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Camacho: Covid-19 crisis shows urgent need to develop T&T’s healthcare system

“[…] The point I want to make here with respect to Covid-19 is that this crisis has brought to the forefront a whole new concept that prior to now was not one that we gave a lot of national attention. This concept is that of ‘National Healthcare Security’.

“I draw a parallel here to the more commonly touted ‘National Food Security’, which is the idea that a country should strive to develop its local food-producing capability to be able to feed its own population rather than solely rely on imports. In the same vein, I have long been an advocate for developing our local healthcare capabilities so as to give us self-sufficiency.

“Never has this ideology been more important than in the present crisis…”

Photo: The San Fernando General Hospital.

The following column on the urgent need for national healthcare security in Trinidad and Tobago was submitted to Wired868 by Christopher Camacho, managing director at MRI of T&T/Advanced Cardiovascular Institute:

The dawn of 2020 has indeed ushered in a new era of transformation. Unfortunately it is not the transformation that many leaders including the ones in Trinidad and Tobago would have projected in their optimistic and forward looking plans for this new decade.

Covid-19 has come like a thief in the night and has challenged everything that we thought we knew, changed every priority and plan that we were determined to follow through on and revoked every freedom that we held as a God-given right. It has forced a worldwide introspection for every citizen in the world from the leader of the free world to the homeless in Port-of -Spain.

This introspection will no doubt teach us many lessons, force us to change our perspectives on life and hopefully our actions going forward beyond the resolution of this pandemic.

Until now and over the last 20-plus years, I have taken great personal pride in being a catalyst for the professional development of many dedicated and talented local doctors, nurses and healthcare professionals in their quest to provide medical services that previously were not provided or otherwise under-provided in our country—specifically in the fields of MRI imaging, heart care and prostate cancer treatment.

Photo: Infection Prevention Control (IPC) nurses in customised donning area.
(Courtesy NCRHA)

I say so not for personal elevation but to highlight the brave souls who would have foregone lucrative personal opportunities in highly developed healthcare systems in the USA and UK to return to Trinidad and Tobago, knowing that they would be working from ground zero to build a service without the support that previously surrounded them during their training.

The point I want to make here with respect to Covid-19 is that this crisis has brought to the forefront a whole new concept that prior to now was not one that we gave a lot of national attention. This concept is that of ‘National Healthcare Security’.

I draw a parallel here to the more commonly touted ‘National Food Security’, which is the idea that a country should strive to develop its local food-producing capability to be able to feed its own population rather than solely rely on imports. In the same vein, I have long been an advocate for developing our local healthcare capabilities so as to give us self-sufficiency.

Never has this ideology been more important than in the present crisis that has enveloped our world and brought countries like the USA, China, Italy, UK, Spain and France to their knees.

As a result, borders everywhere—including our own—have been slammed shut for the foreseeable future and it is now literally every country for themselves, with USA even invoking laws  to prohibit the exportation of their manufactured healthcare supplies. The pause button has been pushed on globalisation and it is only Mr Virus that seems to have a diplomatic passport for unrestricted travel around the globe.

Photo: Coronavirus Covid-19 was declared a global pandemic on 11 March 2020.
(Copyright Thrive Global)

So as we retreat to our respective embankments and bunkers in defence against the onslaught of the merciless, unrelenting microscopic enemy, our national hopes rest squarely now on our newly enlisted front line soldiers—our national healthcare workers.

We cannot call for backup, no one will come; they are busy on their own front lines. You cannot flee to safe heavens overseas, not even if you could afford the best international health insurance or sophisticated air ambulance. For better or worse we have to depend on our much maligned healthcare service and hope it holds up under the strain.

I personally would like to express my sincere gratitude and admiration for all of those brave, selfless souls on the frontline led by Dr Michelle Trotman, Dr Anthony Parkinson and the many other doctors, nurses, ancillary healthcare and support workers.

I also would like to express how impressed I have been with our public health officials led by the Honourable Minister Terrence Deyalsingh and Dr Roshan Parasram; and our government, led by our prime minister who had the wisdom to be guided by them.

They have been on top of this pandemic from the start, even before many—including myself—were taking this threat seriously. Your early and decisive actions, before most other countries in the world, shielded our healthcare system and gave our healthcare workers and nation some hope to be spared the worse of this pandemic.

Photo: Health Minister Terrence Deyalsingh (left) and CMO Dr Roshan Parasram.

Once this war is over, I pray and hope that we will learn from this tumultuous time and not go back to business as usual. Of course this includes all the good lessons of personal hygiene and infectious disease control.

The main subject of this column is to highlight the need for national healthcare security as we progress in our journey as an independent nation. In this regard, there are varying roles for all segments of our society.

