Delivery of quality health services in Dominica on a slippery slope

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.

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96 Comments

  1. Cindy Brown, BSN, RN
    July 19, 2014

    I am a nursing student in the United States, and am currently pursuing a Masters Degree in Nursing Education. I am taking a summer class called Global Cultural Perspectives in Nursing. My focus is on nursing education in Dominica.

    I was hoping that you might describe to me relevant issues to nursing practice and life long learning practices in Dominica.

    I am also very interested to learn about assessments, traditions, practices, disparities, health issues, etc. that nurses face in Dominica. Are there any health issues that are pervasive in Dominica and how do your nurse educators address these health issues?

    I would very much like to communicate with any health professionals, nurses or others involved in the delivery medical care or medical education via this post or email in regard to these questions and will use the information provided to write a scholarly paper for the class. Any information, links, articles etc would be much appreciated.

  2. Affa
    July 8, 2014

    Anyone or their relative had a CT scan on the new machine they got?? Well… it takes one month(4 weeks) to just get in line, then another week to get them to do the scan after numerous excuses why it can’t be done at this time. Gross mismanagement and incompetence going on up there. Heads should roll.

    And they just got the equipment, only one person knows how to do it right now and the other is sick or off. Then they blame the Gov’t, the equipment, the Ordleys, matron, anything they can think of why a scan cannot be done in under 5 weeks. Many have already died by then. :(

  3. burtdave
    July 1, 2014

    Very professionally written and this is the type of sons and daughters who have been trained we need to assist in giving direction to our political directorate in the process of our development. The suggestions are so refreshing and forward thinking I hope that the political directorate stop and reconsider these brilliant suggestions. It is not too late

  4. issues
    June 30, 2014

    First the article isn’t about chikungunya but the system anf how it handles such health situation, which in my opinion is indeed lacking.
    It is a FACT that the Ministry of health knew of Chikungunya. They were told that Chikungunya was on it’s way…and that CHIKUNGUNYA WILL COME to Dominica. The Ministry of health did nothing. Not even give the Doctors and nurses a head up about what this illness is about…because none of them knew about it. It wasn’t until the first case that talk started and not even then was the crisis handled well. The district health team were never invited to sit and discuss an action plan. Not until it was realized that the problem was huge…then and now they want to harass people to run hete and there….but much too….for that is long after persons who knew even less became the face of chikungunya…talking about it on radio and tv….eg: Bakes. Scottie etc. Then were heard from the appropriate health persons. By then too late…so thus the reason why now the public do not believe it’s the mosquito causing chikungunya…the damage had already been done. All this because the powers that be….Minister of health, PS of health, primary health director FAILED at delivery proper management.

  5. Anonymous
    June 30, 2014

    While you are at it doc, let’s talk about the number of Dominicans who are granted scholarships to attend medical school and don’t return to contribute towards Dominica’s health care. Maybe you can suggest to the Government how to go about getting them to return home and serve their bond. That would definitely help boost the medical service.

    • jah cure
      July 1, 2014

      You should know that alot of the medical students do return however they do not find employment, just recently two consultant radiologist returned and was not offered Jobs, however we have two cubans fulling that post at PMH.

  6. Anonymous
    June 30, 2014

    While you are at it doc, let’s talk about the number of Dominicans who are granted scholarship to attend medical school and don’t return to contribute towards Dominica’s health care. Maybe you can suggest to the Government how to go about getting them to return home and serve their bond. That would definitely help boost the medical service.

  7. Anonymous
    June 30, 2014

    Very well said Dr. P! I would also like the MOH to address the issue of government paid doctors (DMOs) who are leaving their posts at the health centers (during gov’t working hours) to work for certain educational institutions, at the expense of the patients of the clinic.

  8. zammy
    June 29, 2014

    Very well said Doc! This is one of the most honest and thought provoking pieces on matters of health in Dominica. The health system in Dominica is really out of it! No wonder Dominicans, shamefully call the Hospital gentle rest, which is very very sad indeed. There is a system in Dominica that is meant to frustrate those who would like to contribute to the development of the nation………….. These elements just wont allow the young and youthful professionals to rise and take their proper place in Dominica.
    But truth be told, what does one expect to happen to the health situation in Dominica, when the health minister is not qualified in Medicine or has any clue as to health issues. Dominicans continue to stomach the tardy work of the labour party government…………. Truth be told, under this labour party administration, every ministry or sector in Dominica can get a failure rating…. Dominicans must be honest to look those in authority in their face and tell them that they have failed and time for change, if not the whole country will keep sliding down hillll…… Goood Job Doc, well said Mate

  9. we need change
    June 29, 2014

    it it that same Dominica the promotes and have thousand medical student on island? real shame on the primer-minister..skerrit

    • Anonymous
      June 30, 2014

      What does that have to do with the matter being discussed?

