Daly Bread: Defining public healthcare management

Regrettably, sharp comment is invited by the recent verbal tactics that the Minister of Health deployed in response to the deaths of seven babies at the Port of Spain General Hospital between 4 and 7 April, connected with a bacterial outbreak there.

Perhaps the Minister is not aware that there is a lack of public trust and confidence in the public health system created over a long period by the bad experiences of citizens in areas additional to post-natal care. That is the area currently receiving intense scrutiny in a “shape” he does not like, but these neonatal deaths have entered into an arena long filled with dissatisfaction.

Minister of Health Terrence Deyalsingh.
(via MoH)

A little over a week ago, the Minister asserted in an interview that: “It can’t be that one terrible incident in one hospital in one Regional Health Authority (RHA) is now being used to classify a whole health care system of 20,000 persons as collapsed, and that is the way the conversation is being carried out, and it is something I would like us to look at seriously as we move forward.”  (See Trinidad Express Friday 26 April 2024.)

The very next day there followed a full-page advertisement. In it the Minister diluted his statement of the previous day by downgrading reference to “the one incident” from “terrible” to “unfortunate”.

A baby receives treatment in a Neonatal Intensive Care Unit.
Photo: MSN

He also rephrased his previous assertion, which now read: “I want to assure Trinidad and Tobago that this one incident, in one intensive care unit in one hospital, in one RHA, cannot define the public health care system in the country.”

It is plainly the work of a political spinner to seek to mask mass deaths over a three-day period as “one incident”—particularly as a total of 11 neonatal deaths for the year were already the subject of legal claims.

Moreover, a mere four days before the two statements were made it was reported that a 12th baby had died.

Babies in the neonatal intensive care unit hospital don’t always need the tests and treatments suggested.

I considered carefully that the Minister at the time of making the first version of his statement, in the course of an interview, expressed strong concern that “healthcare workers, including doctors and nurses, were feeling the brunt of the demoralizing conversations surrounding the deaths”.

He expressed fear that the country was “heading to a precipice with the way in which the conversation is being shaped”. Nevertheless, it is difficult to dispel the feeling that the Minister is himself putting and amending his own “shape” on the issues, motivated by political survival.

Is one also driven to question the Government’s initially professed feeling of pain?

Photo: Minister of Health Terrence Deyalsingh (centre) poses with health workers at the Freeport Health Centre.
(via MoH)

With regard to the arena of dissatisfaction with public healthcare, let us recall, for example, the continuing chronic pressure to get blood for an ailing relative, which is repeatedly felt by so many families.

The failed voluntary blood donation system is deserving of any harsh epithet a commentator might choose, despite the Minister’s claims in 2022 that it will be subject to “five revolutionary innovations”.

It is unnecessary to repeat the contents of my recent column entitled Game of Blood except to add that the Minister might consider how the morale of families desperately seeking blood is adversely affected.

A blood donor makes their contribution.

Then there is the persistent issue of the dismissive treatment of patients and their families. It is troubling how often the word “hoggish” appears as distressed persons—including one grieving mother, who is a nurse employed within the system—tell their stories to the media. These complaints reflect human resource management deficiencies.

Equally alarming are the alleged failures to maintain the appropriate patient/staff ratios and the relevance of this failure to “cross-contamination”.

A reported interview with Trinidad and Tobago National Nursing Association president Idi Stuart in the Trinidad Express on 16 April 2024 and other material in the public domain suggests that there has been a failure to engage in team building between different sections of public healthcare personnel—some of whom allegedly seek to divert patients to private healthcare institutions.

Photo: Idi Stuart (centre, blue jersey) leads a TTRNA demonstration in June 2020.
(via TTRNA)

These are only some of the poor management issues defining the public healthcare system.

It seems obvious that the Minister’s desired shape of conversation is way out of any realistic shape. Does he understand his leadership responsibility?

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