is best. Rather than severing certain organs or limbs from the main body of PMH, and by so doing worsening the better circulation or logistics of health care delivery, the creation, and maintenance of a world class clinical, teaching and research facility ought to be our goal.

Over the ensuing weeks and months, the Opposition will continue to discuss in various forums the principles, values, vision, and ideas we have for health care and a healthier Bahamas.