  10. Truth
    June 29, 2014

    And one another thing Doctor,

    I have heard of Chikungunya outbreak in other islands, is it because their health care is on a slippery slope?

    When the U.S and Asia had an outbreak in Bird Flu, was it because their healthcare is on a slippery slope?

    If human beings are not prepared to work or take heed on precautionary measures during an outbreak, can you hold the Ministry responsible?

    • Anonymous
      June 30, 2014

      Very valid questions.

    • Browne,C (Rastafari)
      June 30, 2014

      The article is not about Chikungunya outbreak. The good Doctor is exposing the fact that Dominica’s health care system (or the lack of it) is non existent at best. Truth, I know your MO, and you’re all over FB running your mouth about how much your PM is taking care of YOU! He might be…the rest of the nation, not so fortunate! The ministers of gov fly to neighboring countries for medical care – that’s how unpleasant and grave health care is in the Commonwealth! How about you Truth, what’s your health care situation like?

    • Anonymous
      June 30, 2014

      Yeah Doc tell us, inquiring minds want to know.

    • issues
      June 30, 2014

      First the article isn’t about chikungunya but the system anf how it handles such health situation, which in my opinion is indeed lacking.
      It is a FACT that the Ministry of health knew of Chikungunya. They were told that Chikungunya was on it’s way…and that CHIKUNGUNYA WILL COME to Dominica. The Ministry of health did nothing. Not even give the Doctors and nurses a head up about what this illness is about…because none of them knew about it. It wasn’t until the first case that talk started and not even then was the crisis handled well. The district health team were never invited to sit and discuss an action plan. Not until it was realized that the problem was huge…then and now they want to harass people to run hete and there….but much too….for that is long after persons who knew even less became the face of chikungunya…talking about it on radio and tv….eg: Bakes. Scottie etc. Then were heard from the appropriate health persons. By then too late…so thus the reason why now the public do not believe it’s the mosquito causing chikungunya…the damage had already been done. All this because the powers that be….Minister of health, PS of health, primary health director FAILED at delivery proper management.

  11. Truth
    June 29, 2014

    Edited version!

    Bravo Dr. Pascal! One would think given your article that your contribution is unbiased!

    Aren’t you a member of the Dominica Medical Council who has systematically built a Cartel to block the entrants of new doctors in the system?

    How do we change the attitudes of some existing medical professionals who have little regard for patient care and treat patients as “second class citizens?

    A leader can put all the resources in place but if the people in the system are slow implementers, have a know it all attitude, and are stumbling blocks to progress because they are more concerned about making money on patients in their private facility, and keeping doctors who posed a threat to their field out, then it is not a leadership crisis.

    The crisis is that some of our doctors want to monopolize health care; but give the opposite impression in public.

    When doctors report false information to regional health organizations and non profit organizations who want to form partnerships to offer free services, how can we move forward?

    But as usual, we don’t want to deal with the real issues. I agree a structure won’t change the issues, as the cultural shift that needs to take place, is in the minds of doctors that sit on the medical boards and key positions in Dominica that do not broaden or further their medical knowledge, practice “touch and talk ” diagnosis, and have no interest in developing our “FREE” public health care system.

    And why haven’t any of the doctors seating on a mountain of wealth, invested in a private hospital or is it only the government to take any initiative in this country?

    Any Doctor, when you are apart of a system, but pretends to be an objective observer, is distasteful and dishonest.

    We ought not to push our political agendas under our professional coats!

    • real possie
      June 30, 2014

      @ Truth I missed your post and I might say you rite on target cause the way the Doc talked it seemed like he wld privatized the hospital and we all know that’s a no no, it seems like you have first hand knowledge of this guy and his working I can feel there is more to this guy than we know.

    • Dr Pascal
      June 30, 2014

      Dear reader,

      For me Impartiality is in the realm of the DIVINE. Desmond Tutu expresses that best when he says “To be impartial is to have already taken sides with the status quo.” In the universe we inhabit the only constant is change so to me the status quo is not an option.It never was and it never will be. Peace

      • Anonymous
        June 30, 2014

        Well he was wrong and you are wrong. I understand your loyalty to the Linton family but politics should be kept out of certain things. If you are just expressing your opinion then you need to broaden your horizon a bit.

