Things that Matter: Health Care Delivery – Part 2, the 20th Century

 

(Continuing an edited synopsis of a lecture delivered as part of the DLP Lecture Series: “Celebrating Fifty Years of Independence”, on June 29th, 2016, at Almond Bay.)

 

Last week’s column summarised the poor and inequitable health care in Barbados over the three centuries from 1627 to 1939, when the Tercentenary Ward was built at the old General Hospital – the tangible trophy celebrating 300 years of Parliament. 

 

In the 1930s there was another key development in health care in Barbados – a private hospital was opened. This was the Diagnostic Clinic, known as Bayley’s Clinic, of the brilliant Dr. Harry Bayley. Dr. Bayley testified before the Deane Commission after the 1937 riots, calling for a FREE NATIONAL HEALTH SERVICE FOR THE GREAT MASSES OF THE POPULATION … He said that the tax payers could pay a pound a month to cover it. This was 10 years before the British National Health Service…. His was a vision of equity, from a visionary who cared. He was a legend in his own time, and he allegedly told many a poor patient who couldn’t pay: “Don’t worry about the bill, my friend Mr. Mahon at Lion Castle will pay it for you”.

 

The Diagnostic Clinic was a phenomenon. It had the most modern laboratory in the English speaking Caribbean, and Dr. Bayley’s skill spread far and wide – patients came from Trinidad, Guyana and Venezuela, and even the USA. 

 

His was the state of the art model for both local best practice AND medical tourism, fifty years before the term was coined. We have A LOT TO LEARN from his example. When Invest Barbados put out a tender for a state of the art, medical tourism oriented hospital at the St. Joseph Hospital site, they were on the right path. Six years later we seem no closer to realising that vision.

 

But health care is far more than hospital care. Until the 1930s our infant mortality was among the worst in the Caribbean … one in three died within a year. And in the 1950s, infant malnutrition was also among the very worst in the region. The dark century of minimal healthcare, from 1838 to 1937, was a textbook case of colonial neglect. 

 

But tragically, when the British Chief Medical Officer, Dr. Humby, called in the Advocate to take a photo of three malnourished infants in a bed in the late 1940s, Sir Grantley Adams allegedly had him summarily dismissed … he convicted the messenger, although he promptly sought a Royal Commission to study and report on a new hospital! The Roy Commission reported in 1948 – and the new hospital broke ground in 1960 – 12 years later …. ANOTHER LESSON FOR US TO LEARN! The message was received but the messenger was sacrificed!

 

The 1950s saw real changes in health care. First came the opening of the first Public Health Clinic, at Arlington House in Speightstown – the vision of Sir Maurice Byer. It was replaced in the 1980s by the Maurice Byer Polyclinic. Then came the Enmore Public Health Centre (perhaps appropriately at the site of public hanging in centuries past), with the assault on tuberculosis and infant inoculation – two success stories, led by Dr. Byer and Dr. Edgar Cochrane. 

 

And in the 1960s came three very big, though very different achievements – 

 

First, the opening of the Queen Elizabeth Hospital (QEH), designed by Captain Tomlin to last a hundred years, he told me – so it has 50 years to go!

 

Second, the National Nutrition Centre, the vision of Sir Frank Ramsey, to tackle our disgraceful infant malnutrition – and in ten years he eliminated it.

 

And thirdly, the arrival of medical teaching, with partnership between the University of the West Indies, the Ministry of Health and the QEH, in 1968. This has been an outstanding example of a successful partnership between the government and the university.

 

In the 70s, the concept of polyclinics was rolled out, providing primary care as well as public health services across the island, and by the 1980s the expansion of the polyclinic system gave Barbados an enviable, comprehensive access to care. The vision of equity was advancing. 

 

The creation of the Barbados Drug Service in 1980, and the benefit service plan to provide free drugs for the most common chronic diseases, was a huge success, and the drug levy met hardly any objections because the benefits were so obvious. Its abolition was clearly a mistake, and a lesson for the future. 

 

There have been many successes and few mistakes of the Drug Service… a recent mistake is, I am told, the withdrawal of test strips for diabetics striving to achieve control on diet and exercise … but happily the successes of the Drug Service far outweigh the mistakes of the past.

 

And so we arrive at our present health care situation. We have a high level, a first world level, of health care expectations, largely through cultural penetration from the USA. But while a lavish polyclinic has been opened in St. John, more than 20 years after ground breaking, the QEH is bulging at the seams, and so are the polyclinics. In Part 3 we will look at our major problems and some of the most practical solutions. 

 

Condolences: To the wife and family and close friends of Sir Frederick “Sleepy” Smith – a statesman of integrity, who was never afraid “to tell it as it is”. And also to the wife and family and our Rotarian friends on the sad passing of Professor Emeritus George Nicholson, consultant nephrologist, whose many contributions to health care, teaching, research and as Dean of the Medical Faculty, UWI, Cave Hill have been rich and made a lasting impact.

 

(Professor Fraser is past Dean of Medical Sciences, UWI and Professor Emeritus of Medicine. Website: profhenryfraser.com)

 

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