THINGS THAT MATTER – UWI and Health Care in the Caribbean – Part 3
“A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.” (Sir Winston Churchill)
The subtitle of my Anniversary lecture was “Successes, challenges and opportunities”. Part 2 last Sunday summarised some of the University’s successes in teaching and research. Today we take a look at some of the challenges and opportunities.
There are several challenges to the provision of comprehensive health care. The obvious ones, of course are funding, staffing, buildings and equipment. But a critical one, perhaps less obvious to many, is the need for data about health status, health behaviours and risks, and disease incidence and prevalence. Often major policy and planning decisions are made without such data. One of the university’s major roles is to support Ministries of Health in obtaining relevant data to inform policy and planning, and it requires not just the execution of the research but the translation of the findings for public health application. This works best when governments and academia work in partnership.
An early successful partnership was that between Dr. (later Sir) Frank Ramsey and the Ministry of Health, in response to the huge challenge of infant malnutrition. After spending time working on malnutrition at the University in Jamaica, Sir Frank obtained a Macy Foundation grant, and set up the National Nutrition Centre here. Within a decade, infant malnutrition, with one of the highest rates in the Caribbean in the fifties and early sixties, was completely eliminated!
One of the outstanding challenges across the Caribbean has been an understanding of the extent of bad nutrition and over-nutrition – obesity and the chronic disease epidemic and the risk factors. The George Alleyne Chronic Disease Research Centre is a good example of a response to a serious challenge, and it could not have occurred without effective partnership between university and government – i.e. Faculty of Medicine and Ministry of Health. The Ministry not only provided the building for the centre (an abandoned residence, Avalon at Lower Collymore Rock, restored extremely cost-effectively with Ministry funds) but has co-funded several key projects that inform health care; the first was the Barbados Stroke Study, the success of which encouraged further commissioned projects such as the Health of the Nation Study.
Another challenge that created an outstanding partnership relates to another building – the wonderful Nightingale Nurses Home, gift of Henry and Annie Nightingale in 1936 to the people of Barbados. This magnificent building was abandoned in the ’90s, but when space was needed for clinical skills teaching the Ministry of Health agreed to a long lease at peppercorn rent, for the UWI to develop it as the Errol Walrond Clinical Skills Complex. I “whistled a happy tune” all the way back across the road to the hospital that day!
Yet another successful collaboration between Government and University was the establishment of the Primary Care Unit at the Wildey Polyclinic, led by Professor Sir Errol Walrond and Dr. Michael Hoyos. Further programme expansion has now led to the Diploma in Family Medicine, providing family doctors with postgraduate training in this formerly neglected specialty.
Sometimes opportunities come about unexpectedly. A favourite example of mine occurred some years ago when a Minister of Health needed physiotherapy treatment at the hospital, which provided the then Hospital Director and me an opportunity to point out the many needs of the unit and to have a consultancy study funded. This led to major improvement of staffing, funding and facilities, with establishment of a full department and a consultant psychiatrist post created.
But the major challenge for health care development is fitting care to need, and it cannot be achieved effectively and efficiently without collaboration and partnership. There has been a tendency for professionals to sit back and wait for politicians, i.e. ministers, to make decisions, sometimes based on hastily put together manifesto promises, sometimes based on personal ideas, and sometimes on advice that may be conscientiously given and received, but not based on either evidence or best practice. This can be a recipe for bad decisions, such as the “red herring” idea of a new hospital being needed, when the problems of our Queen Elizabeth Hospital were related to the five essential pillars of a good hospital - funding, staffing, management, equipment and morale.
At the formal opening of the Chronic Disease Research Centre, Sir George Alleyne said: “I take it that support by the Government means that it’s prepared to embrace the findings of the Centre and consider them in formulating public policy.” To further this translation of evidence into policy and programmes, the Centre and the Public Health Group in the Faculty of Medical Sciences are collaborating on the theme Population Health Sciences, to provide data that will help prioritise both training and health planning, and drive public health interventions, thus completing the journey from evidence to outcomes – i.e. translational medicine.
Opportunities for a university with the quality and reputation of the UWI can produce win-win situations. Our British style clinical education, with major emphasis on clinical skills and less on costly high technology investigations, can be effectively marketed internationally – as was the reputation of the University of Edinburgh for some 200 years.
Barbados also has the opportunity – as the hub of the Eastern Caribbean, with sound infrastructural services, a modern hospital and high quality health care personnel – to become the “Mayo Clinic” of the Caribbean. Just as Dr. Bayley’s then state-of-the-art Diagnostic Clinic received referrals from Trinidad and even Venezuela, and the QEH at its best in the 1980s received referrals from the Eastern Caribbean countries, we could once again, with appropriate investment and partnership between government and the Faculty of Medical Sciences, be a major referral centre for the whole region. Alternatively, with private investment and partnership the St. Joseph Hospital project, put out to tender in 2010 and then shelved, could be such a successful modern, health tourism-oriented hospital, that would both earn income and save us major foreign exchange, as less Barbadians would need to go abroad for highly specialised care. The operative word is partnership, partnership, partnership.
Bouquets: I have two bouquets this week: First to Mr. and Mrs. Maurice Stoute of the Home & Garden Shop in Black Rock. Mr. Stoute is an amazing entrepreneur, who used to work for T. Herbert & Company of Roebuck Street and when they closed some 25 years ago he simply set out to teach himself to make coral stone and concrete garden ornaments and fixtures – making moulds and producing beautiful work, economically. I’ve just bought two fabulous garden urns for far less than imported pots. The Stoutes are inspiring role models for us all at this time. Check them out and embellish your garden.
Secondly, to Carmeta’s, a branch of BADMC. They were offering samples in the splendid Barbados Museum Shop on Tuesday and their cassava great cake and potato porridge are clearly winners!
Postscript: do come out today and join the 5K Run/Walk organised by the George Alleyne Chronic Disease Research Centre, at 3:00 pm. It’s bringing further awareness to NCDs and proceeds from attractive T Shirt sales ($30 each) are in aid of the Research Fund. It starts and finishes at the GA-CDRC at the corner of Jemmott’s Lane.
Professor Fraser is Past Dean of Medical Sciences, UWI, Professor Emeritus of Medicine and Clinical Pharmacology and President Emeritus of the Barbados National Trust. Website: profhenryfraser.com