    • Voice
      June 30, 2014

      Garcon it is not “seating” it is “sitting”! Yes both are words so thus the reason the automatic correct feature did not underline it red.

      Seat is a noun; as in the chair one sits in or the part of your pants where your backside resides. Seating is also a noun that refers to the order of chairs that backsides will sit in! example seating arrangements.

      No “sitting” is the action word! Yes the verb! It is the act of bending knees and placing of backside in a seat! they are two different words buddy.
      They are pronounced differently too! seat – (elongate the vowels) sit – (short and curt! no elongation of vowels)

      Now on to your last sentence of “pushing our political agendas under our professional coats”! Well I thought the argument of your entire post would be concluded as “pushing money and profit agenda under our professional coats”. Is it that you could not contain yourself any longer, Most-Reasoned-and-Unbiased One?

      And what is wrong with a professional pushing a political agenda in dis yah small Dominica? Uh? If the educated and experienced and exposed ones do not push some kinna agenda in this place then it is left to who to do so? Considering that the current government is interested in fattening only their pockets… incidentally the charge you so happily brought against the good doctor….somebody has to speak up on these matters! It obviously cyah be the man on the street. Since it is not going to be the public servants who the unenlightened public is paying to take care of their matters in the public’s best interest, then why not the professional who is even brave enough and rich enough not to depend on the government for food?

      Where were you Mr. Most-Reasoned-And -Unbiased-One when the charges you now levied against the good doctor and his colleagues occurred. Why is it you were not brave enough to raise those issues in the interest of the public? Or were you too busy fulling your own pockets as member of the ruling party or as one of the civil servants we employ to guard or interests but who do so badly? Why did you wait until now to raise them, in attempt to shame the good doctor into silence?

      You see who now has an agenda? and a political agenda at that?

  12. AMAZED
    June 29, 2014

    DR.Pascal, you could not have said it any better but alas! Will the powers that be listen? How can the department or the minister of health for that matter stand by while the only hospital in the entire North Eastern district of the island close? It it time to stop playing politics with people’s lives. Some of us like to pose questions when the PM is blamed for certain things but who should be held accountable for this mess? He is the leader of the country and should have heads rolling for this. It is obvious that our priorities are not right, if your people are not healthy, you have a sick country and our leaders are sick to play this game with people well being. Put the party colours aside and fix the health system.

  13. M.O.H
    June 29, 2014

    Sir, The entire Ministry of Health in management needs to go starting with the RED Permanent Secretary[P.S] They must step down and allow persons who are concerned about the health of the people move on.All the P.S cares about is to board the plane and give orders.

    • !!!
      June 30, 2014

      EH lass…..LaBour has politicized every top job and agency in THE COUNTRY…It has nothing to do with competence…it is all about your political allegiance..THE RESULT IS GROSS INCOMPETENCE THROUGHOUT THE SYSTEM AS IS EVIDENT NOW…..WHILE THE HARD WORKING AND BRIGHT DOMINICANS DO NOT GET A CHANCE TO CONTRIBUTE ..CHANGE IS A MUST …NOT AN OPTION…

  14. Reader
    June 28, 2014

    We are D/cans .Take ur advice to ur home town Ms Saunders.
    BS madame S we ned more people to satnd up and speak truth to these jokers who jumped the ethical ,moral and other fences.
    Structure you say our state lacks it in every way.
    Tell it like it is what method you talking about. One can speak and address issues with civilized humans not these beings without prefixes.

  15. guard
    June 28, 2014

    Are you suggesting that healthcare in Dominiica is worse than a previous time in our history, better or the same. I am suggesting that we have made progress. I am also suggesting that I am in total agreement with the proposed site for the new hospital. If you know of a better site please suggest. It is all a matter of opinion. We have already been through this. Dominica ranks very favorably in healthcare in the world.

  16. Anonymous
    June 28, 2014

    I was hoping for some prescription for the better management of the “Chikungunya epidemic” as per your topic sentence. Is there going to be a sequel to this article that will provide that information?

    • No more light bulbs
      June 29, 2014

      It is not rocket science. I can give it to you. Daily foggings and getting Cuba, Venuzula or China to give every household 100 cans of insecticide. The vectors don’t stay one place, they move to more favorable conditions; More so, where people bathe with Loubiere water.

