COMMENTARY: The National Health Commission, My Reflections.

Dr. Irving “Eipigh” Pascal

I was initially disappointed when I missed the 11am appointment to a hearing with the newly formed National Health Commission. I had welcomed this long overdue Commission needed to address the HEALTH status of the nation. I felt vindicated for the ire I had evoked in Parliament four years ago when I had dared to request an inquiry into the management and leadership of the health system in Dominica. However, a closer read of the invitation letter evoked some reflections that lead me to predict that this commission will achieve little but will surely give credence the old cliché “that doing the same thing and expecting a different result is insanity”.

My skepticism starts with this paragraph from the letter dated May 12th 2018, inviting me to a hearing with the Commission. I quote  ‘The proposed Commission will function as a policy ADVISORY body which will assess the status of the provision of health services, health care, health facilities and resources in the Commonwealth of Dominica and SUBMIT RECOMMENDATIONS for improvement having regard to the declared priorities for the health sector as stated by the Government of the Commonwealth of Dominica, for a more CLIMATE RESILIENT HEALTH SECTOR.”

First, given the widespread knowledge of the appalling state of affairs in the nation’s health sector there is enough factual information available to task any Commission to begin its work by ensuring the implementation of existing recommendations.  This Commission from the outset, however, will have no authority to ensure implementation of any recommendation old or new. This could have been easily rectified by ensuring that the two individuals holding positions in the Ministry of Health with the legal and administrative responsibilities (Permanent Secretary and Chief Medical officer) to advise the Minister and the Cabinet and implement recommendations, are on the Commission. Neither of them are  but interestingly, several members of the Commission have occupied one of these positions in prior incarnations. I don’t consider this an oversight by the Government who I would think is the convener of the Commission; neither do I believe that the “reincarnated” members of the Commission with more than 100 years of administrative experience between them, are oblivious to this apparent folly.  My skepticism is giving way to morbid pessimism. What is really going to change?

Secondly, the Commission did not respond to my request for a list of the declared priorities of the government for a CLIMATE RESILIENT HEALTH SECTOR as stated in its function. This to me, speaks volumes as to the seriousness with which this important endeavor is being undertaken. I had indicated that this information would enhance my preparation and contribution at the scheduled hearing.

Thirdly, as far as I am aware, several present and former senior health care practioners have not received invitations to a hearing with the Commission. The feedback that I have, also suggests that hearings have served primarily as a complaints board for some who attended. Furthermore there is no open day for either concerned “non-invited” health care workers or the wider public to ensure wide stakeholder participation.

I am not optimistic when such a Commission whose mandate is to increase “climate resiliency” in our health system, would be at this stage, preoccupied with collecting known complaints of deficiencies in the Health System. There is a WHO document “Operational framework for building climate resilient health systems. Switzerland: World Health Organization; 2015” that speaks eloquently as to what we should be doing with regards to improving the resilience in our health care system.  The longer we take to act within the guidelines of this framework the less “resilience” there is in the health care system.

I think it is therefore understandable, if I consider the Commission”s real mandate to be another futile cynical attempt to diffuse the growing disenchantment and disaffection in the health sector by affording health care workers an opportunity to naively vent to those with no real authority to improve their situation or the health status of the country.

Like the Commission, I have no authority to ensure implementation of any recommendation I have made. A Marshall Plan for better health care provision in the country is needed. However, in pursuing this, it would serve us well to be guided by the fact that it is the patients who ultimately suffer when the final word on “the practice of medicine” does not originate from your best and most knowledgeable medical practionners. Worst yet, should “the practice of medicine” be subject to the toxic influence of those who really don’t have a clue as to “the purpose and function of medicine.”


May the spirit of my ancestors be pleased.

Dr Irving “Eipigh”Pascal MBBS, FRCS.

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  1. Empress
    August 19, 2018

    From the pattern of behaviour of this government it would most likely be the same people under whose watch the health system deteriorated.No change just more of the same.

  2. Judith Pestaina
    August 19, 2018

    By the way who are the members of the Commission and what are their credentials. I would hope they are persons with the requisite skills and experience to make relevant, timely and ‘resilient’ recommendations to the policy makers. SMH

  3. Neverson St jean
    August 19, 2018

    Truth to power doc. Well stated

  4. Liz M
    August 17, 2018

    I can’t believe they didn’t invite Dr. Johnson, what kind of politicking is that na? At least they invited you so you owe it to us to have attended, that’s bad it seems you protested for the sake of protesting.

