How Could ObamaCare Help The Bahamas?

The Importance of National Health in The Bahamas

Moving Forward With A National Health Care System For The Bahamas

By Dr Kevin Alcena

“The... patient should be made to understand that he or she must take charge of his own life. Don't take your body to the doctor as if he were a repair shop.” (Quentin Regestein)

This article will attempt to show the readers in an objective systematic way, an analysis of the importance of national health in The Bahamas in the form of a parisology.

“To enjoy good health, to bring true happiness to one's family, to bring peace to all, one must first discipline and control one's own mind. If a man can control his mind he can find the way to Enlightenment, and all wisdom and virtue will naturally come to him.” (Buddha)

“The chief condition on which, life, health and vigor depend on, is action. It is by action that an organism develops its faculties, increases its energy, and attains the fulfillment of its destiny.” (Colin Powell)

A National Health System coupled with good system planning would benefit the Bahamian society in a very diamantiferous way. We have to have a saxicoulus acephalous mandate for our health system for a generation that precedes us.

We must be smarter than the Americans and more diligent and transparent than the British. A comparative study of the two health care systems – The USA and The UK - conducted by some researchers a few years ago revealed that:

“According to a 2006 OECD comparative data study, the total health expenditure in 2004 by the United Kingdome was 8.3% of their gross domestic product (GDP), and the United States was 15.3% of their GDP - whereas the mean of 30 countries was 8.9%. This same study reports health expenditure in the United Kingdom as US $2,546 per capita, and US$6,102 per capita in the United States, - whereas the 30 country mean was US $2,550.

Not surprisingly, public spending differs quite significantly between the United States and the United Kingdom as well. Of their respective 2004 total health expenditure public spending - in the United States was 44.7% - whereas the 30 country mean was 73%.” (The Health Care Manager, Volume 26 Number 3).

The Bahamas can also learn a lot from the Swiss and Rwandans Health system. For example, “Rwanda’s health sector has undergone a fundamental transition in the last century; in the time before colonial era, health care consisted of traditional African healing methods. The German and later Belgian colonial period saw the emergence of faith-based health care, and with it - the introduction of modern treatment methods.” (Rwanda National Health Sector Policy, 2005).

We have to be very innovative and creative. The most important element in implementing a health system in the Bahamas is a health information system.

“A national health information system (HIS) plays an important role in ensuring that reliable and timely health information is available for operational and strategic decision making that saves lives, and enhances health. Despite its importance for evidence-based decisions, health information systems in many developing countries are weak, fragmented and often focused exclusively on disease-specific program areas.” (http://www.who.int/.../1HMN_Architecture_for_National_HIS...).

“Health care in Canada is delivered through a publicly funded health care system, which is mostly free at the point of use, and has most services provided by private entities. It is guided by the provisions of the Canada Health Act of 1984.

The government assures the quality of care through federal standards. The government does not participate in day-to-day care - or collect any information about an individual's health, which remains confidential between a person and his or her physician.

Canada's provincially based “Medicare systems are cost-effective - partly because of their administrative simplicity. In each province each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses health care to be involved in billing and reclaim. Private insurance is only a minimal part of the overall health care system.” (Wikepedia)

Hippocrates, the Greek Father of Medicine once said, “A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses.”

Health care is not a new phenomenon. Imhotep the Father of Medicine, was not just an imaginative architect; he was also a doctor and philosopher of the human body and mind and he contributed to medicine in a number of ways:

• “Imhotep's concepts included specializations in many methods of medicine, compared to today's physicians who primarily master one area of expertise. He introduced a blend of new methods including astronomy, philosophy, religion and protective amulets to achieve new breakthroughs.

He was a pioneer in helping to develop tracheotomy to resolve respiratory obstructions, cauterization to circumvent excessive bleeding while operating, and blood drainage to cure diseased collections.

• Imhotep diagnosed and treated hundreds of diseases including diseases of the abdomen, the bladder, the rectum, the eyes, and many of the skin, hair, nails and tongue. He treated tuberculosis, gallstones, appendicitis, gout and arthritis.

• A very significant resource of today's modern medical practices is irrespective of Imhotep's medical school; medical tools such as forceps, scissors and surgical blades were all imitative of ancient Egyptian medical apparatus. And certain remedies for elementary disorders that were introduced from ancient Egypt medicine are still practiced today; castor oil for laxatives, honey as an antimicrobial and Acacia as a cough remedy all are in retrospect of Imhotep's teachings and forward-thinking medical protocols.”

