Good news, bad vibes in health

The Faith Williams case:-

Three-year-old Faith Williams went to the Eric Williams Medical Sciences Complex (EWMSC) on August 31 for repair of an umbilical hernia under the Ministry of Health’s Paediatric Surgical Waiting List Initiative (SWLI). After the surgery, something went wrong and Faith slipped into a coma. She was subsequently taken to the Intensive Care Unit and put on life support. Faith’s parents Kendall and Avril took her off life support on September 16 but the circumstances in which she died raised questions.

At the ICU they noticed her skin had become discoloured and an odour came from her body. They were told that only the life support machine kept her body functioning. The Williams’ said they got a run around for information.

The ministry subsequently suspended further paediatric surgeries and Health Minister John Rahael announced that investigations would take place. At a media briefing on October 20 the health ministry announced it had received reports from surgeons, nurses, anaesthetic technicians, the ministry’s biomedical technicians.

In addition, a report was submitted by Dr John Mecklendurgh, a medical devices evaluator and senior lecturer in the Department of Anaesthetics and Internal Medicine from the University of Cardiff, Wales. Chief Medical Officer Dr Rohit Doon said an independent panel would review the reports and a statement would be made.

The findings of the various investigations are yet to be revealed. A ward has been named in memory of Faith at the Wendy Fitzwilliam Paediatric Hosptial.

Responding to Faith’s death, on October 3, the Medical Professionals Association of TT (MPATT) called for an investigation into the entire SWLI.

Ag MPATT president Dr Rajendra Persad said doctors had received information from colleagues about “deaths and serious complications arising from surgeries being performed in the SWLI.”

He said the temporary programme has been going on for three years but no clinical audit was done to determine the true complication rates.

Liver Transplants:-

The year was also marked by individuals whose lives hung in the balance because they were unable to afford specialised surgery. Twenty-four-year-old Roger Ramnath of Cleghorn Village, Princes Town was clinging to life when he was flown to Argentina’s Austral University Hospital for liver transplant surgery last month. His mother was supposed to be his donor until tests revealed that Roger’s condition was so dire he needed an entire liver. Ramnath has a condition called Bud Chiari syndrome —in which the veins leading out of the liver become blocked and the pressure causes damage to the liver.

An emergency liver transplant surgery was done on October 20 after his condition deteriorated. While the family is happy that he has a chance at life, they are faced with $800,000 in medical bills despite fund raising and contributions from the ministry.

And the family of 11-year-old Evanna Isaac is trying to raise US$2.2 million for liver transplant surgery at Memorial Sloan-Kettering (MSK) International Centre, New York. She was diagnosed with liver cancer and has been out of school since July.

Commission of Inquiry

On September 11, the Commission began public hearings after spending most of this year and the last visiting health facilities and gathering information on site. Testimony coming out during public hearings of the Commission highlighted chronic problems like the nursing shortage but the most damning criticisms came from senior doctors.

Dr Petronella Manning-Alleyne, head of the Neonatal ICU at the PoSGH 2006 said “wheeling and dealing” occurred in the tendering process for equipment in the North Central Regional Health Authority. She said there was “questionable employment practices” and gave the example of a doctor who worked in her unit who showed no technical skills. She accused the NWRHA of “having a fondness for Asian doctors.”

Dr Grevney Richardson head of the accident and emergency at the Eastern RHA, and former registrar in the Department of Anaesthetics and the Intensive Care Unit at the Eric Williams Medical Sciences Complex, Mt Hope, (EWMSC) said many deaths were labelled routine.

During testimony on October 2 he said: “In retrospect, if you looked at them carefully you could see they could have been prevented if there had been better management, had there been better equipment available.”

Testimonies about personal experiences allowed patients and their relatives to vent anger and frustration. Roger Belix’s son Jonathan died of embolism on August 31, 2004. Jonathan fractured his right leg in a motor vehicle accident on July 20 and was taken to the Arima Health Facility.

Due to inadequate facilities he was transferred to the Port-of-Spain General Hospital (PoSGH). The Belix family took Jonathan to EWMSC after a doctor at PoSGH said the equipment for the procedure was not immediately available to do the surgery. Belix said his son died while awaiting surgery at EWMSC.

Joan Gower-De Chabert, went for what was to be a routine stripping of variose veins at the EWMSC on July 29 but woke the next day at the PoSGH “unable to move from the waist down.” She described her experience from then on as a “nightmare” as she tried to find out what happened.

