Da­reece Po­lo

A prob­lem­at­ic pro­cure­ment sys­tem and a “woe­ful­ly in­ad­e­quate” staffing es­tab­lish­ment have left pub­lic health fa­cil­i­ties in a state of pre­car­i­ous dys­func­tion, ac­cord­ing to the Trinidad and To­ba­go Na­tion­al Nurs­es As­so­ci­a­tion (TTNNA). While the pub­lic has long com­plained of a de­te­ri­o­rat­ing pa­tient ex­pe­ri­ence, the front­line work­ers tasked with main­tain­ing the sys­tem now ad­mit they are ter­ri­fied of the very wards they man­age.

“I am telling you as the pres­i­dent of the nurs­ing as­so­ci­a­tion, and I sure the sen­ti­ments are ex­pressed by my col­leagues, that we don’t even feel safe. Even us, as nurs­ing and mid­wifery per­son­nel, by en­ter­ing some of our own fa­cil­i­ties, we don’t even feel safe be­cause we know the short­com­ings. We have the so­lu­tions, we have the rec­om­men­da­tions how to re­solve it, but ad­min­is­tra­tion is push­ing back on it,” said TTNNA Pres­i­dent Idi Stu­art.

The con­cerns come amid re­ports of se­vere staff short­ages, par­tic­u­lar­ly in ma­ter­ni­ty care, where mid­wives say they are be­ing stretched be­yond safe lim­its.

They claimed that in one in­sti­tu­tion, there are five birthing suites and two as­sess­ment rooms, yet on­ly two mid­wives are as­signed to care for five labour­ing moth­ers at a time, de­spite stan­dards re­quir­ing two skilled at­ten­dants per pa­tient.

Health­care work­ers claimed the sys­tem has ex­pand­ed over time, but staffing lev­els have not kept pace, leav­ing crit­i­cal gaps in care.

At the same time, a re­vised pro­cure­ment sys­tem in­tro­duced un­der the cur­rent ad­min­is­tra­tion is be­ing blamed for wors­en­ing short­ages at fa­cil­i­ties such as the Er­ic Williams Med­ical Sci­ences Com­plex in Mount Hope.

Ac­cord­ing to TTNNA trea­sur­er Aleisha Ed­wards, ef­forts to tight­en over­sight have had un­in­tend­ed con­se­quences for pa­tients.

“They are go­ing af­ter any slack­ness, any fraud, any im­pro­pri­ety with req­ui­si­tion of sup­plies. But it is trick­ling down to af­fect the clients. Clients are hav­ing to walk with much of their sup­plies. There is no tis­sue in the NICU. How can we pre­vent in­fec­tion with­out nap­kins, with­out the re­quired tools? When in a NICU, you re­quire one-to-one nurs­ing; there is one to four. There is one to three.”

Ed­wards al­so ques­tioned plans to re­cruit for­eign mid­wives, rais­ing con­cerns about train­ing and in­te­gra­tion in­to the lo­cal health­care sys­tem.

Mean­while, the TTNNA pres­i­dent warned that the strain on staff is in­creas­ing the risk of ad­verse out­comes, par­tic­u­lar­ly in high-pres­sure en­vi­ron­ments such as de­liv­ery rooms.

“If one care­giv­er has to jug­gle be­tween five birthing rooms, it in­creas­es the risk of an ad­verse event,” Stu­art said.

De­tail­ing what that event can look like, he said a dis­as­ter could ma­te­ri­alise if a child los­es oxy­gen while stuck in their moth­er’s birth canal dur­ing labour.

“While the mid­wife is deal­ing with some­body else in an­oth­er room, now that ten sec­onds, that child com­ing out with de­fects, neur­al de­fects, brain dam­age, cere­bral pal­sy.”

“And ten sec­onds could change the tra­jec­to­ry of that child, of that fam­i­ly and prob­a­bly the en­tire na­tion. That child could have been the next prime min­is­ter, that child could have been the chief jus­tice, that child could have been the next pres­i­dent. That be­cause some­body is try­ing to save $15 on every hour has caused an en­tire tra­jec­to­ry of a na­tion to change its course.”

Guardian Me­dia con­tact­ed the Min­is­ter of Health, Dr Lack­ram Bo­doe, for a re­sponse to these con­cerns, but no state­ment was re­ceived up to the time of pub­li­ca­tion.