  5. Diasporan
    August 17, 2018

    Play your blue politics Doc. You have a problem with everything but cannot come up with solutions. Dominica Health systems although laden with its own problems is one of the most resilient health sectors in the world. You are great ENT specialist but you must allow the process to take place before criticizing. Pessimism can’t take this country anywhere

    • Barbara Saunders
      August 17, 2018

      I hope the waste of time commission gets an opportunity to hear from the aggrieved public. To hear of the doctors who are charging people exhorbitant fees for surgeries and other procedures even when they are seen by those doctors in the government hospital.

      I hope they hear that we are now like the USA where they aint touching you until you can come up with the $6,000 and $8000 for surgery performed in the government theatre, with the government paid nurses and other attendants, with the government instruments etc.

      I hope they get a chance to hear of patients being referred to doctors’ private clinics from the government hospital so that those fees can be charged and it is now going to be worse when there is no Ross where most of them worked on government time to supplement the incomes.

      I hope they get to hear that at the end of the day, no politician gives injections or bathes patients, so who bears the greater responsibility for the state of the system?

      • Liz M
        August 18, 2018

        What are you really saying, in lay man’s terms?

      • %
        August 19, 2018

        Barbara,Dominicans are dying.Call upon the lazy cannot do government to step up the health services…Is it that you are one of the “”cannot do”” labourites?
        Skerrit Must Go
        Skerrit Must Go
        Lazy Skerrit Must Go Now

      • Barbara Saunders
        August 20, 2018

        Of course the politicians have to step up. Provide new hospital, all the resources, all the equipment but staff still have bad attitude what is the result?

        the other thing pardner, I see you guys encouraging all kinds of behaviour and think it is Mr. Skerrit who will suffer the consequences. Let me say, whatever culture and environment that you create that is what you will reap. You think people are going to magically change their behaviour with a change of government? Wait my boy! I have actually begun to feel sorry for you all. Retribution is coming, trust me.

        I agree 100%. Skerrit must go. I cannot wait for him to go and look after his young children. Come on next one. Let’s see what you are made of. This is not going to be sitting behind a radio console. This will be reality.

    • Neverson St jean
      August 19, 2018

      One of the most resilient sectors in the world??????? What the hell are u smoking

    • New Yoker
      August 20, 2018

      You must be insane to say Dominica heath system is one of the most resilient. Tell me what is in place to rehabilitate stroke vistims. I am American trained and experienced Dominica healthcare first hand. Stop the ignorance

  6. Roger
    August 17, 2018

    Why is it always about the messenger and not about the message? Read my people!!! Not who wrote the story but what the story is telling us.

  7. REAL!!!!!
    August 16, 2018

    “Your Health is your Wealth.”

    What are these guys plans, to kill out Dominicans at home and replace them with Mr. Ling?

    Thanks Doc for sharing.

  8. Peeping Tom
    August 16, 2018

    So you vex that you have neither policymaking nor policy implementation power, that some of your pals were not invited to partake in the Commission, and that you did not receive information you requested and because you are so vex, you think the public needs to know. Really? What is the public value of this badly written rant?

    Frankly, for a man who works so hard to make others believe in the upliftment of black people, you, Dr. Pascal, spend too much energy in negativity. Show some maturity, for once, and be counted when it matters. Stop fighting and making daybah. Leave that for Linton et al.

    • viewsexpressed
      August 16, 2018

      You are a real peeping Tom, with absent minded thoughts that really promotes your stupidity and disrespect. Total disrespect. Dr. Pascal is a proud Domininca, excellent service

    • Far-i
      August 17, 2018

      PEEPin’ tom I think you need a FAR EYE and a HEARING AID (talk to Doc). Please be reminded that what you see,hear and feel is filtered through your own experiences,values,beliefs expectations and even DESIRES.
      Peace out!!

  9. August 16, 2018

    Any reason for you not to get involved, always my way or the highway.

    • Crap'o
      August 16, 2018

      You are joking, right?

      • viewsexpressed
        August 17, 2018

        No, not joking, an iodic blind to reality and promoting ignoramous. It is so obvious with the Peeping Toms, the Alexanders and the the rest of the blind loyalist failing, inept and waste of time PM Skerrit.
        Doctor Pascal, a well renowned Medical specialist in Domininca. thanks much for your comments. This corrupt labour Government and their blind loyalist are not of the level of goof governance, and continue to show and demonstrates their bind loyalty to a failed PM Skerrit with idiotic language and comments.
        It is time this failed government goes and prepare for decent government and governance with serious, qualified people running our poverty stricken island and elevate to one of social and economic development.

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