However, throughout the year members of the public and health workers had cause to show their anger with the failings of the service and system. This month there were vociferous calls from the Opposition benches for the Minister’s resignation.
There was some progress in health this year, but disease and death again stole the spotlight. People will remember 2008 as the year of the “dengue outbreak”.
From early January reports of persons contracting dengue fever began surfacing and continued consistently throughout the following months. To date the number of people who have contracted dengue is not known but there were many. Westmoorings, St Augustine, St Joseph, Caroni, Sangre Grande, Tabaquite and Freeport were among the areas hardest hit.
In January, 12 Chinese construction workers employed at the site of the multi-million dollar National Centre for the Performing Arts on Keate Street, Port-of-Spain, contracted dengue and there were fears that the disease would pose a threat for the Carnival season.
The workers were housed at Keate Street compound occupied by SCG International TT Ltd, contractor for the project. Six of them were hospitalised at St Clair Medical for treatment and the Keate Street area was subsequently sprayed a few times. The Port-of-Spain Corporation Public Health Department visited the site and made recommendations for cleaning.
On January 27, Mayor of Chaguanas Suruj Rambachan criticised the Health Ministry for failing to provide personnel to spray homes in the Borough to prevent dengue. He said there were ten confirmed cases and his office had to spend $13,000 to purchase chemicals to spray affected areas.
Reports of dengue deaths also made news throughout the year, with several cases receiving media attention. The death of eight-year-old Sasha Bickram on August 9 sparked outrage and Narace was severely criticised for saying her death was not due to dengue.
His view was reinforced at a media briefing chaired by Chief Medical Officer Dr Anton Cumberbatch who said “a confirmed established cause of death can only be certified by a post mortem performed by a qualified pathologist and in this case blood investigation and report from that investigation must also be supporting the pathologist report with respect to dengue”. An autopsy was not done on Bickram.
There was more anger heaped on the Ministry when 11-month-old Josh Moonilal died at SFGH after being warded for dengue haemorrhagic fever.
At a post-cabinet media briefing on August 14, Narace said there was no dengue outbreak in the country. He said up to the middle of this year there were 120 cases and this figure was well below the mid-year national average 228 for the past three years. Narace also said there were no deaths this year from dengue and from 2003 to the present there were no confirmed deaths due to dengue haemorrhagic fever.
The Medical Professionals Association of TT subsequently responded to the Ministry’s data by stating that two deaths occurred in March and July this year.
In August the Ministry hosted an Inter-sectoral forum on dengue at Crowne Plaza in which Narace said two deaths did occur this year but provided no details. At the forum Narace said the Ministry was expecting an increase in dengue cases and had provided a $6 million allocation for goods and services to deal with dengue.
The CMO said there were 1,000 suspected dengue cases in the country and the last major outbreak was in 2002 when TT had 6,308 cases. Cumberbatch said the Ministry’s objective in 2008 was to prevent an increasing number of reported cases. However, the perceived dengue situation caused the UK Foreign and Commonwealth office to warn British citizens about “increased activity” with dengue.
A team of experts from the Pan American Health Organisation (PAHO) came to TT in October to provide advice on dealing with dengue. The visit was at the request of Narace and the findings of their report are yet to be made known.
The death of 22-year-old UWI student Camille Ramcharan of Frederick Settlement, Caroni on December 9 prompted a series of protests against the Health Ministry and its Insect Vector Control Division (IVCD). Residents led by Ramcharan’s father Freddy have demanded action to deal with the conditions in the area (overgrown bush, dirty drains) which they believed were contributing to the mosquito infestation problem which caused approximately 50 residents to get dengue fever. The IVCD held a media briefing on December 22 to provide an update on the work done in Frederick Settlement outlining a series of spraying activities. But this has not placated the residents.
The Ministry has said a full update on the dengue situation will be given in January 2009 by the Chief Medical Officer.
Security breaches and health workers attacked
The Eric Williams Medical Sciences Complex (EWMSC) had the misfortune of being the health institution whose security system seemed to have the most problems. Providing adequate security given the size of the EWMSC has been a challenge over the years. This year showed that the system in place still could not cope.
In April, the friend of a patient who died at the Adult Surgical Ward attacked a doctor. The patient had been on the ward receiving treatment for injuries from a drive-by shooting. This caused medical and surgical clinics to be cancelled. Security was beefed up after the incident and the North Central RHA introduced a system of visitor passes and restrictions on visitors to patients. A sign was posted telling the public that shouting, abuse or threats to staff would not be tolerated.
Also in April, two foreign nurses were attacked by a female patient with a mental disorder. This caused nurses to sick out and demand improved security because their jobs had become “high risk”. The protest caused the Adult emergency department to be closed, and dialysis and other services cancelled. A meeting took place with the NCRHA executive and it was agreed that monthly meetings would take place for six months with a team representing nurses and a health and safety committee established.
December saw two serious incidents at EWMSC. A 20-year-old mentally challenged woman was buggered when she went to use the toilet at the Thoracic ward. The man who attacked her was a visitor on the ward. He was apprehended while attempting to flee the hospital. He was later charged and went to court to answer charges of buggery and indecent assault.
The Radiology Department was shut down for one day after a man who went to have an MRI ran amok and randomly attacked persons in the waiting area with a cutlass. Luckily, no one was seriously injured. The man, who was later described as an outpatient of the St Ann’s hospital, became angered after he was asked to wait. This incident caused the NCRHA to assign three more guards to the area bringing the total to four.
