It was in a DNO article titled ”Delivery of quality health services in Dominica on a slippery slope” and published on the 27th June 2014 that I critiqued our leadership in health which brought on me the wrath of our rulers during the 2014 Budget debate. I must confess that I hardly pay attention to Budget debates in our parliament and consider them boring financial affairs, where well-dressed politicians pretend to debate financial issues of which they seem to know so little. I fail to comprehend the usefulness to ordinary citizens of a budget debate with little or no prior public input, that never influences the automatic endorsement by the “ayes” in the majority. Why not just call it a Budget address, allocate one hour for precise delivery and move to implementation as quickly and efficiently as possible. This would definitely spare us the humiliation and embarrassment of witnessing the limited capacities and unbecoming behaviors of so called honorable men and women in Parliament and indeed save the nation some dollars.
I must admit that my interest in listening to the measures related to health care was dampened when the Budget debate was suddenly aborted for reasons that were never explained. However the health measures mentioned in the aborted debate and recent official public pronouncements on health care have done little to indicate that there has been any measurable improvement in the leadership approach to the future provision of quality health care services in the “Nature Isle”.
I think the political directorate was either ill- advised or disregarded its technical advice in its approach to Dr Carissa Etienne’s recommendations for a tax on unhealthy foods. The research shows that a broad strategy that includes increased health education, regulations to limit bad food choices in and around schools ((example no bakes and busta in schools), increased physical activity in the targeted population, strategies to decrease cost on healthy foods (example reducing costs on farming inputs), and a tax increase of 20% on the unhealthy habit is required for such a measure to influence behavioral practices that improve health outcomes. The tax is the easiest part and some studies suggest that in the absence of the other measures it could actually hurt those it was supposed to help.
Our politicians in power seem to have now understood that a hospital building is not a service, however they are further advised that according to Wikipedia.org “ the phrase “state of the art” has been used since 1910, and has become both a common term in advertising and marketing, and a legally significant phrase ……………. In advertising, the phrase is often used to convey that a product is made with the best possible technology, but it has been noted that “the term ‘state of the art’ requires little proof on the part of advertisers”, as it is considered mere puffery”.[1] . The current exaggerated emphasis on a “state of the art hospital” and the number of specialists being trained does not reflect the reality that a newly trained specialist will need time and experience to acquire the necessary skill set to provide optimum quality of care. Furthermore the training of a specialist is just one of the requirements in providing quality specialist services. Provisions will need to be made for other categories of health care workers, equipment, complimentary and support services, continuing education opportunities, adequate remuneration to list a few. The emphasis should also be on putting the personnel and systems in place that will ensure that those newly qualified specialists can indeed maximize their training and contribute fully to improved quality of health care.
I contend that we risk compromising our quality of care if we proceed with the “new” hospital as proposed (10.5 million dollars was allocated for this in the 2015 Budget) under the present management structure. At least three studies dating as far back as 1998 have recommended that a Hospital Board overseeing a more effective management structure would improve delivery of care at Princess Margaret Hospital. This recommendation should be dusted off and implemented. Though it has not been mentioned I would hope that there are plans to recruit or train Dominicans in Hospital Administration or Hospital Management . I recommend training two Dominicans in this field as a priority since it is universally accepted that the efficient management of health-care resources is one of the most important considerations in Health Care Financing. Another major challenge facing the country.
To date no objective evidence has been provided to justify the old compound at Goodwill as the best site for providing future secondary and tertiary health services. I think given the marked increased in trauma and accident cases and our susceptibility to natural disasters we should consider modernizing and diversifying our emergency services around the island with the main trauma and emergency centre at the Goodwill site. Our secondary and tertiary services could then be located at an appropriate site along the west coast. This would avoid concentration of services at one site in case of a disaster and allow for strengthening our training commitment with the two offshore medical schools thus encouraging closer cooperation and numerous future possibilities. (I understand land at Warner has been sold to All Saints Medical School for expansion.) Could this decision to build at Goodwill reflect the failure of the leadership in health to provide the health research or evidence that would convince the political directorate to rethink or is it a desperate politically motivated decision? I am unaware of any dialogue or consultation with relevant stakeholder input to support this decision.Now this is a topic for a useful inclusive National Debate for the benefit of the present and future generations.
