Delivering Medical Care

Jul 03, 2013 Editorial

Two seemingly unrelated recent reports in our newspapers raised the question as to whether there is any overarching plan to ensure that our medical system, in which we are injecting billions of dollars annually, delivers the optimum medical care to patients. There is an unfortunate tendency to equate medical care with the number of doctors per person available in a country. But while doctors play a critical part in the delivery of health care, they are simply one part of a very complex system.
The first report had to do with the discovery of large amounts of expired pharmaceuticals and other medical supplies in two hospitals. While the expired drugs might not all be stored in morgues, the problem is very widespread in all the hospitals and clinics in the country. And this is especially true at the bond at Georgetown Hospital. What is clear, then, is that there is no effective system of inventory control of stock that matches usage and requisitions/orders for new supplies.
While there will never be a seamless fit between requisition and usage, better monitoring by the administrative staff should help to redistribute the supplies in a more efficient manner. Apart from the savings that would be generated, it might just address the endemic problem of unavailable supplies, since it is quite possible that the latter problem might just be an allocative one. Then again, even if this is not so, the savings generated can subsequently be used to purchase needed supplies.
What we need in Guyana is more attention and greater importance given to matters of inventory control. In these days of computerised records, hand-held scanners and instantaneous transfer of data, the problem of expired drugs and out-of-stock supplies should not be so extensive. There has been a great deal of publicity given to the government acquiring its own warehouse for the storage of medical supplies. This is supposed to address the need for greater control of stocks, but as we are arguing, unless the manpower is properly trained and motivated, we will remain in the situation that presently obtains, or maybe even worse. Already we have had reports of problems at the level of supervisory staff at the warehouse.
The other news report concerned the advanced training of nurses in our health system. In Guyana, we are stuck at the retrograde level of only considering nurses as mere adjuncts or helpers to doctors. While they may be so in certain circumstances, nurses have a very wide range of independent duties in patient care. Nurses will have to be treated as independent professionals in their own right, both by the public and by those that administer the health system.
It was very heartening therefore to learn that a programme has been launched in Guyana to train specialist nurses in such areas as critical care, anaesthesiology, neonatal care and psychiatry. This programme must be broadened in other areas such as paediatrics etc. In the developed countries this has been the trend in medical care and in fact, the salaries of some of these specialists have matched or even surpassed those of novice general-care physicians. It was somewhat surprising that the programmes have not been accredited as yet: whatever might be the reasons they must be resolved immediately. In the absence of such accreditation, which would lead to greater remuneration, we will lose these highly trained individuals to foreign medical systems.
It should go without saying that the well-publicised challenges in the Nursing School for new nurses must not be swept under the carpet. As was done with the programme in the Cyril Potter (Teacher) College of Education, the nursing programmes at all levels must be integrated within UG. Whatever lacuna might exist in reference to accreditation, can be rectified in such programmes that hopefully can be patterned on the established ones in the developed jurisdictions.
Just as crucial as the training, however, is the recalibration of the doctor-nurse relationship in Guyana. While it may sound harsh, this will only be accomplished when nurses’ salaries are significantly raised.

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