When we compare Caribbean diabetes mortality (death) rates of our ‘big brother’ countries like the USA, Canada and the UK, we immediately see that the rates in the Caribbean are many times higher here. This is exactly what Sir George Champ Alleyne, then Director of the Pan American Health Organization (PAHO), told CARICOM Heads of Government back in 2005. In fact, he spoke about all the Chronic Non-Communicable Diseases (cncds) in general and not just diabetes. In all likelihood, the situation has gotten worse, not better, as Caribbean Ministries of Health have been unwilling or unable to implement programs to change the course of ship CNCD.
A similar point was made by Professor Karl Theodore, Director of the Health Economics Unit at UWI, St. Augustine when he gave a public presentation in Barbados in 2019. But instead of focusing on mortality rates, Prof. Theodore noted that unless there was a drastic change in the trajectories of ship CNCD, the Caribbean economies, in addition to its people, were in danger.
It is amazing that the ‘big brother’ countries are extremely alarmed by their ‘lower’ mortality rates, and are attempting to do something about it but our health decision makers give speeches about the CNCDs and then adopt the NATO philosophy: No Action Talk Only, also called an Implementation Deficit Syndrome.
A condition called chronic kidney disease (CKD) in Barbados highlights these points. A majority of patients who develop CKD do so because their diabetes or their hypertension or both these conditions were not controlled. CKD can be treated either by dialysis or by kidney transplant. Because we have not developed a Kidney Transplant Service here, most of our patients with CKD end up going on dialysis.
In 2017, the Queen Elizabeth Hospital, our single main public hospital, spent BDS $19M on dialysis services, probably making CKD the single most expensive disease being treated there. This was approx 13 per cent of the hospital’s budget. That year, there were 117 new patients referred to the dialysis unit, yet 69 of them (59 per cent) did not survive 12 months. So spending millions of dollars on CKD patients is no guarantee of survival (and of course, there is no refund when the patient dies). CKD is draining the Treasury while filling the cemeteries.
One would think that our health officials would attempt to introduce program(s) to reduce the development of CKD; this would save money and lives.
Adequate treatment of diabetes and hypertension in the first place can significantly reduce the number of patients who develop CKD. This is the role of primary care. In Barbados, primary care is offered at all polyclinics. Unfortunately, the data generated by the Health of the (Barbados) Nation Study in 2015 – an epidemiology study which analyzed 1, 234 adults aged 25 years and over – showed that 42 per cent of hypertensive patients on treatment, and 58 per cent of the diabetic patients on treatment, did not have their diseases controlled. Unfortunately, this was followed by a sharp reduction in the drug budgets to these same polyclinics in April 2017, likely to exacerbate an already difficult situation.
Preventing diabetes and hypertension is also possible, but the polyclinics are not offered the resources to do “Health Promotion and Disease Prevention”.
So Sir George Alleyne and Prof. Karl Theodore are both right – unless we attempt to urgently change the current trajectory of ship CNCD, our people will suffer and die, and we will run down the treasury in the process. “Captain, the ship is sinking.”
Dr C.V. Alert MB BS, DM.