The first and most obvious segment is the policy maker, the Government of Trinidad and Tobago. I have always empathised with the government as they try to meet the costs and demands of the tremendous national healthcare burden out of dwindling tax revenues and shrinking resources.

It is an unenviable challenge and dare I say one that is possibly unachievable with the current realities, given the ever rising cost of health care treatment driven by continuous advancements that rely on high cost equipment, supplies and medications that must be imported.

At the same time if we want to be self-sufficient we have to also attract the best human resources to return to Trinidad after their specialty training. If we are to attract the required personnel, we need to pay them sufficient salaries or allow them to earn a reasonable livelihood commensurate with their role, bearing in mind the other overseas options available to them. This also increases the healthcare cost to the government.

Photo: A satirical take on health.

We as a nation need to understand that this cannot be funded from normal tax revenue; the same way the government can no longer afford subsidised fuel. It is my view that the only way forward is to have a completely separate national health insurance fund, which comes from contributions by the working population.

The health surcharge currently deducted cannot possibly fund healthcare costs and a proper actuarial analysis needs to be done. I understand this will not be politically popular but I cannot see a realistic alternative given the undeniable state and future projections for the energy sector.

Until this is achieved, my suggestion is the government should forge a national policy framework and work more closely in a strategic partnership with insurance companies and the private healthcare sector to help to ease the burden on the public system and promote the national healthcare security agenda.

With regard to the insurance companies, the government should encourage the insurance companies to develop their health insurance portfolios and give tax incentives to employers to get more persons covered by health insurance. This can be a precursor to the national health insurance scheme.

I have always been puzzled by successive governments’ stance on the private healthcare sector. In most other private sectors, for instance construction and manufacturing, there is a strong push for incentivising and encouraging development of local industry. This has not been my experience in private healthcare and I am not talking about this government alone.

Photo: North Central Regional Health Authority (NCRHA) CEO Davlin Thomas (front left) poses with staff at the Caura Hospital.
(Courtesy NCRHA)

In my opinion, a vibrant private healthcare sector is imperative for a country of our size to get close to achieving national healthcare security, as it can: ease the burden on the public system, help train and retain top end healthcare human resources, provide excess capacity at a lower negotiated cost to the public sector, push the envelope for new advanced services, pay taxes for health care services back to the government rather than just being an expense, create jobs, promote regional health tourism to generate forex and, crucially, make us more self-sufficient.

I have always been willing to work with the government in this regard and will continue to do so. But I urge the government to make this a point of priority and to encourage and support the local private healthcare sector and stop seeking external solutions to our national needs, which ultimately will not be sustainable.

We should always first engage nationals to solve national problems. You have good bright doctors and nurses right here, let’s engage them together in partnership.

There is also a role for the population in achieving national healthcare security.

We need to cherish and encourage our healthcare workers and understand that they are not always working in the most ideal circumstances, which can wear them down. Our current reality is not where we want to end up, it’s just where we are now. We should not cry them down or malign the sector.

We also need to take personal responsibility for our own health and lifestyle, like we are doing now out of the fear of Covid-19. This will help to reduce the burden.

Photo: Members of the public are asked to wash their hands properly to help prevent the spread of Covid-19.

We also need to see healthcare costs as part of our personal responsibility, like we do food, water and every other essential service. Our struggling national economy will unavoidably lead to a decline in our national healthcare capabilities, if we don’t take on this responsibility.

So unless we are prepared to lower our healthcare expectations to match the declining oil prices and production—a position which I will never advocate—then we must be ready to take up part of the cost burden. Invest in private health care insurance, even if your employer is not covering it. We cannot go on relying on barbecues and boat rides to fund our unexpected healthcare needs.

A larger health insurance pool will stimulate the healthcare sector, reduce the burden on the public system and promote our national healthcare security.

Finally, there is a definite role and need for the manufacturing sector to get into the area of healthcare supplies and consumables. The folly of relying on China and the USA has been exposed in this crisis. USA has banned exports of their medical supplies and China has increased prices 25-fold for basic supplies.

There is no doubt that our manufacturers can produce basic medical protective clothing like gowns, goggles and masks, as an example. We also already have companies like Genetics Pharmaceuticals Limited who have been manufacturing basic drugs locally with limited support.

After this crisis, local drug manufacturing should be emphasised, encouraged and expanded. Trinidad and Tobago should take the lead on this in the interest of regional and national healthcare security, for all the same reasons that I outlined above for private healthcare services.

Photo: A family enjoys a healthy meal.

This topic doesn’t get a lot of air play but it is suddenly our national focus. Wise elders have forever told us that there is no happiness without health and never has that been truer than now.

Economic considerations and freedom of movement have all been cast to the wayside as we try to safeguard our national health against Covid-19 and so it should be. We need to remember this long after the virus is defeated and gone.

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