Introduction:
As I sat down to write this week’s BU contribution on a pressing financial economic matter, I came across the break out of serious antibiotic-resistant bacteria problems at our only hospital. Those of us familiar with the various infections that plague British hospitals would not be surprised that Klebsiella bacteria has now arrived at the QEH. I must admit, it did not come as a shock to me, since a friend and I have only recently been discussing the rat-infested, rubbish-strewn, health and safety hazard that is the Queen Elizabeth Hospital. But it was the compulsive, arrogant, obstinate greed of the doctors behind their objections to alternative medicine that tipped me over in to widening the debate on the future of the health service and long-term care. It is not a concern about patient care, nor about the general welfare of ordinary Barbadians, but rather a determine attempt to co-opt the attorney general in their little game of protecting their money-making interests. To put it in simple terms, we are in a deep cesspit of our own making, typified by the abandoning of the elderly, so-called granny dumping, for which the entire nation should be ashamed, yet all these expensively educated people could think about is their own bank accounts.
Analysis:
There are issues of more pressing concern that doctors should be involved in, such as the mortality rate at the hospital, the high costs of X-rays and MRI examinations, of overall poor patient care by doctors, who attend surgeries as and when they like. Few Barbadian doctors, aware that their profession is about public health and not just money-making, have raised their heads from the trough that is taxpayers’ money to battle for improvements in the state of public health. But, typically, they are more concerned about the continuing rise of unregulated medical practice – so-called complementary medicine – not in the interest of the public, but because this medical practice main block one of their most lucrative income streams.
Doctors are the most expensively trained people in Barbados, whether they are educated at the University of the West Indies or go ‘overseas’ to receive their training. They also have an awful record of picking their fights: against ordinary people who had the good fortune to be trained in Cuba, one of the best medical set ups in the world, while prepared to turn a blind eye to the rise of so-called Chinese medicine, one of the biggest unregulated scams to hit the Western world. But, long-term health care will be the biggest burden on the national economy in the years to come and unless we – that means all of us, including doctors – do something now to control this massive spend, the already-creaking economy will not be able to stand the strain.
Public Health as Policy:
Public health policy is in need of emergency treatment, from the epidemic of obesity, HIV/Aids infectivity, and overall nutritional shortages, to the $800m cost of the proposed new hospital. However, by far one of the most brutal, uncivilised and savage symptoms of this paucity of policy and funding to be played out in public space is that of granny dumping – leaving elderly relatives stuck in hospitals and other public institutions until they are removed at public expense. Apart from the fact that this anti-social act should be made a criminal offence, anyone dumping an elderly (disabled or mentally ill) relative in any public institution should also be automatically disinherited.
We cannot be a society in which inhumane relatives can relieve themselves of any social responsibility for sick and elderly relatives then hope to inherit family assets. More than that, this reversal of sociological history is to retreat in to barbarism: historically there has always been a trade off between generations; parents have children to whom they are obliged to provide care and protection until they reach adulthood; then, as adults, they go off and raise their own families. As their children grow, the older generation, now also grand parents, continue to enjoy their early old age until such time that they cannot look after themselves. Part of our social compact is that their children then perform a dual role; looking after their parents while also keeping a watchful eye on their own children, who by now would be in their late teens or early adulthood. This is the generational trade off that is part of human culture and which is now mainly practised in Asia – the so-called Confucian principle – and to a certain extent in India, although here is it more something talked about then practised. It is only in Western culture that care of the elderly is palmed off to privatised institutions – so-called long-term care – in which their children and grandchildren believe that a weekly or monthly visit usually on Sundays for an hour or so, fulfils that generational obligation. What is compounding this post-Independence brutalism is that with advances in medical science and lifestyle changes have combined to change the structure of the family. Instead of the three-generation extended family (children, parents and grand parents) many young people are now living long enough to get to know their great grand parents, many of whom now live to their late eighties, nineties and over 100. This development will not only re-configure the shape of the family, but will re-write our social obligations to each generation, over and above any impact it will have on the economics of health care.
