June 23, 2007 – At last week’s two-day Regional Health Conference, healthcare providers and lawmakers gathered from Cayman Islands to Trinidad to peer inside each other’s healthcare systems along with principals from the non-profit Cleveland Clinic of Florida and our Virgin Islands hospitals. The mission was to consider collaboration, to exhibit medical advances made in the U.S. Virgin Islands in primary care, heart procedures and cancer treatment, and discuss challenges facing all Caribbean people in the delivery of and access to quality healthcare. What came out of it were tangible solutions, short-term and long- term, unique to Caribbean health issues that will make a major impact on the delivery of healthcare in our region.
It became clear at the onset what we already knew to be a fact: the Caribbean Islands are in essence a single community, forged together by our customs, values and attitudes, exemplified by the food we eat, the dances we dance and the health challenges we similarly face.
Health challenges such as hypertension, diabetes, prostate cancer, breast cancer, heart disease, HIV/AIDS and stroke, evenly affect Caribbean people regardless of island country.
Throughout the conference, it was stated repeatedly that an open-door policy is the most viable means to achieve the goal of making the region, with emphasis on the V.I., the home of first-class medical care. By combining resources, we could become our own “Mayo Clinic,” providing state-of-the-art medical care in the sunny Caribbean.
The enthusiasm for this conceivable concept did not cloud our sense of reality: the Caribbean islands do not have the resources to provide the sophisticated equipment and professionals required to bring this concept to fruition. However, the solution to immediately upgrading medical treatment throughout the region is collaboration. Collaboration resonated in every one of the presentations. Improve healthcare in your own country through collaboration. Collaborate on consultations and diagnoses through modern e-health technology. Collaborate with the uniform collection of data. Simply put, isolation is no longer the biggest challenge to providing access to health care in the Caribbean, and exposure to the issues faced by our neighbors offered specific solutions.
It followed that the investment should be made on each island to put video and audio imagining in place, making consultation possible between, for example, Dr. Mercedes Dullum, Cleveland Clinic thoracic-cardiac surgeon, Dr. Roy Flood, V.I. cardiologist, and Dr. Winston Forbes, Bahamas Rand Memorial cardiologist, a commonplace procedure. It was Dr. Dullum who emphasized the importance of “embracing modern technologies and forming strong alliances across borders.” She introduced the reality of “virtual office visits” whereby patients and physicians in remote communities have access to consultation with specialists and colleagues as well as state-of-the-art techniques and assistance with diagnosis through virtual viewing, telephone or through the Internet.
Participants learned of milestones made in V.I. healthcare from CEO’s Rodney Miller of Schneider Regional Medical Center and Gregory Calliste of Gov. Juan Louis Hospital. With emphasis on the Cardiac Care Center on St. Croix and Kimelman Cancer Center on St. Thomas, both whose strategic development and success are reliant on regional cooperation with other Caribbean countries, the administrators outlined their state-of-the-art medical services both online and soon-to-be in operation.
Grenada's Sen. Ann David-Antoine R.N., minister of health, described in detail how a worsening economic situation for developing countries reduced the ability to educate and train primary health care workers. Grenada, like many island countries, is still recovering from the destruction from a hurricane that interrupted progress, particularly in the training of health professionals. Her experience was to include national or international consultations at all levels of health planning, as her country has done with their National Strategic Plan spanning from 2006-2010.
Haiti’s representative presented a unique statistic. Eighty-five percent of the country is very steep and mountainous, reachable only by jeep, with minimal telecommunications. Yet a 2005 cartographic study disclosed that all of Haiti’s modern health facilities were located in altitude zones between zero and 200 meters, thereby denying access to many residents. Health professionals in Haiti decried the use by residents of “traditional or non-conventional” family medicine that requires little or no expense. An investigation done in two Haitian municipalities, Verrettes and La Chapelle, whose populations totaled 128,637, found that 1208 “leaves doctors,” who prescribed plants called “simples,” were the preferred medical professionals and little has been done to change that mindset.
Ambassador Dr. Izben Williams of St. Kitts/Nevis emphasized that “Most developing countries, while they have an enormous amount of local readiness for action to improve quality, frequently attempt to improve that quality in an insufficient environment.” They lack the know-how as well as the infrastructure and financial, human and physical resources to make the improvements. He suggests that a change in political policies towards harnessing knowledge in science and technology can be accomplished only if our policy makers have the political willpower to redirect our priorities. According to Dr. Williams, we have the ability to change our political mindset about the importance of health access. But do our leaders have the desire to raise it up on the list of priorities?
All of the island nations have one unanimous complaint: we have a critical shortage of nurses and the inability to retain them. It was suggested that the law require a standardized nursing degree, aided by computer technology and reinforced by medical endorsements. Regional nursing policies and a strengthened Caribbean Nurses Organization would help standardize nursing practices.
Dr. Marion E. Howard of Barbados, president of the Caribbean Nurses Organization, detailed the history of the profession in the Caribbean and cited vast reforms in recent years in both the nature of services and the status of nurses. Dr. Howard deplored the nursing shortage in the Caribbean as the single, most major challenge to the delivery of safe and effective health services, declaring “it is likely to be intensified by the continuing and aggressive recruitment of highly-trained, competent Caribbean nurses by developed countries such as the United Kingdom, United States and Canada."
Author Richard Bach wrote, "A tiny change today brings us a dramatically different tomorrow.” The seeds of change that would allow access to quality healthcare for all Caribbean people were planted in what looks to become an annual event. Participants saw possible solutions in the area of nursing, from increased regional training of nurses to greater sensitivity on the part of mother countries when it comes to recruitment of an already limited nursing population. The concept of virtual office visits was shown to be an achievable goal, with a minimal amount of investment resulting in a maximum of medical consultations. A Health Professionals List Server, which is a continuing Internet dialogue between the participants, is being constructed and will allow these health-related conversations to continue. This conference initiated those first steps. With dedicated healthcare providers and lawmakers imbued with a desire to initiate change, we will make the necessary strides so badly needed to make state-of-the-art healthcare available to everyone in the Caribbean.
Sen. Louis P. Hill
Editor’s note: Sen. Louis P. Hill serves in the 27th Legislature.
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