    • English Rose
      June 30, 2014

      When Dominicans start to practice more cleanlinesss, then such diseases will not have such an impact on tehm. There are several players in this game … it starts with the CITIZENS anD their laissez faire attitudes towards keeping their homes and surroundings clean. I remember when growing up as a child, everyone swept their yards and disposed of their trash everyday – sometimes twice a day. The ROSEAU TOWN COUNCIL used to have people sweeping the streets and sidewalks everyday. Rats and dogs running rampant in the streets were an oddity. Dominicans seem to have lost their sense of pride and with that will come more disease. Stop looking to the GOVERNMENT to fix everything. Prevention is better and cheaper than cure. Watch your diets, clean up the place and there will be less need for hospitalization.
      God help you all!

  17. Ras B
    June 28, 2014

    I share IP’s concerns expressed in this well written article. I have from this distance observed the palpable decline in our primary and secondary health services. It seems that we are drifting along from one public health disaster to another. In 2012 and 2013 we had people dying from leptospirosis because of the failure to acquire the proper medications for the afflicted. In 2014 we have a mosquito borne infection wreaking havoc on the country with no obvious signs of arresting the disease.

    Why you may ask? Is it because of lack of leadership? Is it because of lack of vision? Is it because of carelessness? Is it because of defective administration or is it a combination of all of the above? My guess it is!!!! So may the medical stalwarts in our Country IP, Hazel, Rhonda and the others from my ‘sifocol’ days rally around each other and rid the country of this mockery of health leadership.

    Surely, our previous leaders have given us strong shoulders on which to stand, so please don’t allow them to roll over in disappointment in their graves!!!!!

  18. Anonymous
    June 28, 2014

    Talking about health care services, I have noticed that Dominica is not doing too badly when in coms to health services worldwide. I just read a ratings list for worldwide healthcare services. As bad as we think or healthcare services are we are still among the better ones. There is always room for improvement.

  19. T mama
    June 28, 2014

    Great article, and totally agree…also we must remember that the Government says they are going to build new hospitals, that is fine But it is not the BUILDING BUT THE SERVICE…PMH needs better equipments, more doctors and better service to save our people….when you are genuine with your care and love great things happen….and Ministry of Health see about your nurses, many are getting injured on their jobs and no one is seeing to their needs,,,,Step up…..Time for Change People of DA

  20. mm
    June 28, 2014

    It is nice to see someone from the medical field addressing this serious issue, people lives and jobs are at stake, god bless, lets up politics aside this is our country, our village and land, Dominica belongs to all of us, a healthy people builds a healthy land.

  21. huh!
    June 28, 2014

    Chinekay!!!!!!!!!!!!!wat spirit of ancestors? we no longer believe in de Creator / Almighty God?
    somebody watching too much african movies??????????????????

  22. Oh Yes
    June 28, 2014

    I am of the opinion that square pegs continue to be placed in round holes. As I have said in the past, technical persons are not allowed or perhaps their contributions are not respected in Dominica. For whatever reason politicians, qualified or not, take on responsibilities for which they are qualified, yet fail to take responsibilities for outcomes especially bad ones. This Marigot hospital saga is a national shame. Our national leaders must seek AND take advice for community and national enhancement programs. The bilateral relationship between the off-shore medical schools and the ministry of health is weak, or at least seems weak for lack growth. What are the accrued benefits over the last 35 years? Is it just pressure testing and glucose testing and a few employment opportunities? There is need for a reviewbof this relationship and the overall management of the health sector. The doc knows what he is talking about. If it’s been construed as political so be it but I have read his work and listened to his reasoning and he makes lots of sense. Everythingbin this country should not be political. Messages get misread and distorted because someone does not like the messenger.

  23. June 28, 2014

    Excellent piece of article.New building, no equipment defeats the purpose.Politics aside, its very embarrassing to have a healthcare system in disarray. Politics should not be a factor in the development of our healthcare system, irrespective of the location.

  24. DD
    June 28, 2014

    Well said Dr Pascal. I am a Trauma/General Surgeon originally from Pointe Michel. I have made several attempts in the past three years to contribute to the healthcare system in DOminica. I had an American company willing to assist with laparoscopic and endoscopic equipment to facilitate an Endoscopic Suite in Dominica. We got the run around and lack of response just turned us off. I would like to contribute my expertize to my country but there are elements that are holding us back.

    • CYRIL LLONGTING
      June 29, 2014

      Never turn back! Keep on working at it…please, and thank you!

  25. Malgraysa
    June 28, 2014

    Medard once said we can train nurses and EXPORT them to B/dos for ej and other regional states.
    And they cannot fix the Marigot Hospital and ward off the current epidermic with all D/can expertise and our so called best medical services in DA!

