No action on Dr Quamina’s 23-year-old report

THE EDITOR: I am appealing to your newspaper to publish the other “half” of Minister Imbert’s “half-truths” concerning the Council of the Medical Board, so that his propaganda can be corrected.

Might I say that in 1994, when I myself served as vice-president of the Council, and for some years before this, the Council had submitted memoranda to the Ministry of Health and other relevant Ministries, with regard to our proposals for amending the same Act. We attempted then, to relinquish the “antiquated, outdated and retrograde” practices to which the Minister might have been referring, but the then administration turned a deaf ear! If I am not mistaken, to a significant extent, the rules by which a doctor’s “fitness to practice” medicine in this country, is judged still follows closely, if not literally those guidelines that have been used by the General (not “greater” as the minister calls it!) Medical Council (GMC) of the UK. So it is misleading for Mr Imbert to refer to the process by which Council’s decisions are arrived at, as “...a ridiculous situation where a small group [of Doctors] were (sic) determining who [should] practice in the hospitals and who should not.”

Might I add that, although we here in Trinidad hold `English’ to be our native language, the GMC mandates that local applicants for registration in the UK, via an ‘English’ language proficiency test, must demonstrate proficiency in the use of ‘English’ as part of the application process. In Cuba the native language is Spanish, and the medical curriculum is taught in Spanish; our Medical Council requires similarly that proficiency in English be demonstrated. Now at the ‘say-so’ of a “five-member Ministerial panel” Cuban Doctors are being “allowed” to practise and I do not know whether this caveat applies, or if it does, who, and by what test (whether valid or not), will the “panel” determine proficiency in “English.” Minister Imbert further propped up his argument for this amendment by ironically insisting that: “It would be irresponsible for us not to take affirmative action to deal with the critical shortage of doctors in the country.” Can I remind him that 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 (PMOI, (1981)], the problem of deficient manpower at all levels in the Health Sector was unambiguously outlined.

Does Mr Imbert think that this is a new dilemma? Has it not been in the years that have elapsed since, his administration’s conventional wisdom to make good the shortfall of medical professionals by attracting, and sourcing “foreign” medical manpower? Indeed in my 25 years working at the Hospital at San Fernando, I have had the pleasure of working alongside very competent colleagues hailing from Haiti, Cuba, India, Nigeria, Iraq and Iran to name only a few. However, I ask: where are they today? They have all migrated to other places, just like our much needed nurses, and a significant number of our well-trained Trinbagonian doctors alike. They have all gone to places where the quality of their work is acknowledged and appreciated, where they can work with a view to personal and professional advancement, free from unnecessary and unjustifiable cynicism, and repressive utterances of a Minister of Health. So what is our Minister’s solution? He succeeds in changing the law hurriedly, so that he himself can now allow more rapid entry of more of the same type of foreign doctor, while at the same time, turning a blind eye and a deaf ear to the backward working and living conditions that characterise the status quo. Does common sense inform us that those who will come, however many their numbers might be, or how eminently qualified they might be, will remain here to work? I dare say if the present administration has its way, our population would eventually be served by a full cadre of itinerant or near-nomadic medical personnel. Perhaps that is their aim.

I think it is entirely reasonable to suggest that Mr Imbert should read Dr Quamina’s report so as to be informed of her findings, which completely accord with contractual requests proposed by our negotiators, the MPATT. The problems she outlined existed then, and still do, to an even greater extent today (23 years later!!), and they continue to influence the decision-making of our professional health personnel, whether local or foreign bred, with regard to whether they ought to remain in sweet TT to pursue a fruitful professional life, or look to better places. Dr Quamina pointed to:
* Unattractive living and working conditions
* Poor work organisation and sub-optimal utilisation of Health Personnel
* Poor career prospects, and promotions based on seniority
* Deterioration of skills and knowledge because of lack of facilities for personal initiative, research, and continuing medical education
* Lack of co-ordination 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 jobs for health personnel
* Lack of mechanisms of evaluation of service
* Inadequate co-ordination between community health services and institutional care

I ask since 1981, has any one of these issues been addressed? If they persist, can we seriously expect health professionals to make this country their professional home? To answer this question: at last! At last the media and the Minister have “seen” the truth of the first of the above! One newspaper has reported that over the past two weeks there have been ‘feverish’ attempts to refurbish the “dilapidated doctors’ hostel” at the PoS general hospital for the first batch of Cuban doctors, because the hostel is unlivable. So, fellow citizens, we your sons and daughters, doctors to serve you, will only now see work being done to improve “living conditions for doctors.” in answer to their 23-year-old requests for same! Sadly, we, citizens of this blessed country, would not benefit from it because it is being done for “strangers.” Thank you Mr Imbert!

The General Medical Council of the UK (GMC), has agreed to, and forwarded several proposals for a ‘new’ GMC. Two of these however, are immediately relevant to the Minister’s present criticisms and they are 1) that “There should continue to be an overall majority of elected medical members on the GMC, in keeping with the principle of a professionally-led regulation.” And 2) with regard to numbers: “There should be a new Council of 35 members ... 19 directly elected medical members; two appointed medical members and 14 lay members on the new Council.” There is also the caveat that: “GMC lay members should be appointed by an independent commission according to [GMC’s] agreed criteria.” Their appointment must be free from input from the Minister of Health, a politician. This is to prevent political manipulation. It is not a case of “himself to himself” as Mr Imbert insists. I find it distressing, and irresponsible that Minister Imbert, in wishing to assert his will should be willing to compromise the quality of local health personnel via his hasty amendment, which clearly allows for naked political interference, and the influx of “unfit” practitioners. Then again, it is indeed the present Administration’s modus operandi to arrive at, and implement decisions in a “top-down” manner. This type of paternalism is unwanted; it is inimical to our society growth, as it fails to afford reciprocating and amicable dialogue.
It is a shameful caricature of participatory democracy.

DR STEVE SMITH
Port-Of-Spain