The continued failure to expeditiously upgrade the health services provided at Marigot (100,000 dollars allocated in this budget) is not only alarmingly negligent given its proximity to the airport; it also reflects the disarray and lack of leadership in our approach to primary care services. These are the same services that need to be improved and optimized to minimize disruption in patient care once work is commenced at Goodwill for the “new” hospital. Further evidence of the unsatisfactory state of affairs in our primary care system was demonstrated by our management of the recent visit of the US Naval Hospital ship. There were significant short comings in communication, preparation and organization for this event.The confusion was palpable. This resulted in our failure to maximize the opportunities provided by the ship to the detriment of those who needed it most. If nothing else this should indicate to the” leaders” in health the need for immediate national simulation exercises in disaster management. I suggest a complete evaluation and overhaul of our primary health care system is overdue. At a minimum an audit of the role and effective deployment of the medical doctors in this system after thirty plus years is required. Such an evaluation could be the place to start to address the gloomy forecast of the coming tsunami of the complications secondary to diabetes, hypertension , obesity, cancer, mental illnesses and trauma in our population predicted by a pioneer of primary health care Dr. Carissa Etienne.
In conclusion I exhort those in positions of leadership in health who cannot stop the slide in provision of quality health care services to quietly do the right thing.
May the spirits of my ancestors be pleased.
Politicizing the issue of Government to deliver quality health care service does very little to solve the problem. This is a very complex issue not only in Dominica, so let us not fool ourselves, we can all have our opinions regarding the issue, just like the good Doc. It boils down to people being negligent with their day to day living, to correct this, there need to be a massive need for education and knowledge to decipher the deception of what we are told about health. There need to be a main focus on preventive healthcare, diseases prevention as opposed to diseases treatment, Let us not forget the saying “Let food be thy medicine and medicine be thy food.”
― Hippocrates
nice piece. I like the writing style…power to you Eipigh…NO FEAR…Liberated.
Government ppl like IP need to be on his own and not in the public serving ppl like me. There are enough ENT Specialist in the French and in Cuba we can get to serve us. Am left fearful to visit this man office if the need arises. Let this man go on his own to continue his campaign.
Doc I don’t always agree with you but more and more I seeing you right. …painful true.
Great job Dr Eipigh. I concur. Special consideration should be given to your words…in the name of better for people and nation. I know that your efforts to put yourself out there to be “exposed ” is due to your love for what’s right and country. I am especially glad that you continue to express your truth despite of the attacks on you….YOU ARE MY HERO. Thank you and may God richly bless you
Very well said Doc! What does one expect from a group of ministers who hardly know the difference between night n day? Ministers are clueless about their own ministry. The government is a reflection of the brilliance of Dominicans or the lack thereof.
Teach them doctor teach them..
Dr.Pascal great piece and your a son of the soil,but when you have a dictator running a counrty and his little boys cant stand up to him.We have become a failed state and will not move forward,and thank you for breaking down the term ‘state of the art to these fools.Hats of to you doctor.
Dr. Pascal is in a better position professionally to express a view on the health services than I. What is troubling to me and others is that dr. Pascal is a practicing health professional in the very system he is criticizing. The question is. Does Dr. Pascal really want to see the kind of changes he is asking for in the health services? I think so. Next question is. Is the attempt to speak to public opinion the right and proper place for such a senior health professional to speak to the issue? He is a engaged in the system. He has submitted time and again that there has not been any consultation with stakeholders re the proposed new hospital. Is that a correct. I have heard several ministers both present and past speak to the issue of having held consultations. Who is lying or who is not representing the whole truth? As much as Dr. Pascal is a well trained professional, he knows what he is talking about. He has a view. What about the other equally trained doctors? Are they so foolish?
Its only politicians with their stupid political pride that will not consider your thoughts expressed in this article, a well deserved piece for the advancement of healthcare in Dominica.
Good piece of work doctor, let hope the ppl in authority take notice and act upon.