  26. Malgraysa
    June 28, 2014

    IP for Chief Medical Officer .Dr.David for Marigot district officer. Keeping it Ahfouahthem.

    • Ideal
      June 29, 2014

      He is from Marigot, but is he doing anything for Marigot he
      should have been aware of the bad state of the hospital, does he ever visit those hospitals or does he just sit in his office in Roseau. Please correct if I am wrong but is it one of his duty to visit the order hospitals now and then..I might be wrong

  27. Fix it
    June 28, 2014

    Somethiing has to be done.

    • Views Expressed
      June 28, 2014

      Something MUST be done: Here it is:
      Kick Skerrit and that damn Labour Party out of office. They are incompetent, lazy…lacks visionary skills…..inept, etc etc.. And the List goes on…please someone help…take it from there.

      CHANGE IS AMUST….TEAM DOIMINICA

  28. Lessons in History
    June 28, 2014

    Dr Pascal’s article ,brings to my recollection an article written by someone with the penname Zandoli. It was highly critical of the Administration then not only for the medical neglect but moreso, of the Cuban grads during that era. Funny as it is, the current CMO is a Cuban grad. Now Cuban grad abound in or medical services. Today there are so many. a few years ago, some had to seek opportunities in other regional states . If memory serves me right the article was Cuban trained docs sidelined. Today it would read Marigot Hospital and the Chikungunya epidemic sidelined with grave concerns .

    • Reader
      June 28, 2014

      yep I remember that article and Zandoli too. It was a doctor who UWP screwed work wise after elections also a nurse who contested elections. This guy could write which got him into trouble with the UWP chief his former teacher.
      He attacked DFP like the gov’t after DFP Eddie did not like that so refused him re=employment.
      The current political leader interviewed him on what about then wrote about him in the newspaper after the TV interview then the Doctor lashed out at LL who wrote under the name Starlight at the time. He hit Starlight so hard in his response Starlight disappeared like he did when Tony et Al decided to serve him. where is that doctor now?
      Hundreds of Dominicans who did not like starlight today dislike him more.
      So it’s nothing new doctors doing their little thing on the side challenging and putting SH’s in their places. Zandoli took on evil ones so is Dr IP I think they were school mates
      So these guys did not only learn medicine they learned truth and to write effectively they seemed not to have eaten their recess as we say locally.
      We need more IP & Zandoli docs to take on the powers that be.

  29. Just 4Fun
    June 28, 2014

    Just for fun as name is serious not joking matter in this piece. Medard will use this to impress the need for more Sino funds for his re-election there by guaranteeing re;election when ellections are called deserving ? certainly not.But The former Solid Team ,renamed Team Dominica has become gaseous in state n longer solid(if it ever was)
    It is clear to all and sundry DA will continue to slide down the steep slopes of disaster until the ignorant at home and in the diaspora continue to habour all themalecow doodoo we have been tolerating over 36 yrs. I say without reservations the opposition is useless in contentand form let alone the current neo DLP composed of the very vines and branches who have brought DA to what it is today
    Therein the need for a gov’t of national salvation void of the vestages of the DFP and all opportunists who have boldly & secretly assisted in the decline of the Commonwealth of DA.
    99 dislikes and 1 like stll ain’t going to change what we are and become.
    Hey! you the reader yes you reading this remove your mask and be honest help DA get out of this UWP vs Neo DLO quagmire.

    • National Salvation
      June 28, 2014

      And just 4 fun, we labourotes will vote for Cabral.

    • Deja vu
      June 29, 2014

      Just 4Fun you are like a prophet man! You said 99 dislikes and 1 like stll ain’t going to change what we are and have become. And boy , did the hypos fall for it. They did not remove their masks lol! Ya , you caught 6 napping .
      They did not remove their masks and be honest . They are 6 culprits who support corruption and evil. The gang of 6 lol not even sensible enough not to comment and to get caught in the web.

  30. Change is a must
    June 28, 2014

    Congrats doc…It is high time that our BEST brains are utilized in the future development of our country. We need people with broad strategic visioning to take Dominica out of the deep hole that LABOUR has buried it….It cannot be business as usual for the development of Dominica any more….we are too far behind our sister islands now…..
    .In order for DA to experience serious progress we need to think big…think outside the box…and approach all major development project as an income generating businesses…
    LABOUR DOES NOT HAVE THE CAPACITY TO DO THAT.

