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Systemically and systematically broken: if a ‘system’ only works for some; it’s really a bran tub

“[…] Agility and adaptability are to be commended, but some decisions seem almost erratic: close membership shopping centres like PriceSmart or not? Or open them in a different way? Tape off the Brian Lara Promenade because the problem is the large open space, not the fact that people were maskless and herding. 

“If the health minister had given in to his tearful expression a week before, would it have been off-limits sooner?”

In the following guest column, Anu Lakhan shares her expectations from the Trinidad and Tobago health care system:

Photo: Minister of Health Terrence Deyalsingh.
(Copyright Office of the Parliament)

We are committed to staying with broken systems. The thing is not working if it only works for some; but it is not completely broken if it only fails some. It is consistency and accountability that makes it a thing called a ‘system’ and not a lottery or a bran tub.

A tenant tells his landlord that the security lights in his driveway are not working. The landlord does not live on the premises, nor is he inclined to visit it for this matter that is no inconvenience to himself or his family. He responds by asking the tenant if he’s sure the lights are not working. 

The tenant says he’s sure. It’s not working the way it worked before; he’s jumped up and down in front of it and waved (as one does when checking that sensor lights are working). The little sensor light is not red. It’s not working. 

The landlord asks if it’s connected to the power; if there is, in fact, at that moment, a power outage; if the face of the sensor has been smashed. The landlord does not offer to visit the site or send a technician. The one thing the landlord repeats until the tenant wants to weep is that he, the very landlord, he himself installed this magnificent security sensor; and it had always worked brilliantly. 

Image: A satirical take on the blame game.
(Copyright Don Lee Cartoons)

It makes you wonder if the act of of reporting the damage was somehow bizarrely interpreted as the cause of the problem. 

That’s how we live with broken systems; around the world, possibly—in Trinidad and Tobago, definitely. Often, when a problem is reported to an enterprise, whether public or private, the unfortunate caller is made to feel that their problem was caused by anyone or anything at all other than the provider. 

You may call because your internet is not working. You may call because an appliance you just bought spontaneously combusted. You may call because a sofa delivered to you is not the one you ordered. Or perhaps you did not order a sofa of any kind. 

Whether the issue is eventually resolved or not, you are likely to speak to many people who will take great pains to show you where you went wrong at every step.

All this consumer dissatisfaction talk can only be leading to one cluster of issues: Covid-19, rules regarding public behaviour concerning Covid-19, rates of infection, and communication of information about how the health care system is working.

Photo: Nurse Keisha Gomes Prevatt (left) was first to receive the Covid-19 vaccine.
At her side is Minister of Health Terrence Deyalsingh.
(via TTT online)

The landlord is truly, deeply, not concerned that the sensor light is not working. The fact that the health authorities tell us things every day is neither relevant nor always particularly useful. We have the number of patients, number of available beds, number of deaths. We cannot ignore how hard everyone is working because we are daily reminded. 

But what are the things that are not working smoothly? How is it possible to establish a system of fines but have no way to collect them? 

Agility and adaptability are to be commended, but some decisions seem almost erratic: close membership shopping centres like PriceSmart or not? Or open them in a different way? Tape off the Brian Lara Promenade because the problem is the large open space, not the fact that people were maskless and herding. 

If the health minister had given in to his tearful expression a week before, would it have been off-limits sooner? 

Photo: Minister of Health Terrence Deyalsingh addresses journalists during a virtual media conference on 7 May 2020.
(Copyright Ghansham Mohammed/GhanShyam Photography/Wired868)

It all sounds arbitrary at best and desperate at worst. The landlord set up a system either a long time ago or just yesterday and that is enough. Action was taken. Follow-through is immaterial. 

But the system has definitely, unequivocally, worked for some. This is a significant truth. There are so many stories of people who had excellent, caring service from health centres and clinics. Older people, sickly people, disabled people. 

Then there are stories of people of identical descriptions who have been treated roughly, indifferently, and thoughtlessly. The press conferences do not report these incidents. And more terrifyingly, most of the press is also not telling us about it. 

People do not only worry about the things they know; they also worry (even more) about what they don’t know. 

What are the protocols for treating the disabled who require vaccines? How are we treating with homes for the elderly?

Photo: A nurse administers the Covid-19 vaccine in Trinidad.
(via MoH)

In the absence of a clear set of steps required to take you from home to a shot in the arm, how much pressure are we putting on frontline workers, the public, and the faith we want to have in the process.

It may have taken this long, but it’s become clearer what I, personally, really want out of all these questions and answers and comments: I want to believe that there is a considered and coherent plan, and I want to trust that plan. 

We cannot be so complacent to think that just because we never expected to be given all the information, we don’t ask the questions. 

Soon enough, the mass vaccination drive in this country will start in earnest. If the government is able to secure the large quantities of vaccine it is pursuing, then we can expect to see a massive vaccination effort commence shortly thereafter. 

We have just witnessed the system do its best to get around 75,000 done. Can that same system cope with the task of getting hundreds of thousands inoculated?

Photo: Persons wait for the Covid-19 vaccine.
(via Ministry of Health)

Or is it worth considering how we can make that system more efficient, more predictable, less vulnerable to misinformation—easier to navigate for both the vaccinated and the vaccinators?

Every day, the whisper campaigns and alternative information system undermine every effort at good. But simply telling us that everything is going well is doing us no favours. Not for the public; not for our leaders. 

A system that works for some but not for others is not a system. We need clear, credible assurances from our leaders that the next round of vaccinations will be delivered even more efficiently than the last—because the task will be greater and the cost of failure will mean more field hospitals, more funerals, and more of us weeping in our cars at the sheer futility of it all.

 

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About Anu Lakhan

Anu Lakhan
Anu Lakhan is a writer and editor generally preoccupied with food, and books. And short sentences.

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One comment

  1. Good job. Hits the nail on the head. And makes you think. If you still can.

    After all the BS with which we have been inundated. Continuously.