There are many truth in this writing, nevertheless i havent seen any comments from members of the public so that says alot in the way you have structured this information.
hhhhhhhmmmm, our ancestors would be please with you brother, may your pen never sleep.. and shame on those brothers who seem to sleep because they are overwhelmed with nice gifts from their master.
Thanks Doc. Pascal. We have a bunch of political illiterates sitting on the government side of our Parliament, sewing out unhealthy matters that has serious health contagious effects on our people.
I sincerely hope these ministers especially the one for health discharge themselves ASAP from the positions they hold as they are sickening the nation is unhealthy eating and speaking habits.
Stay well my people of Dominica and our healthy heroes who educate us on healthy matters
Dr. IP, I do hope and pray that one of those good days we will see our leaders paying attention to the message and stop focusing on the messenger. I am an unbiased individual as we speak. Further, I hope that after reading this article common sense will prevail with a view of making some much needed changes to the proposed site and the many flaws that have been identified in this article. It must be remembered that no one man is an island, but we can all learn from each other.
Please allow common sense to prevail and let us go back to the drawing board, for what is done in haste cannot be corrected easily in the future. e.g the West Coast Highway.
You are one of our heroes Dr. IP and I am opined that not too long from now this will be realize.
As a man from the military wing, I salute sir. You are worthy of praise as any Royal Highness/Prince.
You come back with that. See how those fellas looking for trouble and then cry and say the PM this and that.
Is long time the PM promise to expose the skeletons in your closet. So long I waiting for that.
Please don’t respond to this idiot people.- This Red Carpet-Lets pity the dull and ignorant among us for They have their stories and reasons AND YES SADLY THEY BELONG US AS WELL.
Doc- great piece as always- keep up the good and dignified fight and be careful as well.
@ Red Carpet You will always be walked upon like a red carpet.Your brain has become the carpet, so your understanding has gone to hell.Why can’t you just SHUT THE HELL UP!
Who has more red skeletons than Skerrit,this man is a doctor and well educated,Skerrit can never walk in his shoes,keep on defending the crony Skerrit,get a life.
Idiot!!!!
Right on target Doc,,,,,Lets see what they we will do, now you have spoken again.
One question are you the only brave doctor on island that will publicly speak on these health care issues?
That is so sad for dominica ,health is humans priority but it looks like the gov’t in power just don’t care about the population>that’s a disgrace
Well said my doctor! Dr Pascal I just love and admire you! Our future Minister of Health!
Well said. Doctor Eipigh. The DLP government always seems to put the cart before the horse. Our health care is in shambles and yet we have a 27 million presidential state house. It is obvious that the state house took priority over health. How long? Not long! God moves mountains in his time! His time is coming to expel this government out of office.
OMG Dr. You know Skeritt does not like criticism ,mid You doh cause the man to rupture a vessel .
One thing I do not understand is how Skeritt the most frequent flyer of Dominica can ignore the fact that there is no hospital in proximity of the Melville Hall(Douglas Charles) Airport.He is either irresponsible or thinks that the Gods are personally paying attention to his safety either way a dangerous mentality for a Leader.
I hope your suggestion for more Agricultural inputs include supervision of those applications. At the health end of the Agricultural scenario is the issue of chemical residue in the marketed product. We pay lip service to disease control yet we allow untested food products to be sold for consumption. The elevated levels of cancer should lead us to do the primary research by way of case studies of the individual cancer patients with a view to monitoring the environmental interfacing of those patients with potentially hazardous substances including those that are considered safe. This should have started a long time ago considering the knowledge that hydrocarbon based substances are stored in fatty tissue. In view of the high level of obesity in our communities there is a greater level of urgency. Consider a very obese person’s capacity to store those chemicals. In the event of illness and serious weight loss resulting in the release of those chemicals into the blood stream. Poisoning?
Take home message/sound bite.
This would definitely spare us the humiliation and embarrassment of witnessing the limited capacities and unbecoming behaviors of so called honorable men and women in Parliament and indeed save the nation some dollars.