    • Am outside the box
      June 28, 2014

      Who has it Change is must?Team Dominica? No The Freedom dominating DLP? no
      How does one manage to think outside the box when one is in the box? When you can answer the aforementioned I will continue.

      • No more light bulbs
        June 29, 2014

        It shows that you have a very low IQ. Just knock out one side and turn the box into a triangle.

      • Change is a must
        June 30, 2014

        When you release yourself from mental slavery …you will get out of the box!!!!!!!

  31. Just 4Fun
    June 28, 2014

    Previous admin, was the DFP after 1979 Hurricane David- (the CMO is a David too lol).
    The DFP’s reps are in Power in addition to a couple of opportunists who have labour roots or vines.
    The tepid responses are signs of our declining ability to overcome the major challenges of health care .The medicine man of 95-2000 did nothing for Marigot. The current CMO hails from this very affected village. His position is strictly ceremonious ,the author providing his observations and critisms hails from AhfouahweeLand so are some of the biggest mouthsin Radioland.
    I say las parle parwole anytille
    Elections are due in 9monthseither Medardcome up with some of the typical source of funding(the Sinomonies) or Marigot and the environs habitants will have to go to Posse or Goodwill.
    Soon homes all over DA will look like some of it’s fellow worldwide mosquito infested zones covered in mosquito nets. AntiChikungunya drugs will be recomended for travelers to DA. There goes patronage for the creole festival carnival and all other revene attractions on island.

  32. by the school
    June 28, 2014

    An excellent article. The tragedy is that it will fall on deaf ears. A real pity.

  33. real
    June 28, 2014

    I hear u doc. Beautiful article and truthful. Enough of the buildings..were need appropriate facilities that are FUNCTIONAL meaning in space, skilled personels and services.

  34. New Yorker
    June 27, 2014

    But where is Dr. Grell? Is he he denial of the facts in an area he has served the country for many years, we need to hear his views.

    • There you have it
      June 28, 2014

      Good question. Wouldn’t be surprised if he feels somewhat responsible, when he was CMO, and had the opportunity to help do something about it. Instead, he has been looking after himself while rubbing shoulders with the political-powers-that-be.

    • Deja vu
      June 29, 2014

      At Ross making his $.Think all D/cans sort ?Dem man like frogs jumping from stone to stone. Shouting the queen is dead long live the king after 80-90 and long live Neo DLP 2000-2004 and long live Medard 2004-present like on a resume of ethics and morals.
      Like Aaron Levine of Maroon 5″ follow that money and watch it grow.”

  35. silver sliver
    June 27, 2014

    I couldn’t agree with you more, that the ministry of health lacks leadership, creativity and vision. I must,however, disagree with your concept of decentralizing the secondary and tertiary care, and on the absolute need to move the hospital from Goodwill. Dominica, a tiny mountainous island of 65,000 inhabitants needs to use it’s resources wisely! There is enough space from the ” doctors residence to the nursing school”, to build a six to ten floor structure to satisfy our needs, and eliminate the collection of buildings that we currently have. The tertiary and support services need to be improved, work closer as a team to try to provide the best care available. At the end of the day it is not the size, beauty or location of the hospital that matters, but the quality of service provided!

    So whats up with the “trauma center” in Marigot? Somebody please help!!

    • Dr Pascal
      June 28, 2014

      Thanks. Again you have just reinforced my point about wide stakeholder and community participation as well as the need for the appropiate health research to inform objectives and approaches to acheive them.

    • SMH
      June 28, 2014

      The Ministry of Health lacks leadership at all levels. The minister and PS are more interested in malicious gossip and interfering with the livelihood of citizens that they deem to not support the government of the day. With all the challenges confronting the health department one would think they are busy at work trying to put things in perspective. They sit on Boards perpetuating their gossip, lies and mischief. This is a phase that WILL come to an end.

    • @Silver coin
      June 29, 2014

      Silver coin “trauma center” in Marigot? Somebody please help!! Ya man! Marigot Hospital has suffered trauma& needs help.

  36. Anonymous
    June 27, 2014

    Oh please chikungunya is all over the Caribbean and else where. And you fully well know that Dominica have one of the best health care system is the Caribbean.

    • ....
      June 29, 2014

      Nonesense……………..fool yourself….

    • I like it
      June 29, 2014

      lol

  37. Barbara Saunders
    June 27, 2014

    Just wondering

    Is this the new standard? For a person who is part of the health system in a reasonably senior position to make recommendations and criticisms of the internal workings of the system of which he is a part on DNO rather than through a reasoned submission to the Management of the Hospital or Ministry of Health?