The Commission has been beset with delays for various reasons since it was appointed in 2004. The illness of chairperson Gladys Gafoor caused the suspension of public hearing on October 16. It is expected to resume early next month.

MPATT denied recognition:-

On March 6, the Medical Professionals Association of TT (MPATT) signalled that Regional Health Authority doctors would withdraw overtime work (weekends and public holidays) because of the Registration Recognition and Certification Board’s (RRCB’s) decision to “split doctors into two groups making each group a small part of a much larger bargaining unit comprising different categories of workers.” The threat by doctors prompted Labour Minister Danny Montano and the Health Minister to meet with doctors at the Ministry of Labour on March 23.

At the meeting the Ministers told MPATT the government had no objection to MPATT representing doctors however, they stressed that the RRCB was an independent body. Montano subsequently met with the head of the RRCB Clive St Rose to facilitate the process. The doctors also met with St Rose and decided to withdraw the application submitted in 2002 and reapply.

MPATT spent most of the year complaining that negotiations for new contracts 2006-2009 had not started although a proposal was submitted since last year. Consultants, registrars and house officers have been working with letters of continuation since the start of the year. A change in Permanent Secretaries at the health ministry also contributed to the delay since the PS heads the Joint Negotiating Team of RHAs negotiating with doctors. Preliminary discussions started two weeks ago with the PS and MPATT.

EWMSC:-

The country’s tertiary facility had the most unrest this year. The Public Services Association sanctioned a shutdown of the Complex on June 7 and 8 in response to the dismissal of two of its staff representatives, Lyndon Cowan and Dane Durham who were dismissed not long after complaining to Newsday about dogs undergoing CT Scans at the Radiology department.

Scores of workers marched to the NCRHA administration building 39 demanding the reinstatement of the staff reps and resolution of issues ongoing for years.

The PSA called for members to stay at home after a two-hour meeting with the NCRHA CEO Charles Mitchell. First vice-president Stephen Thomas called for Mitchell and the Board to be dismissed for failing to deal with corruption and mismanagement and permanent employment for long serving workers, and payment of arrears of increments and allowances.

The protest continued on June 14 and Health Minister John Rahael tried to diffuse the situation by meeting with the workers outside building 39. He promised to meet in two weeks with the NCRHA CEO and PSA representatives to discuss their problems and tour the complex to see to the complaints which were highlighted by workers.

He could not guarantee that Cowan and Durham would be reinstated since hiring and firing were the responsibilities of the RHAs. The workers did not stop protesting and the Minister did not tour the facility.

A meeting did take place between the CEO and PSA representatives at the end of June during which the NCRHA gave an August deadline for the payment of arrears. However, NCRHA later revised this deadline to December.

There were also complaints from payroll, stores and telephone operators who sought redress for their complaints by complaining in the media.

Apart from protests, EWMSC was the scene of a murder on July 13. Twenty-two-year-old Nicole Gibson was lured to a washroom and murdered.

She worked with the non-governmental organisation Missions International. It has partnered with the ministry on the Surgical Waiting List Initiative and has an office at the Complex.

Staff was outraged by the murder and the NCRHA beefed up security.

Avian Influenza

Early in the year bird deaths at farms in Cumuto heightened fears about the H5N1 strain of avian influenza. While the cause of the deaths turned out to be the aspergillosis bacteria, public confidence in the safety of local chicken plummeted along with chicken sales.

It took months before sales were back to normal. That incident caused the agriculture ministry to issue a reminder to farmers about the need to notify the Poultry Surveillance Unit when unusually high numbers of bird deaths occurred.

In August, routine testing by the PSU detected the presence of AI at a farm in Central Trinidad. The ministry announced that the AI found at the farm was a low strain common in bird populations throughout the world and did not pose “significant threat to human beings.”

Samples were sent to the United Kingdom for verification and the ministry said measures were implemented to contain the spread of the disease. The results confirmed that initial tests were a false positive.

To combat AI in the region the Ministries of Agriculture and Health signed the United Nations Food and Agriculture Organisation (FAO) Emergency Assistance for early detection and prevention of Avian Influenza in the Caribbean Project. TT along with 14 other Organisation of the Eastern Caribbean States countries will have access to US$500,000 to share information and develop emergency preparedness plans.

The scope of the project includes improving laboratory services, and establishing information technology network links between countries.

Legal amendments

The health minister evoked the ire of the Pharmacy Board of TT and Medical Board of TT with proposals to amend legislation governing these bodies. In February, the Pharmacy Board objected to the “vindictive steps” being taken to amend the section of the Pharmacy Board Act related to the register and registration of pharmacists.