Imhotep’s most famous quote was "Eat, drink and be merry for tomorrow we shall die." Of course this is quite ambiguous today as we know diabetes, and hypertension is affecting the global health system like it is nobody’s business, and the general population of our global family is suffering as a result of their eating and drinking habits. Redd Foxx was also sardonic when he said, “ Health nuts are going to feel stupid someday, lying in hospitals dying of nothing.”

According to the statistics posted by the World Health Organization for 2011:

• 346 million people worldwide have diabetes.

• In 2004, an estimated 3.4 million people died from consequences of high blood sugar.

• More than 80% of diabetes deaths occur in low- and middle-income countries.

• WHO projects that diabetes deaths will double between 2005 and 2030.

The inexplicable global health system in regards to obesity and hypertension has impacted all governments in the world in a negative way. Obesity is a resipiscence because it is one of the biggest health problems in the world due to our lifestyle of food choices.

There is a global war on obesity and health experts are stentorophonically crying out to the world’s citizens to stop this trilemma because it is killing us and putting a great strain on the health system. Some statistics taken from the World Health Organization points out that:

• Worldwide obesity has more than doubled since 1980.

• In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese.

• 65% of the world's population live in countries where overweight and obesity kills more people than underweight.

• More than 40 million children under the age of five were overweight in 2010.

• Obesity is preventable.

“Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” (World Health Organization, 1948).

How would ObamaCare help The Bahamas?

It is quite simple. America leads and the world follows.

It is all indication that there is a new pedagogy in the global health system. ObamaCare will ignite the consciousness of leaders to implement a comprehensive national health service in their respective countries in a bombastic way.

Take a look at Cuba for example. “The Cuban health care system is respected around the world, and is literally decades more advanced than any system found in Latin America. For this reason, the Cuban system serves as a model for Third World developing nations.” (http://library.thinkquest.org/18355/health_care_in_cuba.html)

In conclusion, we in The Bahamas have an opportunity to model our health system with the best management team in our country. National health should be run by a quasi government corporation that compliments strategical business sense in the protocol of them delivering quality health service in a circumambagious way.

“The greatest wealth is health.” (Virgil)

Source/Comment

We live in one of the most violent countries in the world

‘A phenomenal burden’

By CANDIA DAMES
Guardian News Editor
candia@nasguard.com


A closer look at the impact of crime on PMH


The high level of violent crime is stretching resources all around, and officials at Princess Margaret Hospital (PMH) know that all too well. “I think that it has been said repeatedly that the impact of violence, crime, accidents on the public health care system has been almost overwhelming,” said Senator Dr. Duane Sands, who is consultant surgeon at PMH.

“The national statistics would seem to suggest that we have a murder count of whatever. In reality that number, the number of absolute deaths from violence belies the real problem.

“And this is not a new phenomenon. This is something that has been going on now for at least a decade.”

But Sands noted that the hospital continues to see more gunshot victims than in the past.

“We see on average in this country, in excess of 400 major stabbing or shooting traumas (every year),” he added.

“What has happened in the last three years is we’ve seen the knife been replaced by the gun. And so what that does to the emergency room, what that does to the operating room, the Intensive Care Unit and the wards is put a phenomenal burden [on them].”

According to information provided by Sands, in 2000, there were 323.6 assaults recorded for every 100,000 inhabitants in the United States.

By extrapolation, The Bahamas might anticipate 900 to 1,000 assaults per year.

Instead, it is recording more than 3,000 at PMH alone.

“We live in one of the most violent countries in the world,” he noted in a recent presentation at the Medical Association of The Bahamas conference.

“Trauma is a major public health problem.”

Sands noted in an interview with National Review that Medical Advisor to the Public Hospitals Authority Dr. Glen Beneby recently released a report that examined occupancy rates in all of the hospitals that fall under the PHA.

He said while there is no question that PMH is challenged on most wards (Pediatrics, Gynecology, Obstetrics etc.), occupancy rates on the surgical wards range from 92 percent to 104 percent.

Hospital officials have created another ward in what used to be the out patient area of PMH.

