Dr Carlos Chase, president of the Barbados Association of Medical Practitioners (BAMP), recently went on the public record and warned Barbadians to expect to be charged hefty medical fees by himself and other similar specialist doctors. Yet, this is the same Dr Carlos Chase that is urging the Barbadian people to sell their nation’s only public hospital –– our Queen Elizabeth Hospital –– to corporate Barbados and to doctors like himself, in order that they might run it like “a hotel”.
It was at a town hall meeting held at Queen’s College on Tuesday, February 9, that Dr Carlos Chase defiantly declared that he has to bear sizeable insurance costs, and therefore “if . . . you visit me or do a delivery, you can expect that I’m not going to charge you peanuts”.
I cannot speak for the rest of my fellow working-class and middle-class Barbadians, but as far as I am concerned, Dr Carlos Chase is not the type of character I would wish to have exercising ownership and control over the only major general hospital in my country. As far as I am concerned, nothing can be better than to have the only major general hospital in Barbados owned by the Government and people of our country!
As an amateur historian, I am only too well aware of the abysmal and minimalist health care that was available to the masses of black and poor white Barbadian people until, with the advent of universal adult suffrage in the 1950s, the various black-controlled Governments of Barbados radically expanded the state-owned public health care system, inclusive of the establishment of the Queen Elizabeth Hospital (QEH) in 1964.
Indeed, I maintain that the experience of the entire world over the past 100 years has demonstrated beyond the shadow of a doubt that the cornerstone of any effective national health care system is the public, state-owned general hospital that provides citizens with a comprehensive range of free (or taxpayer-supported) medical services and facilities under one roof.
We Barbadians already possess such a system in the form of our state-owned QEH, and we would be fools to listen to the siren voices of the likes of Dr Carlos Chase and give it away. Whatever problems and deficiencies currently plague the QEH can be remedied without privatizing our hospital!
I am therefore calling on all sensible Barbadians, and particularly on the mass membership of the Barbados Association of Medical Practitioners (BAMP), to completely disavow Dr Carlos Chase and his backward idea.
I, like many Barbadians, am only too well aware of the several problems and deficiencies that currently plague our QEH, and over the past ten years I have devised many proposals designed
to correct these shortcomings.
Here are a mere four of such proposals which I conveyed to management of the QEH several months ago:
1. A voluntary citizens’ funding mechanism. I believe that there are literally tens of thousands of citizens and residents of Barbados who would voluntarily make financial donations to the QEH as their preferred “charity of choice”, if a mechanism existed to make such giving easy, convenient and stress-free.
I have therefore suggested to the Bankers Association of Barbados, the Barbados Co-operative Credit Union League, and to the QEH board that a national programme should be put in place whereby citizens and residents who already possess accounts at the six retail banks and the five major credit unions of Barbados could be encouraged to determine upon a charity of their choice –– the QEH –– and to execute a standing order authorizing the officers of their bank or credit union to transfer a monthly sum –– with $10 being the monthly minimum –– from their bank or credit union account to an account that the charitable organization (QEH) will establish at each of the six banks and five major credit unions.
Barbadians should be encouraged to engage in philanthropic giving, and those of us who could afford it, should be inclined to make the QEH our charity of choice and to sign a standing order to give $10, $20, $50 or $100 per month (whatever we can calmly afford) to the QEH, and not feel that we have taken any undue burden upon ourselves.
2. The National Insurance Scheme to the rescue. Whilst the Government and taxpayers of Barbados will always have to subsidize a majority of the operating expenses of the QEH, the National Insurance Scheme could be utilized to underwrite a significant portion of these expenses.
I propose we modify the currently existing National Insurance Scheme, and establish a new component of it under which we set aside part of each contributor’s monthly National Insurance contributions for a part payment of the cost of any medical treatment that such contributor or their immediate family members receive at the QEH.
In other words, let the National Insurance Department set up a special medical services account into which a suitable percentage of each contributor’s monthly NIS contributions are paid –– say five per cent of the contributions. These funds will then be called upon to help finance a stipulated portion of the expenses associated with treatment at the QEH of the contributor or the members of his or her immediate family –– spouse, children, parents or grandparents.
These NIS funds would provide the QEH with a steady and reliable stream of income which, in tandem with Government’s annual financial allocation, should be sufficient to cover the recurrent operating costs of the hospital. (This initiative would also provide an additional incentive for all employed and self-employed Barbadians to sign up and contribute to the NIS!)
3. Reform the management structure of QEH. The QEH is the largest and most complex institution in Barbados, employing some 2,500 workers and carrying out some of the most technical and complicated medical procedures imaginable. Such an organization cannot be adequately managed by a group of part-time directors who are not intimately involved daily with the complicated workings and procedures of the hospital.
In spite of this reality, the currently existing Queen Elizabeth Hospital Act stipulates that “members of staff of the hospital shall not be appointed as members of the board”.
This is sheer nonsense! The act should be immediately amended to provide for a board of management comprised of the chief executive officer of the hospital, the senior medical, engineering and administrative officers, and representatives of the junior doctors and ordinary hospital workers.
Such a board of directors would be possessed of the specialized knowledge and information on which the hospital operates, and would therefore be well positioned to engage in the complicated decision-making that is necessary.
Such a technical board of management could then be held accountable by a board of public trustees whose function would not be technical management or decision-making, but rather, ensuring that there is no corruption or nepotism at the institution, and that high ethical standards and a code of ethics are maintained.
4. Collaboration with the Cuban health care system. My fourth suggestion is that the Barbados health care authorities (inclusive of the management of the QEH) make use of Barbados’ enviable relationship with the Republic of Cuba, and collaborate with the Cuban authorities in programmes designed to improve the quality of health care in Barbados.
The Cubans, for example, have developed a system in which a patient does not wait longer than half an hour in the Accident & Emergency Department before receiving medical attention. Cuba has developed a system of preventative community-based health care, at the centre of which is medical doctors who are assigned to a specific number of households in a community.
Cuba has also made tremendous advancement in the manufacture of pharmaceuticals, including new, cutting-edge drugs to deal with the ravages of such chronic non-communicable diseases as diabetes.
The Cuban government, I am sure, would be more than happy to collaborate with our Ministry of Health and our QEH in sharing the benefits of the Cuban health care success story with us. All that is required of us is that we make the necessary proposal or request to Cuba.
(David Comissiong, attorney-at-law, is president of the Clement Payne Movement.)