Preventative Medicine:
The first lesson in good health care, as we have all now learned, is that prevention is better than cure. Good diet, regular exercise, proper rest, cutting down on salt, sugar, unsaturated fats are the ingredients of sound health, and they are the very lesson that the chief medical officer, the ministry of health and individual doctors should be pumping out every day. To reinforce this, government should have a basket of fresh fruit and vegetables, virgin olive oil, fresh fish, well sourced chicken and minimum red meat, should be zero-rated for Value Added Taxation. Policymakers should accept that the short-term loss of taxation could provide incredible long-term dividends in terms of a healthy nation. To this end, it will be cheaper in the long-term for the state to establish a number of leisure centres, complete with gyms, than to focus our health spend on the hospital and medical emergencies.
Science V Tradition:
Part of the mis-education of a former colonised people is that the victor writes the rules. Part of this cultural dominance is the promotion of Western medicine over that of traditional communities, who, through trial and error (the traditional equivalent of the Kuhnian revolution) have worked out which plants are best for which disease. Western science over-ruled this for over a century, but now even this is in reverse as the Big Pharma companies trawl the world looking for fauna and flora, and even the DNA of some people, in which to develop new medicines. In fact, not so long ago the government and medical establishment in Barbados allowed an American biotech company to come to Barbados and take the DNA of one of our ,many centenarians to order to get their lab technicians to develop a medicine to prolong life.
We can be sure that, apart from what they have already received, neither the family nor the nation will benefit from that intellectual property right when it comes on stream. That, I suggest, is the price of ignorance and is something that senior doctors and politicians should have protested loud and hard about at the time. Instead they remained silent, a silence enforced through their collective, embarrassing ignorance. But Western-based medical science versus traditional medicines will continue to occupy health scientists, health economists and social policy experts.
Big Pharma, Big Money:
Doctors all over the Western world are in the hands of the global pharmaceutical companies. It is in their commercial interest to medicalise ordinary aches and pains, develop a medicine for them, then charge the world. It is how they make their billions and little states like Barbados must push back against this dishonesty, now allow our self-interested doctors to encourage us to spend more. If you want to really read about this US$800bn Leviathan, see Marcia Angell’s The Truth About the Drug Companies, Merrill Goozner’s The $800M Pill, Jerome Kassirer’s On the Take. They also provide good background information on why the entire pharmaceutical industry, so-called Big Pharma, is up in arms against Obamacare.
Analysis and Conclusion:
Barbadian doctors have a lot of questions to answer: we want to know doctors’ death rates, their failed operations, when they are late for appointments, their continuing professional development – in short, if they are professionally fit for purpose. This is information that should be made publicly available, especially to people undergoing surgery. Worldwide, doctors routinely botch operations on unfortunate patients which only come to light by word of mouth or if one is related to a victim. Either in Barbados we have the best doctors in the world or a number of patients are botched, even killed, without as much as an inquest. With no proper patients’ representation, no political enthusiasm for taking up constituents’ issues and the historic deference Barbadians have for so-called professionals, being a doctor in Barbados is almost a licence to murder. But doctors have a greater social responsibility beyond their clinical presence, such as for example when middle aged women have to undergo a hysterectomy or any other serious and life-threatening operation only to be discharged from the hospital within hours because insurance companies do not want to spend the money on their care or there is a shortage of beds. This is an ethical issue, and not one of finance, and doctors should intervene to warn insurance companies that they are putting their patients at risk. But do they? There are areas of medicine and health that we should be actively involved in, if not leading the world: sickle cell, prostate cancer, type-two diabetes, etc, which have a high ethnic and cultural correlation. But their greed has confirmed the urgency of the need for health care reforms, restricting the business and private practice of contracted health service doctors and imposing a strict demarcation line between the expertise of doctors and the care and welfare responsibilities of nurses.
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