“If we look at the impact on the operating room, the operating room basically has now been forced to focus on emergencies and trauma,” Sands said.

“If you look at the impact on the Intensive Care Unit, the Blood Bank; if you look at the impact on the pathology lab (it’s great).”

This means that on many occasions, elective surgeries are constantly put off, Sands noted.

“And so if you look at the impact on health care in general from violence, it is a lot more significant than just the numbers we are seeing in the public,” he said.

“Resources are indeed stretched and we take this as a duty. We have to respond. And so the hospital responds however we can.”

What the public sees from this growing problem is increased waiting times, a shortage of blood at the Blood Bank and the postponement of those elective surgeries, as mentioned.

“This is the real impact of the violence and trauma on regular, ordinary people,” Sands added.

“It is a big, big problem.”

A RISKY ENVIRONMENT

“If you look at the impact of all of the violence and trauma, let’s take my house staff in surgery or in the emergency department, they are constantly exposed to the most outrageous forms of violence — seeing people beaten, stabbed, raped, molested etc.,” Sands told National Review.

“It is almost surreal, the impact on these individuals...They see the worst of people every single day. You couple that with a public response, which is not terribly supportive...and while we understand this, bear in mind that those two things put together create a very challenging emotional and psychological environment that we try to provide support for.

“To be very candid with you I don’t think we do as good a job as we should.”

The high stress level for the medical professionals is sometimes worsened when street fights continue into the emergency room.

“Notwithstanding that we have beefed up security significantly, it is not foolproof,” Sands said.

The government spends a significant amount on initiatives to provide a safe environment for staff and patients, noted Coralee Adderley, PMH administrator.

She said there may be a need to improve security even further.

“I would say that 20 years ago as a young administrator the weekend report, when you got [it] on a Monday morning, a stab here or there, a gun shot once a month was a big story,” she said.

“Now it’s almost every day and that’s a huge cause for concern.

“Any particular evening you can find that the emergency room is inundated with shootings, stabbing and so forth.

“That coupled with the fact that a lot of these patients, once they are admitted to hospital are in police custody. So that creates another dynamic for us, not just in the emergency room.”

Dr. Sarah Friday, the physician in charge of A&E, admitted the situation takes a personal emotional and psychological toll.

“I’ve been in emergency medicine for quite some time and after a while the [constant flow of trauma] patients coming in and you’re not getting to see other people with the [other] medical problems as quickly because maybe somebody with a gunshot to the chest or a stab to the arm or something like that would take precedence,” Friday said.

“You have other people with the other medical emergencies but because of the time sensitive nature of a person who is bleeding you find that other persons may have a delay in their care because we have someone who’s bleeding and that of course will take priority.

“If you talk to a lot of the staff it does take a toll on you because you walk out of the trauma room having seen somebody stabbed to the chest and then you turn around and then somebody, a diabetic patient for instance who may have missed his medication, and you’ve just left somebody who may have died.

“And so [when you see] the next patient you’re still carrying that burden of a young 17-year-old just shot to the chest and is now dead and you have to see that next patient.”

A DOUBLE THREAT

With chronic non-communicable diseases (CNCD) already placing a strain on health care services, the rising cases that stem from violence are worsening an already bad situation.

The Pan American Health Organization (PAHO), which is the regional arm of the World Health Organization (WHO), predicts a 300 percent increase in deaths from cardiovascular diseases in the region over the next 20 years.

Sands pointed out in his recent presentation at the Medical Association of The Bahamas conference that The Bahamas, like the rest of the Caribbean and America, is experiencing an epidemic of deaths and morbidity from the CNCDs such as obesity, high cholesterol, diabetes, hypertension, tobacco use, physical inactivity and unhealthy diets.

Sands indicated that violence and trauma divert scarce resources from other medical conditions and have done so for many years.

He also noted that the “culture” of violence creates a hazardous work environment that adds to absenteeism and attrition among medical staff.

Sands also noted that trauma patients not operated on in a timely fashion suffer more infections and thrombotic complications.

THE WAY FORWARD

“The debate about the way forward with health care is a debate about choices,” Sands said.

“And this government has made it very clear that it is going to adjust the resources upward for the provision of health care and has done a number of things.

“There is no question that we need a new hospital and that is going to create a whole lot of discussion about where those funds are coming from.”

