Guyana’s public health sector a work in progress but major improvements being made -Ramsammy

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See full statement from Adviser to the Minister of Health Dr. Leslie Ramsammy

A letter in the Stabreok News under the title “The healthcare system in Guyana is fractured and needs major surgery”, provides an opportunity to highlight some of the advances in the health sector of Guyana. In several public engagements over the last two years, much information has been provided relating to government plans for the health sector, relevant to the matters the letter-writer raised. The MOH does need to improve communication with the public because clearly the information we have been repeatedly sharing does not seem to be reaching persons who are interested, including the media.

Further information on the Pediatric and Maternal Hospital will be provided in a few days when the President and the Minister of Health turn the sod in a matter of days. From information already publicly provided by the President, the VP and the Minister of Health in several public statements, the pediatric and maternal hospital will be staffed and equipped to provide specialized services to deal with a wide scope of medical interventions for children and pregnant women and for complicated gynecological conditions. The hospital will respond to children with cardiology, neurology, nephrology, oncology and other major complicated medical conditions. With this hospital, there ought to be little to no need for children with complicated medical conditions and women with complicated ob/gyn conditions seeking overseas medical care. Diagnostic imaging will include MRI.

Six new Regional Hospitals being constructed will be staffed and equipped to provide all Level 4 package of services that Guyana articulated and have publicly presented at several public events, the last one being on Monday and Tuesday July 18/19. The PAHO/WHO has affirmed that the Level 4 Package of Services for Guyana is a comprehensive package. These hospitals will add 450 high-quality beds to Regions 2,3,4,5 and 6, with operating theatres, ER, ICU, HDU and NICU services. There are major upgrades that will begin soon at the GPHC, Linden and New Amsterdam Hospitals, bringing these to among the highest standards in CARICOM. Similarly, Bartica, West Demerara and Suddie Hospitals are to be replaced by new hospitals. Resources are being mobilized for a new National Psychiatric Hospital. Already, major rehabilitation work has occurred at Leonora, Mabaruma, Port Kaituma and Lethem Hospitals.

All these hospitals, the new ones and the ones for upgrades, are being built to international standards. International codes and standards such as IBC, Eurocodes, ASHRAE, NFPA, etc., are required in the construction. While most persons will not have knowledge about such codes and standards, it is re-assuring that international standards are being enforced for the construction of all new hospitals in Guyana. All hospitals will be equipped with elevators. HVAC, hot water, steam etc., wherever required for services, will be available as part of the infrastructure. Whether hot water will be available in non-clinical areas is a policy issue Guyana will need to determine. Health facilities must meet the highest possible standards. Indeed, old hospitals in Guyana did not meet these standards. Some of the newer constructions, such as the GPHC Emergency Building, the In-Patient Medicine Building and The National Public Health Reference Lab were in accordance with these standards, but periods of poor maintenance have affected optimal functioning. Additional resources are now permitting Guyana to demand higher standards.

While building standards are indispensable for quality healthcare, clinical, medical, nursing standards are also important. Gradually, Guyana moved towards introducing and delivering healthcare in accordance with treatment guidelines that have been tested, tried and improved in developed countries. By 2010, most diagnosis and treatment followed international guidelines. But for Guyana, this is a work in progress. Much effort went into enshrining these standards between 2000 and 2015. Much of the progress was stymied for a period of time, but the public health sector is working towards ensuring that standards and protocols that work well in jurisdictions such as the USA are standardized in Guyana. It will take time to get it all right. To accelerate progress towards the highest standard of clinical practice, Guyana has entered partnerships with world-class institutions, such as Mount Sinai, Northwell, Vanderbilt, McMaster etc. Regular clinical audits are now being conducted to ensure standards and guidelines are being implemented.

EMS is a work in progress at this time. An Emergency Medical Service (EMS) with well-equipped ambulances and staffed with Emergency Medicine Technicians (EMT), such as the EMS in the USA, is a significant need. We expect a fully functional EMS in Guyana by 2025. Before 2001, there was not even a semblance of an EMS or EMT service in Guyana. Although efforts were made after 2001, EMS remain, by and large, an under-developed service. Recent efforts have accelerated advances that began in 2001 towards a high-quality National EMS. The majority of patients picked up in Region 4 in 2021 and 2022 so far have been by an EMT-led ambulance service operated by GPHC and the Fire Service. Since the start of EMS in Guyana, more than 20,000 persons have been served by an EMT-led ambulance service, with an average of 5,000 per year in the last three years. This training program and introduction of an EMT-led ambulance service is being presently rolled out in Regions 3 and 5 and will be introduced for Region 6 in January 2023. Training of personnel is presently being conducted.

