Solutions to Guyana’s alarmingly high infant mortality

Jul 22, 2018 Letters

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Dear Editor,
Please permit me to add my professional opinion on the recently released figures on the alarmingly high infant mortality.

Mr. Editor, you may be aware that a letter written by myself which you were kind enough to publish characterised the health services in Guyana, both public and private as, ‘ National Death Chambers’. Mr. Editor you may not be aware of this but I got lots of abuse for my characterisation.
To begin with, I should define what constitutes a death chamber. The Webster’s New World College Dictionary, 4th Edition defines a death chamber as a room in which condemned prisoners are executed. Simply put, it is a place where prisoners enter alive but their biggest fear is that they will leave in a body bag. And their fear is not unfounded or unreasonable.
Speak to anyone going to the public or private health care services in Guyana and ask them what is their biggest fear. Most of them will tell you that they are afraid that they will leave those hospitals in body bags. Not because they have a terminal illness but mainly because health care professionals commit negligent acts with impunity and on many occasions resulting in patients’ premature deaths without any investigation. Now you understand why I view the health facilities as National death chambers. Patients are unnecessarily dying by the hundred every month.
So now, we have this infant mortality figure and there is this big outcry. Fact be told that 2017-2018 is not a outlier year. This has been happening for decades with no action by the past or present Government. Reason? If the President, his Ministers, Opposition leader or MPs sneeze, they will be medivaced out for overseas treatment. It is the Guyanese plebs who have to endure the terror at these death facilities.
Mr. Editor, infant mortality is now topical but they are others. I am sure maternal mortality would be ridiculously high. I am sure unexpected deaths would be ridiculously high. I am sure that hundreds if not thousands of these deaths can be classed as ‘preventable deaths’. I am sure that infectious disease and coronary artery diseases are the leading causes of deaths in Guyana. This is a national disgrace. For those who abused me for calling the local health facilities national death chambers, I have a little homework for you. What is the life expectancy of Guyanese? How does this compares with the rest of the Caribbean and the wider world?
So what can be done? I will humbly make the following recommendations, Ten Commandments, if I may.
1. The Government should set up an apolitical, independent and nonpartisan regulatory body to set minimal standards for hospitals in Guyana. This body should have powers to inspect hospitals both announced and unannounced using statistical matrices to grade hospitals as either excellent, good, satisfactory or poor. This body should also be empowered to close down poorly functioning hospitals. All information on hospitals should be made public.
2. Patients should have a say concerning the service they received. It should be made by law that all hospitals provide a minimal number of patients, family and staff feedback. The feedback will help inform the regulatory body accreditation of the hospitals. The feedback should also be made available to the public and conspicuously displayed in the hospital.

3. The Government should start focusing on disease prevention. For example, controlling patients’ blood pressures, blood sugars, cholesterol, body weight, patient education, etc. Just forget about those ridiculous sophisticated treatment like coronary artery bypass surgeries, kidney transplants, electrophysiological studies etc. Get the basics right. The fancy stuff can follow. Simple things save lives.
4. All unexpected hospital deaths should be reported and investigated by the local hospital. This investigation should be undertaken by independent consultants who were not associated with the case. The regulatory body should be informed of unexpected deaths and steps taken and lessons learnt to minimise reoccurrence. The purpose is not to apportion blame but to learn lessons. This is important if we expect doctors and other health professionals to have a duty of candour.
5. All doctors and nurses should be trained in adult and paediatric advance life support with regular updating. All hospitals should have a cardiac arrest team to tend to patients with reversible cardiac arrest. In hospitals, cardiac arrests have better outcomes than out of hospital.

5. All Government hospital boards should be apolitical. Stop this ridiculous charade of hospital CEOs, managers and medical directors being political appointees. If they are political appointees, no one should be surprised when they feel they are only accountable to their political masters and not to patients, relatives and staff.
6. The Medical Council should be apolitical and independent of doctors. They should have an independent investigatory body responsible for investigating complaints against doctors. Definitely no political appointees.

7. There should be a national register of medical doctors and medical specialists. Unless a doctor is on the specialist register, he/she cannot work independently as a consultant. A doctor who has done a one year masters is not a specialist. He/she lacks the required skills, knowledge and experience to function as a consultant. There should be an independent body that reviews doctors’ postgraduate specialist training to ensure that they are qualified to be added to the specialist register. It is because of these masquerading consultants that we are having such high mortality figures among our patients. Quite frankly, they do not know what they are about and playing with patients’ lives.

8. The Government should just abort those postgraduate masters training for doctors. They are a complete waste of time and resources. Guyana does not have the facilities to train specialists. These doctors should be sent overseas for proper training. Forget what the Canadians are saying that the masters training is good. Ask the Canadians to have those very doctors tend to their Canadian patients and you will get their true opinion of these doctors’ postgraduate training. Knowing that the doctors will only be unleashed to the unsuspecting Guyanese plebs will make them say all good things.
9. We have a neonatal intensive care unit (NICU) without a neonatal “intensivist” and we are surprised that the neonates are dying? How ridiculous! What is happening on that NICU is the blind leading the blind. We also need specialist neonatal intensivist nurses to work on the NICU. Frankly, whatever investigation that is being undertaken by the Government to investigate these 119 deaths, part of the solution would be to have the right staff in the right place. We need skilled staff to operate the NICU, not doctors and nurses who are just guessing.

10. This is the most controversial recommendation of them all.
The Government should shut down the NICU. It is not fit for purpose. Babies and infants are dying. It is not safe because of many reasons with the major reason being inadequately skilled staff. In the short term, our neonates and infants should be stabilised and then medivaced to the closest available NICU. Government should stand the expenses. If Granger, Jagdeo et al can go overseas for treatment paid for by the state, so should our babies. In the long term, the Government should focus on providing overseas training for neonatal intensivist, neonatal nurses and heavily invest in our neonatal service with a view to providing a safe neonatal service. Don’t tell me that we do not have money. They had monies to give themselves a 50% increase, to pay rent at the sum of $500,000 for their ministers and provide an exorbitant Presidential and Prime Minister pensions.

Dr. Mark Devonish

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