March 25, 2019
Hon Dr Kenneth Darroux
Minister of Health and Social Services
Dear Hon Dr Darroux,
Good health and blessings to you.
For some years now the nursing service has been under extreme and increasing strain to deliver adequate and quality health care services to the people on Dominica. This is due to less than positive practice environments. Unfortunately Tropical Storm Erica and Hurricane Maria caused, aggravated and added to the strains and while we were hopeful that your ministry would address them in reasonable time you have proved us wrong.
Most if not all nurses would have made their work concerns known to their supervisors over and over again and we are aware that some have communicated them directly to you at a meeting at the PMH about this time last year. Some wrote to your ministry and copied their letters to our association and to the Public Service Union. Our executive also communicated most if not all of these concerns to you in written communication and in a face to face meeting on April 13, 2018. Additionally we know that the Public service Union has not only written to you but has met with you on the behalf of the troubled nursing service.
To date minimal relief has been reported and the issues are escalating, consequently nurses are choosing migration as a way out. This is very worrying, and it is compounded by the fact that our esteemed partners in healthcare – the physicians are also leaving at a rapid rate.
In light of the above we wish to ask you some pertinent questions in the hope that your responses would enlighten us on solutions we may have missed. But first we thank you for relief in the following areas :
1. 100% increase of the $20 night duty allowance
2. repeat uniform allowance disbursed in view of Hurricane Maria
3. repair of some health facilities damaged by hurricane Maria
4. appointment of several nurses after a prolonged period of temporary employment
5. the recruitment of foreign nurses to partially address staff shortage
Now for the questions:
1. Is your government considering salary upgrade for nurses as recommended by the Caribbean Center for Development Administration since 2013?
2. Why haven’t you apologized for falsely accusing the DNA of recruiting nurses for overseas employment?
3. Why is it that security is very unreliable and inadequate at the Accident and Emergency department at the PMH and other health facilities where staff are often working in fear esp during the night shift and during festive seasons?
4. Can your government introduce a Workplace Violence Prevention for Health Care Workers Act?
5. Why are the staff and patients of the Acute Psychiatric Unit not relocated to a safe environment and why are they forced to inhale construction dust and face other construction risks during the renovation of the unit which begun since the week of Sept 11, 2017?
6. Has your ministry adequately addressed the security concerns of the staff of the Reginald Fitzroy Armour Hospital reported since October 2013?
7. Why hasn’t your ministry addressed workplace bullying as investigated and reported by Mr Gerard Burnette since 2011? Where is that report?
8. Can you update us on any progress made concerning policies to address psychological violence in the workplace?
9. Has your ministry repaired the leaking skylight overhead windows at Castle Bruce health center reported on May 9, 2018, and which you visited?
10.Why doesn’t all health facilities have a functional landline phone, and why do nurses have to frequently use their personal phones to communicate work matters?
11.Why are district nurses who are transfered not accommodated in proper houses?
12.Why are nurses appointed on probation after four and more years of employment?
13.Why does an already stretched nursing service have to spend time teaching nurse recruits English on the job?
14.Why is it that foreign nurses are provided with transportation to their homes after the late shift and local nurses are denied?
15.Why is it that the Newtown Health Centre is still being housed in a cramped container at the Roseau Health Centre at the Botanical Gardens?
16.Why is it that some nurses on the Dominica Nurses Association are being victimized and declined permanent appointment in positions they have acted with excellence for prolonged periods?
17.Considering the qualification criteria for nursing leadership positions in Dominica was reviewed during the period 2011 to 2015, why is it that some nurses have been appointed to some of these positions after that period, without the required qualification?
18.What can your ministry do to arrest rampant victimization and favoritism in the nursing service?
19.How is it that two nurses have to operate from their private vehicles to deliver primary health care, because their health centers are still compromised from the hurricane?
20.What is the reason for the prolonged delay in the commencement of the Marigot District Hospital?
21.Why is the Mahaut Health Center still covered with tarpaulin? Why are all health centers not repaired as a matter of primary healthcare priority?
22.If the nursing service is a critical and essential service such as the police, fire, and prison services why isn’t there a deputy head as in the case of the other services?
23.Why are some Health Center’s doors and windows still boarded up?
24.Why are nurses allowed to work in mold infected health facilities to the point that three nurses are on sick leave at the same time for mold related reasons?
25. Why is the Coulibistrie Health Center still being operated from a church
26.Why are all district nurses who have been transferred from their home communities not being given proper and paid accommodation?
27.Does your ministry have a nurse retention strategy?
28.Finally is your ministry aware of the campaign for Positive Practice Environments (PPE) for Health Professionals? If not, here’s an invitation to join us.
The campaign which has been initiated by the International Council of Nurses(ICN) and the World Medical Association(WMA) among others, and endorsed by the World Health Organization(WHO), promotes that “All health sector stakeholders, be they employer or employee, private or public, governmental or non-governmental, have their respective and specific roles and responsibilities to foster a positive practice environment” (WHO, ICN, WMA et al, 2012). We hope you can draw practical interventions from the key characteristics of the PPE available here :
http://www.whpa.org/Key_Characteristics_of_PPE_for_Health_Care_Professionals.pdf and save our
dwindling nursing service and our collapsing health sector.
We look forward to your respectful, open and favorable responses as well as your honest commitment to do better for the nursing service and the entire healthcare sector.
A better health sector means a healthier Dominica because quality workplaces most definitely translate to quality care.