    Perhaps, to give the benefit of the doubt, he has done so previously without a response/reaction from management so this might be a last resort?

    I believe all organisations have some sort of code of ethics for their employees. In some cases, the terms of contract of employees do not allow them to disclose information about the workings of the organisations for years even after their contracts have ended. Not saying that this should be so in this instant case but it just strikes me as odd that this can be seen as ethically acceptable.

    If this is the new standard, can we expect it to continue to be upheld and tolerated from other Government employees in the future if things change? Just asking!

    • Dr Pascal
      June 28, 2014

      Fair comment. I suppose I could have hidden behind a pen name but it’s not in my “spiritual” DNA and the genetic modification is not yet complete. In the past I have suggested the enactment of a whistleblowers type act in the public service to protect the country. No response either.

    • Voice
      June 28, 2014

      Well let them fire him nuh?

    • true
      June 28, 2014

      Does this government listen to professional who are SMEs?
      all hey care about is lining their pockets

    • !!!!
      June 29, 2014

      Don’t pretend you don’t know that views are solicited or accepted based on who you are perceived to support politically….

    • Standards my foot
      June 29, 2014

      IP will respond Ms Saunders. Look like you are caught up in the old standards.In DA’s politics and MO standards are like a foreign language even if we now have many who speak French ,Spanish and now Chinese.

  38. June 27, 2014

    Excellent and to the point. This government does not have the right leadership for this country. P.M got to go

  39. Concerned citizen
    June 27, 2014

    I agree wholeheartedly with the doctor. But we should remember by the health administration we are to think of the current technocrats who have failed to deliver! I ask the good doctor and his team of colleagues to challenge the current PS,CMO and PNO what are they doing for health other than travelling,attending meetings and hearing themselves on the media. These are the ones I hold responsible for the decline of our health services.

  40. Erasmus B. Black
    June 27, 2014

    The health services saga, as outlined by the good doctor, is such a classic case of cognitive dissonance!

    When he was appointed Minister for Health, the Member for Roseau North cited a lack of proper management as one of the most major setbacks facing the health sector. And whist prioritizing the management of communicable diseases as his new thrust, he also touted his superb management skills. That was 4 years and 6 months ago. The whole approach however, seems to have been very near-sighted while the ongoing strategy seems to be attacking ideas and voices not originating from “Labour.”

  41. KALINAGO CANADA
    June 27, 2014

    Very eloquent comments.
    Jah bless he who cares for others.
    Keep fighting the good fight my brother.

  42. slave leader
    June 27, 2014

    doc….man,

    indeed, the comments and views articulate the present situation and I beg, it call for the tertiary approach and strategy to avoid a peril situation our people health. Let be alone,….you never can tell, its an unhostile take over to perish the common man…..

    another brave heart!

  43. CHIK
    June 27, 2014

    Thanks, The Ministry of Health has a P.S that IS SO PARTY POLITICAL she thinks, she is the Minister of Health She puts her Red colour before work and cannot work as a Team. She surely is not a Team player. She should go back to her notes on MANAGEMEMT.

  44. real possie
    June 27, 2014

    Doc here it is you talking about what was done politically but your whole post has you political preference all over it, am here looking for you to add in all the expensive equipment’s that was brought in for cancer services no mention not to long I saw they were addressing the infant mortality issues I must say the way they go about the old ways of providing health care services needs a major overhaul at the same time I can say that is all over the world ask someone who goes to the hospital in ST Thomas and they will tell you how long they have to wait to be looked at, am sure these people get training but some of them are just hell bent on not doing their job rite like for instance there’s a nurse in Marigot named May I was told all the patients love when that lady working she goes above and beyond. I remember they were looking at some where else to build the hospital rite here on DNO people said its up a big hill but am sure it can remain where its at rite now just put in a better road network there ie a hospital only lane, you might be right with all or most off what you said but putting politics in what you had to say was being political in your judgment and that is why I think things are the way they are in Dominica we wont say and do things the right way we only do things to score points for people and party. PS there’s a lot off other islands that have not put as much into their health system like Dominica has that’s all I will say.

    • real possie
      June 27, 2014

      And don’t get me wrong the minister for health should be held responsible for the state of what Marigot hospital condition cause at some point he should be going to all the clinics and hospital on island at some point to make sure all is well I know he was sick for a while but who ever was acting that was their job too and all the Palreps should do the same but that’s DA for you the people don’t hold their feet to the fire so they keep doing a poor job in some of their work in Gov.

