?The selection of a new Minister of Health, the ninth or tenth since I know myself to be a doctor in T&T, offers hope for a resolution to the almost constant conflict between the ministry and the doctors in the public sector.
There is little doubt that under the last three ministers, relations deteriorated to a point where aggression and lack of trust had replaced the normally benign symbiosis between the minister and the people who actually make his ministry function. Doctors are the driving force in the Ministry of Health and a Minister of Health simply cannot afford to be constantly antagonising them as was repeatedly done in the last seven years. The way is now clear for a new appointee and, at the time of writing this, I am not sure who the unfortunate person will be. Despite the presence of some dedicated people, the Ministry of Health is a depressed organisation and it will take an enthusiastic, clear-minded individual to bring it out of its doldrums and make it move again. Whoever that person is, this seems an opportune time to give some advice freely and without prejudice, not that I expect it to be taken. The only Minister of Health, and I have known most of them quite intimately over the last 30 years, to ever take my advice on the one or two occasions that I was asked for it was, up to one week ago, more concerned with smirking and writing letters to the newspapers than fixing the country's drains.
The first thing is to re-establish the connection with the medical profession. There are three things to do here. First, call everyone together for a two-day workshop and let people talk things out. Sit down with the doctors.�Being a new appointee, you will have a lot of goodwill going for you. Most doctors are not vengeful. You have some good, young, frustrated doctors around. Listen to them and come up some sort of agreement or truce, get some breathing space, give the doctors more access to you and get the ministry thinking positive again. Two, appoint a group of respected, senior doctors and nurses to advise you. Most of these professionals are retired now from public life but still busy in private. They have served faithfully for many, many years and still have the confidence of the public who remember them from years past. Be careful however not to choose characters who are seen to be political.
Then as a matter of trust, within six months of being elected, readdress the Medical Board Act with all stakeholders, addressing all the points raised by the present and past Medical Councils, ie, a larger council, led by the profession; composition to reflect the varying views of modern society with at least one person representing the "man in the street;" evaluation of medical education and recertification; specialist registration; the establishment of appropriate fees and, above all, the establishment of varying types of disciplinary and educational measures for doctors to more accurately reflect modern thinking.
The second major thing to do is implement some of the recommendations made by the Gafoor Report. As with anything else, the Gafoor Report has deficiencies but it is a blueprint for moving the ministry forward. A summary of the more important recommendations would include: Eliminate the "shortage of human resources" and improve the "unacceptable physical conditions under which health professionals work" and the "poor human relations at almost every level of the health sector." This would include "a comprehensive human resource audit of the public health sector and develop a strategic human resource plan with specific focus on resource needs, recruitment and retention, succession planning, compensation and training," as well as a "detailed forensic audit of the five Regional Health Authorities."
People still appear surprised to learn that doctors, nurses, lab technicians, porters etc, whilst on call in our public hospitals, have nowhere to rest, nowhere to bathe and nowhere to eat. A forensic audit of the RHAs would surprise them even more. Improve maternal and child health care to address the "inordinately high national perinatal and maternal mortality rates." Our infant mortality rate, the most important public health indicator of health in a country, is now the second worst in the Americas.�We beat Haiti.�That figure is the most shameful legacy of the PNM movement, especially considering the close ties between neonatology and the party.
Improve health services "for the elderly and the disabled." All of us know of�Trinidadians-Tobagonians with money who live abroad and want to retire back home but are afraid to do so because of our poor hospital care. Our record of assisting both adults and children with disabilities is astoundingly bad and another national disgrace. These are just a few of the many recommendations made and, apart from the first, perhaps reflect my personal interests. The point is, there is a need to get the Ministry of Health moving again and the Gafoor Report is a ready-made guide for us to follow.