The government had intended to use proceeds from the sale of a majority stake in Bahamas Telecommunications Company (BTC) to build a new hospital.

But with a dramatic downturn in the economy, the government was forced to increase borrowing, which resulted in rising debt levels.

The new plan is to use the proceeds from the sale of BTC to Cable and Wireless Communications to pay down the debt.

The government has instead opted to build a new critical care block on PMH’s compound. It will have an additional six operating rooms.

“But we have other challenges that have to be dealt with and we are preparing various position papers to put forward to the administration and the Ministry (of Health) to consider,” Sands said.

“While we all have a duty to try and intercede [as a result of] this carnage that’s going on in this country, we (PMH) have to stand in the gap.

“So the physicians, the nurses, the ancillary staff, the hospital administrators, we don’t have a choice. This hospital does not close and we have to do what we can with the resources that we have.”

Sands said, “It is a real, real problem and it is the direct impact of everything that’s going on and the choices that Bahamians are making, and fundamentally resolving this is going to require the energy and the effort of every single Bahamian.”

He said the hope is that there is not a further escalation in demands being placed on PMH because the hospital has no other choice but to care for people who come for treatment.

Adderley added, “Despite the sometimes negative comments that we hear in the news from patients and family members, we do have a group of committed individuals here who want to see improvements to this facility, to our health system to provide the best in care.”

4/17/2011

thenassauguardian

Bahamas Blog International

The Promised National Health Insurance (NHI) Plan in The Bahamas

No Definite Plan on How National Health Insurance Would Be Financed in The Bahamas

Timing of National Health Insurance Remains Uncertain

By: Candia Dames

candiadames@hotmail.com

Nassau, The Bahamas

21 October 2005

It remains unclear whether the government will establish the promised National Health Insurance Plan before the end of this term, but Prime Minister Perry Christie said on Wednesday that he is still committed to making such a scheme a reality.

The National Health Insurance Plan was a major campaign promise of the Progressive Liberal Party in 2002, with Mr. Christie continuing to tout the importance of it as prime minister.

Early in his term, he appointed a 15-member Blue Ribbon Commission on National Health Insurance, headed by Dr. Perry Gomez, to examine the feasibility of such a scheme.

On Wednesday, Member of Parliament for South Andros Whitney Bastian asked Prime Minister Christie whether national health insurance will be in place before the end of this term.

It was a question that the prime minister failed to answer in any specifics, saying only that Cabinet will make a decision on that.

He did, however, point to the "urgency" of looking into such a plan.

"From a personal point of view I wanted it to happen," he said.  "Cabinet obviously has to make a decision on it.  It is something that I heralded from the platforms during the last campaign.  It is something that I have always believed to be of vital importance to the poor of this country."

Mr. Christie said the recent poverty study tabled in the House of Assembly by Minister of Social Services and Community Development Melanie Griffin is evidence that there is a significant portion of the population desperately in need of national health insurance.

The poverty study found that just under 10 percent of the population is living below the poverty line.

"Poverty obviously creates a real problem in our country, particularly as you go to the islands," the prime minister acknowledged.  "When you reach Andros and go farther south it’s from 12 percent to 20 percent."

The prime minister did not give a timeline, but he said that he will make a communication to parliament as soon as his government makes a decision on national health insurance.

Dr. Gomez told The Bahama Journal several months ago that the government had appointed a planning committee to formulate specifics as it relates to national health insurance after signing off on all of the recommendations of the commission.

But while the committee was working aggressively to come up with the right formula for the scheme, it had not yet come up with a definite plan for how national health insurance would be financed, he said at the time.

Nevertheless, he indicated that the plan is no longer a matter of "if", but "when".

"The social health insurance levels the playing field in health," Dr. Gomez told The Bahama Journal.  "I believe that health is a right of individuals, not a gift; it’s not a privilege.  All people are entitled to the best of health care that their countries can afford, regardless of the individuals’ ability to pay.

"That’s a problem we have in our country to a large extent.  There is a discrepancy between the health care of the haves and those who have not and I think the best way of trying to address this issue is by finding some means of insuring the entire population and the best way to do that from all I have looked at and the Blue Ribbon Commission has studied is through this programme of social health insurance."

At the time, Dr. Gomez indicated that the development of the scheme is "highly technical" and he indicated that one of the more difficult challenges faced by authorities is coming up with a cost structure for the plan.