With the help of Vanderbilt University, one of the renowned universities and medical centers in the USA, Guyana established an Emergency and Trauma Medicine Residency Program. This post-graduate training program is presently headed by Dr. Zulfikar Bux. There are now several Guyanese specialists in ER medicine who work at the GPHC, New Amsterdam, Diamond and West Demerara Hospitals and, hopefully, in the years to come more ER-certified specialists will be managing every ER department in Guyana. Guyana introduced the first-ever CARICOM residency program for ER Nurses. This program is being expanded and more of these certified nurses will be assigned to ER departments around the country. Several doctors from several CARICOM countries have completed their ER and other residencies in Guyana. The ER program in at least one CARICOM country is led by a doctor who completed residency in Guyana.

The GPHC’s Institute for Health Science Education (IHSE), in collaboration with UG and many of the top universities in the world, presently conducts post-graduate training in sixteen areas. ER medicine is only one area. General Medicine (Internal Medicine), Ob/Gyn, General Surgery, Orthopedics, Radiology, Psychiatry are among the many post-graduate programs at the IHSE. The IHSE also leads post-graduate training in Nursing, with such programs as anesthetic nursing, neonatology and cardiology.

Like many hospitals around the world, GPHC has many problems. But for those who know the hospital before 2000, the GPHC is a far different hospital. The most critically-ill patients, rich or poor, find themselves at GPHC. For any patient with a poor prognosis, the GPHC is their only destination. Not all the relevant staff is available at GPHC and not all the technology. Increasingly, however, the most specialized staff in Guyana is available at the GPHC. More than 90% of the specialized staff at the private hospitals are GPHC staff. Every new intervention introduced in Guyana has been introduced at GPHC first. We readily concede weaknesses and are working towards reducing and eliminating them. But there are things that we can also boast about. It is young Guyanese doctors, many from poor family connections, who are blazing the trail.

Investments are being made to improve equipment and technology at the GPHC. Soon, Minimally Invasive Surgery (MIS) will dominate the surgical space at GPHC. Very soon lithotripsy (laser) treatment for kidney stones will be available. Already digital imaging (X-Rays, fluoroscopy, CT) is routine and because these have been installed with PAC system, the GPHC is able to provide other hospitals with teleradiology services. More than 25 patients receive free cardiology interventions such as angiograms, stents, valve replacements etc. every month. No single team perform more cardiac interventions than the GPHC team anywhere in CARICOM. The transplant unit is the most active in CARICOM. Now requests for kidney transplants are coming from CARICOM citizens. Thus, it is not all gloom and doom.

While a policy on MRI is still to be made, the GPHC procure MRI services from the private sector. The public-private mix is a policy direction Guyana began some time ago. The PPP government has announced that the public-private mix for delivery of healthcare is a policy it wants to promote more aggressively. Working with professionals from the diaspora and with international partners, many new high-quality interventions are being pursued. For example, Guyana is putting together with Guyanese professionals in the US a urogynecology program to reduce and eliminate the backlog of women living with incontinence.

People flocking outreaches conducted by both local and international teams is not a measure of the quality of services the healthcare system delivers. Some of us have also participated in outreaches in Queens, Bronx, Harlem and those outreaches are several times larger than the ones in Guyana. There is no need to surmise anything from this observation.

The MOH is presently engaged in standardizing the operation of medical schools and other private schools to train healthcare professionals. Between 2015 and 2020, the private medical schools openly operated in a “wild west” scenario. We are presently correcting this scandalous situation. The GPHC established the Institute for Health and Science Education in 2006. It presently operates sixteen post-graduate programs, working alongside UG and many of the top universities in the US and Canada. Together with UG and partners in CARICOM and the US, there is a growing research capacity that is being built. In fact, the GPHC would be ranked above the vast majority of CARICOM hospitals when it comes to research. Private universities and research centers are welcome to join.

As far as medical tourism is concern, way back in 2010, Guyana signed an agreement with the EXIM Bank and an Indian company to construct and operate a specialty hospital that would have reduced the need for any Guyanese to travel abroad and that would have brought people to Guyana for specialized care. Construction started in 2014. The previous government terminated the contract and ended the move to build a specialist hospital and pursue the medical tourism strategy. We are happy to see that there are Guyanese, both in Guyana and in the diaspora, outside of the PPP government, who support medical tourism strategy. It was a horrible misstep, on the part of the previous government, to terminate that project. It was too bad that many chose to remain silent when that project was terminated. Today, at least, four specialized private hospitals are being constructed that will make medical tourism a part of their marketing.

At the end of the day, finding staff will be critical. Presently a Human Resource for Health strategy is being drafted and the public will soon be engaged in the outlines of a new health HR strategy. The Public Health Sector in Guyana is a work in progress. It has imperfections and we expect to be held accountable for these imperfections. WE also hope that attention will be paid to the significant progress that have been made. There are reasons why the maternal and infant mortalities are down, why fewer persons are dying before 65 years old from cardiac conditions and why persons with end-stage renal diseases are living longer. The GOG is determined to ensure that Guyana has one of the best health care services in the region, sooner than later.

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