I think the political directorate was either ill- advised or disregarded its technical advice in its approach to Dr Carissa Etienne’s recommendations for a tax on unhealthy foods. The research shows that a broad strategy that includes increased health education, regulations to limit bad food choices in and around schools ((example no bakes and busta in schools), increased physical activity in the targeted population, strategies to decrease cost on healthy foods (example reducing costs on farming inputs), and a tax increase of 20% on the unhealthy habit is required for such a measure to influence behavioral practices that improve health outcomes. The tax is the easiest part and some studies suggest that in the absence of the other measures it could actually hurt those
Ver captivating. The truth is A it is said is stubborn. After reading the article the recurring question emerges that is
How can we advance on lies and illusions?. Until we truthfully and honestly identify the problems ,faults and failures then we will continue to be last.
Instead of critically examining Dr Pascal’s comments and recommendations we know that wolves in red will come out to eat Dr Pascal alive.
Until the Labor Party government administration is out our country will continue to run on illusions,with smoke screens, propaganda dissemination. Willful deception remains the most effective means to mental bondage and poverty
well said doc. seems like you are the only voice in the wilderness crying out on our behalf on CREDIBLE matters of health…I am confident that one day your call will be heard and acted upon. Thanks Doc.
Very good article. Excellent points raised.
It’s really a pity we have a bunch of incompetents lead by a master of incompetence playing government of Dominica.
At least one of our professionals has refused to stay MOO MOO…….!!!!!!. Hope some of the others who are seeing the evil and wickedness that’s being perpetrated against the people of this poor country wl follow suit!!!!! THANK YOU DR PASCAL!!!!
Excellent.This is what we expect from our serious professional-at home and in the DIASPORA!! Not only in medicine but in the field of Law, History Culture,,Education and so on.
Well said
My boy well said but im sorry to say your good recommendations will be looked at as an attack strengthen your back.
Always a very sound mind – Dr Eiglph…
Now who in leadership of the Island’s future endeavours is going to take heed – listen and pay attention to the humble advice fo a true patriot for the love and well-being of a nation?
Doc, though I didn’t support you last year in that debacle, I understood your point. But now this article is stately and timely. It is apparent that people in that political arena are pandering to the higher one(s) with very little fore-thought, taking very little advice from consultants and poor planning. After all, ours is a small population with only enough population to fit in a mid-sized stadium in the UK or the US. Even the boy scouts could plan better health care improvements for citizens than that.
What Dr Pascal said last year is no different from what he is now saying.
Let’s hope that at this time around the government will get serious and implement every suggestion put forward by the good Doctor. Dr. Pascal has on numerous occasions demonstrated that he is a true Patriot of impeccable character and intellect. One who will not sit silent while things go wrong in the Country. Notice that he referred to his DNO article written in 2014 where his analysis of our health care system can now be seen as a prediction of the recent report on the unhealthy state of our health care system by the director of PAHO. Martin Christmas should be fired and Eipigh should be appointed Senior Medical Advisor to the government, so that he can work with the government to effectively implement his brilliant proposals. This man has a clear integrated vision for health care in DA. However, don’t get too excited about the possibility of government hiring Eipigh, I don’t think they have matured sufficiently. It would be good to be wrong in this case.
Brilliant piece from a brilliant mind.It is so invigorating and encouraging when our brave professionals who love country more than party can speak out.Dr Pascal you are one such loyal and brave professional.I know all the DUNCES in the medical field and the clowns in government will read this piece over and over!!!KEEP ON WRITING!!!!
in my opinion, we make too much noise in our country, acting and pretending to be famous, all for nothing, when it comes to our health servies and those in need of proper health services, are always at the back of the line and being told,” put up or shut up”. If we continue to act like experts in all things and ignore the real issues. my opinion, we are far from ready, and the train has left the station long time. It appears that in our quest to do the right thing, and i pause to add, there a those amongst us who are trying to right the ship and doing the right thing. May God continue to bless you all. Madam speker! I Rest! This reference artical by one of our own should enlightened all of us regardless of our Party afiliation and place us to the Path of really Good health if we are serious. I am Dominica, are You? just my opinion.