  45. Anonymous
    June 27, 2014

    I admire your courage sir!REAL AND TRUTHFULL VIBES.

    • June 28, 2014

      Great article! But with some clarification needed. First off you must have completed all your government bonds or you are so confident that you will become the next Minister of Health under Lennox that you speak and write so liberally these days, espousing your personal view wherever you can. More power to you. I am a bit perplexed though by this statement: “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.“ Are you giving kudos to a particular predecessor or predecessors in one hand and taking it right back with the other hand? What period or time of reign are you referring to? OJ from Aug 1979 right up to election time in 1980? Eugenia from 1980-1995? Or Edison from 1995-1999?
      “If like our predecessors in 1979, we are to fulfill our mission of delivering quality health care services to our present and future citizens we need to reevaluate our purpose, function and methods.“ Which predecessor or predecessors are you giving praise or not? That, my friend, made the article too vague.

      • Dr Pascal
        June 28, 2014

        Thanks for giving me the opportunity to clarify for your benefit and hope you will accept it .I am referring to our predecessors in Health Administration at that time. Dr D.O.N McIntyre(R.I.P), Dr Carissa Ettienne, John Fabien(R.I.P), Jennefer Astaphan, Jean Jacob, Mr Charles Maynard(R.I.P) etc.

  46. LISTEN!!!!!
    June 27, 2014

    Doc you have made many eloquent and strong points in your commentary but it will fall on deaf ears as our current administration is not about doing right by Dominicans but pleasing themselves only…………….

    I know you are going to get attack by this administration for your well informed piece but I am very aware Doc you can defend yourself.

    Who have eyes shall see and ears shall hear!!!!!!

    Blessing!!!!

  47. We the People
    June 27, 2014

    Government has employed Experts like you to do the work, so if things fail, then you all have failed. :?:

    • New Yorker
      June 27, 2014

      We the People, Hoog wash take that to your labar camp, politicians do not listen to or take advise from the experts most of the times.

    • real
      June 28, 2014

      Did you read well? The health professional are not consulted..so most time they are left with a poorly functional facility. So since the powers that be are refusing to consult the health professionals, who have tried repeatedly to advice but are give cold shoulders….he is doing something the best way he knows how…this article.

      • Anonymous
        June 30, 2014

        As far as i’m hearing on the ground from thepeople in health care they are being consulted in most of the decision making. Wherever politics rears it ugly head there will always be confusion.

    • Truth be Told
      June 28, 2014

      It never ceases to amaze me that there is always one like you who understands nothing but is always so eager to comment, open your mouth and show the fool that you are! If Government does not set the right policy and put the right systems in place it matters not who they employ – failure will inevitably follow! You follow?

      • There you have it
        June 28, 2014

        Well said, Truth be Told. A minister is appointed following his Party election win, and straightway, he becomes the authority in his ministry. Strange, isn’t it?

    • by the school
      June 28, 2014

      What a myopic manner of shifting the blame!

  48. Truth
    June 27, 2014

    Preach it. Dominican need to wake up.

  49. Voice
    June 27, 2014

    Very good proposals for the current “Leadership” to consider. Unfortunately, they will not , so how are we going to see that they “step aside or be held accountable”?

    Just on aside, you needed to give the article one more read through though and that picture of you is too dark. We can hardly see your handsome face in it.

    May the ancestors be pleased.

  50. vieille case
    June 27, 2014

    thank you sir

  51. Country needs Purge
    June 27, 2014

    The system is crippled by scritgunya. They say there is a lack of resourses and the fogging process is at a stand still. The ravines and the busheries unattended to. The elderly, the babies, the sick and the crippled, the sysem does not care about them. Our tax dollars are not being put into good use but into election campaign.
    I have made up my mind. They can jump hi, they can jump lo, I am going to vote for the opposition and I am ready to make my little contribution.
    The country needs purging and I think Dr Emmanul can make some recommendations as the topic ‘constipation’ is his feature today.

  52. 100% Dominican
    June 27, 2014

    Great article Doc…but have a little bit of an issue with this statement “If like our predecessors in 1979” think it should be 1980 to support another statement u made “However, the insight commitment, creativity hard work and clarity of vision of the then leadership delivered our once renowned Primary Health Care System”…all this happened from 1980 with the then DFP government headed by the Dame and such esteemed ppl as Dr. C Ettienne

  53. Ian
    June 27, 2014

    This is a wonderful contribution from Dr. Pascal. A hospital building is not a health care service!!!! This says a lot.

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