Does Guyana Need A Specialist Hospital?

Jun 17, 2012 AFC Column, Features / Columnists

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Health care is a global engagement, for which Guyana owes its contribution to the realization of the desired health status of the citizenry of the world. It is therefore incumbent of each nation to have a sound national policy, contextual to the extant and emergent needs of the people, and necessary for sustainable economic growth and development. As such health economic literatures are replete with the role of each stakeholder, necessary for a holistic approach to health status appreciation.
In the pursuit of the aforementioned, four sets of primary health care reforms are identified in the WHO (2008) report, one of which is “service delivery reforms”, which addresses the reorganization of health services around people needs and expectations.
In this regard, the Dartmouth study, according to Dr. Pho (2011), instructs us that specialist care though more aggressive and expensive, produces outcomes which on average are not better or is even worse than those achieved with primary health care physicians. Such a caveat, in the context of health and Guyana’s economic outlook, therefore behooves the following questions:
    Has any study been done on health expenditure and health outcomes in Guyana, which can instruct us on this critical national issue?
    Would this national health care institution, be a means of care for only the rich? If no,
    What percentage of the population, with depreciated health status, has need for such a care?
    What percentage of this population subset, are from the working class or indigent, and what percentage is wealthy?
    Would government subsidize the cost of specialized health care? If yes, what are the criteria for the granting of such subsidies? How would such subsidies be financed?
    Does a rise in the level of citizenry, seeking health status appreciation at a specialized institution, reflect a failure at the primary health care level? If yes, has integrated health care management been effectively used? What are other reasonable explanations for such a failure?
Answers to these questions would not only help decision-makers, but all stakeholders, as to the judgment used by the political actors and thinkers, of the PPP/C government. It is therefore my hope that same would be provided with alacrity.
James O Bunbury Jr.
Pharmacist (RPh)
MBA Finance (Health Care)

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While the PPP/C Government is adamantly pursuing a Speciality Hospital, the foundation for a good health care system is being forsaken. The AFC found a number of areas for serious concern at the nursing school:
1.    There are unconfirmed reports that the Nursing School has not been accredited since 2003
2.    With over 450 students enrolled, the school has only 4 full-time lecturers and about six part-time lecturers. It must be noted here that the international standard is one lecturer to 25 students.
3.    Student nurses are not receiving any clinical demonstrations and training. The training programme should provide for the student nurses to gain practical experience by matching what they learn in the classroom with training on the floor. This is not happening, as there are no clinical lecturers to take the students through their paces on the floor or in the wards.
4.    Student nurses are working at the hospital unsupervised. Third-year student nurses are sent to the wards, the High Dependency Unit, Emergency Room and other critical areas where they carry out the duties of a fully-trained nurse without any supervision. Very often, these student nurses are used to fill the gaps in nursing care created by a shortage of nurses at the hospital.
5.    There have been serious deviations from the curriculum for the nursing programmes. The curriculum clearly set out the number of hours for each course but this is not being adhered to. Some 20-hour courses are being delivered in two hours. Obviously, this means that lecturers are not given enough time to teach the course so the quality and level of learning is compromised.
6.    Only four toilets at the school are in working order and about 400 students have to use these four lavatories. This creates a most unsanitary condition.
7.    Overwhelmed by the number of students at each lecture session, lecturers have become frustrated because they cannot provide the quality of teaching they know is needed and necessary.
Given this state of affairs, the AFC is urging the Minister of Health and the General Nursing Council of Guyana to immediately address what is happening with the nursing programmes. The Nursing Council especially, which is the body responsible for accrediting nurses, should seek an immediate intervention so that the quality of training required is guaranteed.
Nurses are the backbone of any health care system and to have persons out there who may be certified but lack the required level of competence is a very dangerous situation and as we said last week, it is a crisis in the making.
The AFC would like to know, who will be held responsible in the event that a life is lost due to inadequate nurse care? Can we blame a nurse who was not properly trained?
Remember we are talking about human lives here.

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