Dr. Pascal,
This a well written article. It would not surprise me that the so called leaders of our nation make you a pariah after these well thought out words. This government has under invested in the priorities of this nation. Wise men take time to analyze and implement ideas. This government implement and analyze bad ideas. My hope for this nation is for the wise and objective observers to be impartial and honest in their criticism and stop being beholden to the government which lacks moral fortitude and honesty to lead. My friend Rosie Douglas must be crying which is something he seldom did. He once mentioned to me that his goal was to educate the masses so that they would be able to think and confront dishonesty.
And as for the US hospital ship. The organizers did a huge disservice to people who are really in need to critical services that are unavailable on the island. People went on the boat to do pregnancy test and blood pressure checks. Are we serious? We have no urologist, cardiologist, oncologist, etc on the island. Shouldn’t people wanting such services be given priority. Though it was a free gesture by the United States, had we been able to properly negotiate we would have been able to benefit in a much bigger way from this gesture. Shame on the organizers, the permanent Secretary and the director of primary healthcare gave the impression that things were so well planned and organized and when u get to the site it was basically a war zone. Again lack of management skills and negotiation skills on their part. But both are political appointees so this brings us back to the same underlying problem. Too much politics killing this poor country of ours.
I concur. If our primary health care was in such an excellent state as claimed by the authorities this scenario would not have occurred and the “Comfort” could have concentrated on more serious cases, which our small economy and population have little hope of catering for with our own resources.
Very eloquent. I agree, its the system which needs to change/evolve leading to both an economic and improved medical service to patients: Products of revolutionizing this current system. I am of the opinion that the PMH should be turned to our MAIN trauma unit atleast at its central piority. The portsmouth place could PIORITICE PEDIATRICS. Upgrades should be made to every health clinic throughout this island. Dispersing and perhaps rotating family doctors. Train not just administrators but paramedics. Of course a third hospital building should be constructed. Where several of the specialist both under the government’s wing and others. The attitude of healthcare personel should be addressed as well, not displaying arrogance but humility. Knowing the boundaries some ppl r troublesome. Yes to educating. Yes to implementation of activity based programmes. Having the personnel for these, extend to suitable persons for the more technical disciplines. The potential with two med schools!
*atleast as it*
that is just one person vision of one important field in our nation. There are those who could improve this, going beyond this vision. The same can be done to other sectors of our society. But the Pascals of these sectors should be verbal and perhaps even take the first step. Every person got a vision, some push it out of the realms of their minds, if those in authority and the means to bring it to be don’t pay any attention to it, which would benefit all, then trying to shoulder it comes next i guess. Got to say love what is being proposed here.
Interesting read, but is anyone paying attention? There is definitely a deficit i leadership within the health system. This is what happens when every technical officer is politically appointed. I’m going to assist you to sound that alarm, if something is not done about our health care services very soon we will ultimately have a health related tsunami on our hands to deal with.
The politicians neef to stop playing politics with serious issues as health. Dr. Paul is no longer there, anyone ever stop to think of his replacement? Yes we got maybe two general surgeons at the hospital but just as Dr. Pascal mentioned, none are experienced. Shouldn’t Dr. Christian be considered to fill that post, coming in with all his experience. No he can’t because he is not a supporter of the DLP government. People are we serious here? Are we really allowing politics tp turn us into such ugly heartless monster?
I second that motion for Dr. Sam Christian as chief General Surgeon.
What about an online petition?
One voice ignored, Many voices heard….
I’m in full support of this petition in whatever form. We need to take responsibility for our health as a nation.
That’s my Doctor. I wish these guys would listen. Get our best professionals on board and stop politicizing everything in this country for the betterment of all citizens.
Right on Dr. Pascal.
As usual, very profound and well-though out presentation. My humble opinion is that this important aspect of our lives and development is being left to mere chance and unscrupulous (unprincipled) management. This needs to be taken seriously, very seriously!
I can’t expect you to say anything good cause you are one of the haters.
I don’t think that he is a hater! He says it as it is.
We need many more professionals with the courage tbat he has!
“Truth indded sounds like hate to those who hate the truth”. Go figure
Just keep saying positive things while our country goes to hell in a hand basket as a result of corruption and incompetence. You are the worst kind of hater, a hater of truth. Dr. Pascal is a hater of deception and incompetence.