God help this country!

THE EDITOR: I wish to correct a bit of misinformation concerning the difference in salary that exists between doctors who work in Trinidad vs those who work in Tobago. Can I say that, in view of the seriousness of our health situation, it does no one any good to advance opinions that are emotional, illogical or that have no basis in truth or factual information.

First, the differences in salaries: A House Officer (HO) is a Junior Doctor. One does 18 months of internship before being so designated. For the year 2001, a consultant, like myself, employed with the MOH in Trinidad, (with 25 years experience), earned $20,680.00/month, while a HO in Tobago earned $20,500.00 during the same period. A Consultant in Tobago earned $28,555.00 (per month). The employer is the same. I wonder if Mr James can rationalise this disparity? Does the fact that one works in Tobago justify a difference of $8,000.00 per month, or the fact that 18 months of hands-on experience is rewarded the same as 25 years experience and specialist designation?

Secondly, the nature of the work: The Scarborough County Hospital serves a catchment population of 47,527. The SWRHA’s catchment population is 346,755, that of the NWRHA is 198,661, the Central RHA is 475,670 and the Eastern RHA: 100,959. (Annex 3: NHS Plan) The existing numbers of Health offices for these areas respectively are: 18 (Tobago), 17 (NWRHA), 30 (CRHA), 25 (SWRHA), and 16 (ERHA). The spectrum of illness, the degree of disease severity, and in general the burden of disease must be different for both Tobago and Trinidad. The ethnic composition of both catchment populations is quite different. This too would impact on the health needs of these two populations. Confining myself to the San Fernando General Hospital (SFGH). That Hospital admitted an annual average of 46,650 patients to all departments (1987-1990).

For the Scarborough Hos-pital this figure was 5,485, or about 11 percent of our admissions. Over the same period, the average turnover rate for Tobago (as an index of that Hospital’s ‘productivity’), was 56 percent as compared to turnover rates for Port-of-Spain GH: 71.5 percent; San Fernando: 100.6 percent; and Point Fortin Area Hospital: 73,9 percent. (Min of Health Ann Rep: 1987-1990). Doctors at the POSGH attended to 192,343 outpatients. At SFGH we saw 137,517. In Tobago at your Hospital, your Doctors saw 8,504 — or about five percent (average) of our workload. With 18 health centres in Tobago, each would serve a notional catchment population of just 2640 persons compared to an average of between 5000 to 10000 people in Trinidad.

Mr James admits that doctors working in Tobago are today better paid, but adds that “this was not always so.” I think it is fair to say that before this present anomaly, at no time were our salaries different, save perhaps in respect of small allowances. He further states that the health sector in Tobago “was always in intolerable crisis” and that “there is only one Hospital.” He laments the shortage of ‘specialists’ in Tobago. He needs to e reminded that the Tobago population is only 47,527. I should add that using hospital mortality as a surrogate market for clinical outcomes, this has averaged around 5.5 for Tobago compared with 6.5 for hospitals in Trinidad. One therefore could hardly say that the Tobago Hospital has a “crisis” of any sort.

I hope I have got across the point that in Tobago, that 96 bed hospital sees between 5-11 percent of the patients we see at our major hospitals. The range of clinical problems is far narrower because of the small catchment and relative ethnic homogeneity. There are not at present, nor is there any plan to include ‘tertiary’ services at Tobago. Hence, Mr James’ main concern will still not be addressed after completion of the “new” facility. Patients in need of tertiary care wills till have to be flown to Trinidad! Of necessity, then, there is no need for the range of specialists to equate with what exists at Trinidad. It would be a waste of manpower.

Finally, can I recount a few “Administrative and Organisational Problems” listed in a 1981 appraisal of this country’s Health Manpower needs Report of The Committee To Study Health manpower Needs of the Present and Projected Health Services of Trinidad and Tobago” — Dr Elizabeth Quamina PMO1)]. These problems were short listed and documented by Dr Elizabeth Quamina, Principal Medical Officer (Institu-tions) under the PNM Administration of 1981! These existed then, and still do, to an even greater extent today (23 years later!).
* “Unattractive living and working conditions:
* Poor work organisation and sub-optimal utilisation of Health Personnel;
* Poor career prospects and promotion based on seniority;
* Deterioration of skills and knowledge because of lack of facilities for personal initiative, research, and continuing medical education;
* Lack of coordination between training, administrators and personnel;
* Shortage of qualified staff in personnel administration;
* Absence of procedural manuals vis-?-vis the function, services offered and categorisation of job for health personnel;
* Lack of mechanisms of evaluation of service;
* Inadequate coordination between community health services and institutional care.”

The above is not from me nor is it from MPATT of some politician. It is from the pen, and the heart of one of this country’s best PMOIs, Dr E Quamina (deceased). Hence, when we as a group repeat this list of short-comings which was compiled by one of their own, are we being “political?” The Minister claims that he has had no problems in the past with Indian and African doctors. Where are they today? They have all left in frustration and exasperation. Who has remained? Who will continue to stay and serve in spite of unredressed difficulties and an oppressive Minister? Our contract negotiations seek only to address those and other problems, identified by one of their own trusted members, yet Mr Imbert continues to politicise the problem, rant and rave and would willingly allow the status quo to prevail. You are right, this is really a “fight between the rich and poor!” All I can say is God help this country!

DR STEVE SMITH