Dr. Irvin "Eipigh" Pascal

Dr. Irving “Eipigh” Pascal

The less than inspirational management of both the Chikungunya epidemic and the Marigot Hospital closure raised grave concerns for the future delivery of health care services in Dominica, These tepid responses are but further  signs of our declining ability to overcome the major challenges of health care financing, improved management of the complications of chronic non communicable diseases (CNCD) or  the rehabilitation of our Primary Health-Care System.

Our responses at present reflect not only the lethargy, weakness and apathy of the leadership in our health system. They also confirm the presence of more lethal symptoms including a lack of  purpose, leadership, creativity, resources(financial &personnel) and vision, which are diagnostic of decaying organizations and institutions.

In 1979 Hurricane David left our health system in shambles. However, the insight commitment, creativity hard work and clarity of vision of the then leadership delivered our once renowned  Primary Health Care System  now unacceptably  decapitated and in disarray. The present lack of urgency and effective leadership in responding to these recent challenges is palpable.This state of affairs  requires an urgent enquiry to prevent and limit further morbidity and mortality for citizens.

A hospital building is not a health care service!!!!  It is my view that the proposals for the re-construction  of the hospitals at  Marigot and Goodwill have confused the two entities.. How else does one explain the lack of the inclusive consultation and pertinent stakeholder contributions to the process of preparing the proposals? Where is the clarity of vision supported by medical research that demonstrates how these  new structures will impact  our challenges of financing our health care services  or improving the control of CNCD”s .

In Marigot, emergency funds should be made available to temporarily relocate the hospital services  to the Marigot Foundation High School or similar compound . A comprehensive plan should then be developed for the delivery of modern health care services in the district. The plan should be informed by massive public and professional stakeholder  participation.   Provisions must be made  for adequate number of professionals trained to deliver  emergency and post disaster services   given the proximity to the Melville Hall airport.

Finally it would be a dereliction my national and medical duty not to publicly question the  decision to reconstruct Princess Margaret Hospital in the form proposed at the already congested Goodwill location. As far as I am aware, this decision was not research or evidence based, neither was it informed by broad public and professional stakeholder consultation . It seems to me that the initial decision was influenced mostly by toxic doses of political and economic considerations, more to the benefit of sitting politicians than of future patients. This is not the forum for a detailed submission. However, I propose that like our predecessors after Hurricane David  we use the appropriate  research to reevaluate our delivery of present and future hospital services especially how they can impact our major challenges. Our findings could very well result in an innovative model that uses ALL of the fifty million dollars to convert the  institution at Goodwill to house the following 1) a properly equipped and staffed modern trauma and emergency care centre inclusive of a helicopter service  2) the Directorate of Primary Health Care Services,  3) the Roseau District  Primary Health  Centre, 4) An Upgraded Psychiatric  Unit and 5) a Rehabilitation and Social Care Services Unit. I would complement this with the decentralization of our secondary and future tertiary care services crucial for the management of the complications of CNCD’s to another location (e.g. Warner). This could be done in collaboration with our offshore medical schools  and other private sector stakeholders  thus concretizing the much touted public/private sector cooperation so crucial to financing future health care services.

If like our predecessors in 1979, we are to fullfil  our mission of delivering  quality health care services to our present and future citizens we need to reevaluate our purpose, function and methods. The time has come when those who can’t or won’t stop the slide should step aside  or  be held accountable.

May the spirits of the ancestors be pleased.