THINGS THAT MATTER - Health care delivery (Part 3) – The good and the bad
Sun, 07/31/2016 - 12:00am
Sir Henry Fraser
(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 big changes in health care in Barbados in the 20th century – the call of Dr. Bayley for a National Health Service and his own state-of-the-art Diagnostic Clinic, development of public health services, the building of the Queen Elizabeth Hospital, the National Nutrition Centre and the elimination of infantile malnutrition, the UWI and medical teaching, and the polyclinic system.
Today we need to review our health care systems, identifying the strengths and weaknesses, and bearing in mind the goals of equity and health care for all.
What have we got? We have a high level of health care, and a high level – a first world level – of health care expectations, partly created by the steady improvement of facilities, but also largely through cultural penetration from the USA. And these expectations are linked to the expectation of free health care for everyone who needs it or wishes it. But the QEH is now bulging at the seams, and so are the polyclinics.
And we have a huge and growing burden of chronic diseases and their costly complications. The cost of the high technology diagnosis and care associated with the complications of the chronic diseases has long outstripped the capacity of government financing, even if we were not still in the grip of a prolonged recession.
But the fundamental problem facing the country is the MASSIVE epidemic of chronic diseases. We saw it coming, and like the cholera epidemic, we did nothing for a very long time. The advocacy – the unrelenting message from Sir Trevor Hassell on the growing burden of high blood pressure and heart disease, of Dr. Oscar Jordan on diabetes (and let me pause here to give Dr. Jordan credit for his refusal to give up) and yours truly on obesity and hypertension, finally led to the creation of the Chronic Non-Communicable Disease Commission, a decade or so ago, chaired by Sir Trevor Hassell.
By which time Barbados had achieved the distinction of having some of the highest figures in the world for obesity and chronic diseases…and some of the largest figures in the world (pun intended)… Because two thirds of women are overweight or obese… more than one third are obese… and one third of men are overweight or obese… our men remain active far longer than women, who are getting fatter at a younger and younger age…
Twenty per cent of all adults have high blood pressure, and HALF of those over 45 have high blood pressure…by age 60 it’s 60 per cent! And twenty per cent of adults over 45 have diabetes!
These are frightening figures and the costs are even more frightening! These chronic diseases – obesity, high blood pressure and diabetes and their complications – cost two thirds – yes TWO THIRDS – of the QEH budget and TWO THIRDS of the DRUG SERVICE BUDGET!
Dialysis for kidney failure, due to the combination of diabetes and hypertension, costs more than $35 000 per patient per year. We pay to dialyse 220 patients – that’s eight million dollars a year, the health care costs of 6 000 other patients
And the economic impact is huge, not just on the country but on the individual and the family – sometimes destroying other individuals and families, who simply can’t cope with the hugely obese patient with an amputation and a stroke or both.
A few years ago a calypsonian wrote about liking his women big and fat and thick. I parodied it in my Sunday Column with my own calypso –
I like my woman big and fat and thick,
Wid just one leg and a guava stick –
Wid sugar, blood pressure and cataract
I like she big and thick and fat!
I like my woman big and fat and thick
But she can’t even move cos she arthritic
She can’t jiggle no more – cuh dear! it en’ fair!
An’ to get bout she need a motorise chair!
I like my woman big and fat and thick
If she don’t weigh a ton, she can’t get a pick
She riskin’ she life to mek me feel good
And would get up outta bed if only she could!
The chronic diseases reduce earnings, and poverty increases the chronic diseases. It’s a vicious cycle … a vicious, vicious cycle The Chronic Disease Commission has achieved wide recognition of the problem, with discussion on many lips and in the media daily. But we’re merely holding the ground, at best, rather than solving the problem.
Twenty-five years ago, encouraged by Sir Trevor Hassell, I developed the Chronic Disease Research Centre or CDRC as a unit of the Medical Faculty of the University. It opened in three rooms of the condemned building, Avalon, on the Ena Walters roundabout (restored at a fraction of the cost of a new building.
Now when I came home in 1977 government’s budget for medical research was $2,500 dollars towards the Caribbean Health Research Annual Conference. To date, over 24 years, the CDRC has raised more than 40 million dollars in research grant funding – two million a year – to fund research crucial for planning our health care.
Our mission was to provide a facility to study the epidemic of chronic diseases and its causes, so that research could inform government policy, planning and programmes – to improve health care in Barbados.
The very idea of serious research here was poo-poo’d by many, but with the brilliant work of Professor Anselm Hennis, my successor, now at PAHO in Washington, Professor Clive Landis and their research teams, and our new director, Dr. Alafia Samuels, the CDRC is now a shining star of the University, addressing the chronic diseases and the diagnoses and development of public health care guidelines.
The approach of medical research in Barbados, started nearly three hundred years ago by Dr. Hillary, is finally performing at the highest level of global excellence at the CDRC … and what’s more, it’s doing so in full partnership with the Ministry of Health.
The CDRC has produced cutting edge research, explaining the causes and nature of the diabetic foot, of the stroke epidemic of Barbados, the magnificent Barbados Eye Studies (and discovering the glaucoma gene in our population), the Health and Ageing study, the National Cancer Study, the Health of the Nation Study, the Barbados Surveillance Registry, Centenarians in Barbados, The Barbados Diabetes Reversal Study, and I could go on and on because the research output is simply phenomenal and its impact on health care - here and elsewhere - is clear. The immediate goal is to expand the public health role, to ensure translation of the findings into practice.
Next week: some realistic proposals for providing the best health care for all.
Professor Fraser is past Dean of Medical Sciences, UWI and Professor Emeritus of Medicine. Website: profhenryfraser.com