The PBTT claimed that full registration would be given to foreign pharmacists without having to undergo 500 hours of supervision, a customary requirement for pre-registration.

Rahael also incensed the Medical Board of TT with proposed changes of the composition of the Council of the Board from seven elected doctors to a board comprising the Chief Medical Officer and seven other people.

The MBTT said the amendment would give politicians control over the Council and doctors had a right to regulate themselves.

Bacchanal

It came as a shock to people when news surfaced in August that consultant pathologist Dr Neville Jankey was allegedly beaten by another doctor at the mortuary of the Port-of-Spain General Hospital. Dr Jankey sought medical treatment at the Accident and Emergency Department and a report was made to the Belmont Police Station. Senior doctors at the hospital took up the cause and met with the CEO of the NWRHA, Ursula Wilson. She assured them that measures would be implemented to ensure Dr Jankey’s safety while an internal investigation took place.

On the bright side

*Babies put a smile on the faces of many people in 2006, not just their parents. Thirty-three-year-old Rosilia Parris of San Juan went to the Mt Hope Women’s Hospital (MHWH) on February 6 expecting to have one baby. She found out that she was having triplets — two girls and a boy. The babies were born a month before their March due date.

Trincity couple, 33-year-old Dion and 32-year-old Hermese Alexander welcomed Aysha, Brianne and Clay on June 7 at the MHWH. The first-time parents were overjoyed since they had tried for six years to have children. They eventually tried in-vitro-fertilisation. The babies were delivered via caesarian section at 30 weeks.

*November 20 marked the birth of the second set of triplets for EWMSC. Arima couple Christopher, a sales manager and Curlene Toppin, a nurse said they dreamt about babies years before and had selected names since January 2004.

The three boys were given names inspired by the Bible—Levi, Jonathan, Jeremiah. They were 35-weeks-old.

There were also babies whose births were unusual. Twenty-nine-year-old Rachel Bermudez gave birth to 34-week-old Zhane Shilah via a c-section on June 7. She had carried the baby in her abdomen. An egg was fertilised on top of the womb and the pregnancy was risky since many babies do not survive outside the womb.

At the San Fernando General Hospital, Yolanda Phillip gave birth to 1.1kg Asa. A laparotomy was done to remove the 34-week-old baby from her abdomen. However, the baby did not survive and died on August 23.

Lystra Aberdeen created history at the Port-of-Spain General Hospital on November 7 when she gave birth to four babies. “Four came instead of one,” was how 27-year-old Aberdeen described the birth. Aberdeen was preparing for “one last” child when she found out she was pregnant earlier this year. The babies each weighed approximately two pounds. She is also the mother of three other children.

*The National Organ Transplant Programme got underway in January with the first kidney transplant. Eight others were done during the year. While kidney transplants are not new in TT, they were the first batch under the national programme, free of charge to patients. The surgeries were done by Dr David Mitchell from Bristol, UK and local doctors Celestine Ragoonanan and Hassan Khan.

*The second voluntary counselling and testing centre (VCT) for HIV was established at the Morvant/Laventille Health Centre in July.

*After several delays since 2003 and protests by cooks, the North West Regional Health Authority officially opened the $1.6 million refurbished kitchen at St Ann’s Hosptial in February. The project cost $1.6 million and includes new equipment.

*The TT Network of People Living with HIV/AIDS (TTN+), an umbrella organisation of groups repesenting people infected and affected by HIV/AIDS was launched in October. The Network will work with the public and private sector to achieve the goal of a multi-sectoral approach to the virus as “full and equal partners in the fight against HIV.”

*The National Radiotherapy Centre, St James, opened the Peregrine Chemotherapy Suite which added 31 recline seats for patients getting intravenous chemotherapy infusion.

*19 patients were decanted from St Ann’s Hospital to the Arima Rehabilitation Centre in June as part of the community care programme for stabilised mental patients to be gradually reintegrated into society and ease the crowding at St Ann’s. A total of 43 have been transferred for the year.

*This year the Neonatal Intensive Care Unit of the Mt Hope Women’s Hospital (MHWH) achieved the lowest levels of perinatal mortality since the inception of the hospital 26-years ago. Deaths have dropped from 10.2 to 2.7 monthly. This news was given at the formal opening of the refurbished NICU in October.

Approximately $12 million was spent refurbishing the unit. Equipment (including a high frequency oscillator, a new form of ventilation for babies) was not included in the cost.