Families outraged by deaths at public facilities
During the year there were numerous reports of deaths at public health institutions. Families have accused every major health institution of negligence.
Two-year-old Luke Marshall was taken to the Paediatric Priority Care Facility of the Eric Williams Medical Sciences Complex on March 4 for treatment of fever and earache. He was diagnosed with an ear infection and medication was prescribed. However, he was rushed to the facility on March 6 with breathing problems and later died. An autopsy later said the cause of death was due to bacterial meningitis.
Also in March, 24-year-old Shan Ramsook of Manzanilla was taken to the Sangre Grande Hospital with chest pains but died while awaiting medical attention, Sita Jawahir went to the Port-of-Spain General Hospital to give birth but the baby died and Sandra Harry, died four days after giving birth to a daughter by caesarian section at the Mt Hope Women’s Hospital.
An autopsy stated that Harry’s death was due to severe infection. A hospital official said she had medical complications prior to going to the hospital.
The San Fernando General Hospital (SFGH) and Scarborough Hospital were also accused of negligence this year.
Ambulance on fire
On March 28 Sharda Hanooman was en route to the Chaguanas District Hosptial when the ambulance suddenly caught fire. Her mother Samdaye Hanooman, and aunt Savitri Pandeosingh and paramedics Sharon Debideen and Dino Ramsaroop all received burn injuries to their bodies. Forensic experts from the United States were brought to TT to investigate and Hanooman (Samdaye) and Pandeosingh were flown to the Jackson Memorial Hospital in the US because of the severity of their third and second degree burns. Global Medical Response of TT (GMRTT), paid the cost of their treatment.
In January the Ministry and RHA’s announced plans to deal with bed shortages, improved security, infrastructure upgrade and preventive maintenance.
The South West RHA announced a bed bureau management system to provide information on bed availability and a standard operating procedure to facilitate the transfer of patients from SFGH to private facilities. The North Central RHA also announced plans for an interim patient registration system at the Eric Williams Medical Sciences Complex and the Eastern RHA sought to divert non emergency cases from its Accident and Emergency at Sangre Grande Hospital by introducing a filter clinic in March.
Despite 100-day plans though, insufficient beds caused problems this year. In April more than 20 specialist nurses of the Accident and Emergency Department of SFGH went on “sick out” because of overcrowding.
In August, TT’s boxing champion Giselle Salandy waited 16 hours at the A and E of the SFGH for a bed. She left the hospital before getting assigned a bed. Due to the bed shortage patients were being accommodated at the asthma room. At the Adult Accident and Emergency at the EWMSC, patients waited on trolleys or wheelchairs for available beds.
Chronic staff shortages continued to adversely impact on health services this year. Heart surgeries were being cancelled at EWMSC because of insufficient ICU nurses and a shortage of senior doctors at SFGH caused the cancellation of elective surgery in neurosurgery, paediatric and plastic surgery.
Throughout the year the media highlighted numerous reports of families appealing for help for relatives who required expensive specialised surgeries.
The death of nine-month-old Marissa Ramlal and the criticism that the Health Ministry did not do enough caused Narace to announce that steps were being taken toward establishing a system to assist patients especially children. Ramlal died on October 28 without her family being able to raise the TT$1.8 million needed for liver transplant surgery in the US. The Health Ministry was approached for financial assistance but Narace said the maximum which could be given from its medical fund was $60,000. He said his Ministry received requests every day to assist children and adults. The group HealthcareWatch wrote Narace in October lobbying for Ramlal and proposing the establishment of a unit to coordinate efforts to assist patients requiring specialised surgery. Narace indicated that the Ministry would pursue collaboration with the private sector to help patients. At a post-cabinet media briefing he also announced that funding to assist persons in need of specialised surgery could come from the National Health Insurance service.
On September 19 during debate in the House of Representatives Opposition Member of Parliament for Caroni East Dr Tim Gopeesingh alleged that the Government was spending $260 million for two weeks of training for 130 public health staff over a two-year period. He said there was no tendering for the agreement with the Johns Hopkins University.
Gopeesingh also alleged that tendering did not take place for the contract to manage the Catherisation laboratory at EWMSC. Responding to the allegations, Narace called for evidence so an investigation could take place.
Gopeesingh also levelled allegations against Narace regarding contracts to Trinre, an insurance company owned and operated by Narace’s family. The UNC A MP wrote to the Integrity Commission on the matter and received a response last month that the complaint would be investigated.
•The first set of kidney transplants involving children took place at the EWMSC in April.
Three children had surgery from Transplant Links, a UK charity established by a group of British doctors to save and improve the lives of children with kidney disease.
•Diabetic patients finally begin receiving their glucometers and strips. The programme was to begin in January but was delayed until July when the first batch of glucometers were distributed to juvenile diabetics.
•Baby Arianna Ramcharan was the smallest baby (15.8 ounces) to survive at a public health facility. She was born on July 21 at Mt Hope Women’s Hospital and spent five months in care before being discharged.
•The first all local cardiac surgery team performed surgery at the PoSGH in November.
•The Paediatric speciality ward and refurbished Paediatric Accident and Emergency at EWMSC, and Neonatal ICU at PoSGH officially opened.
As the year draws to a close cuts in the national budget due to effects of the international economic downturn also impacted on the Ministry. It has postponed the new Port-of-Spain General Hospital (which was to be built in conjunction with Johns Hopkins University) and the new hospital for central Trinidad. Work is expected to resume on the National Oncology Centre in the new year and construction will begin next month on the Pt Fortin Area Hospital.