The tragic death of Alexis Syfox earlier this month from pregnancy complications prompted a frank admission from Minister of Health Dr George Norton about the difference between criticising a system from the outside and addressing its difficulties from within. As the shadow health minister in the 10th Parliament and as an ophthalmologist within the public health system, Dr Norton would have had a bird’s eye view of the failings of the health infrastructure and he had been severe in his criticisms within and outside of the National Assembly.
Vaulted into the office of Minister of Health on the accession of APNU+AFC to government, Dr Norton immediately reflected his insider awareness of the problems of the health system coupled with his experience as a practitioner. Visit after visit to health facilities produced growing concerns by him at conditions with the attendant pledges to right the maladies. Of course, as most would know, the curing of ailments is curiously fickle and subject to its own dynamics. The minister’s public dressing down of the condition of the medical facilities was also rife with risk as he was to later find out. On his initial visit to the National Psychiatric Hospital in New Amster-dam, Berbice on June 3rd, 2015 Dr Norton was appalled by what he found.
GINA reported him as describing conditions at the facility as disgraceful. The Minister interacted with staff members who expressed concerns regarding the water supply, which they had not been receiving for the past two months. They also cited problems with electricity, telephone service and furniture.
“It is pitiful to see the conditions where we have our Guyanese brothers and sisters dwelling… the wards are being cleaned with water from the drain and persons are bathing with and even drinking. This has been going on for two months, this is totally unacceptable,” the Minister declared.
Clearly these conditions required immediate attention. However, it appeared that nothing substantial was done between that visit and the end of August when a patient known as Eda was killed by another patient in conditions that could only be described as sub-human and the antithesis of what care in a mental facility should be like. The death underlined the point that instead of simply criticising, as the person in total charge, Minister Norton was one who could have ensured that immediate changes were made to improve the conditions and circumstances of patients like Eda at the institution. It was clear that the conditions at the facility posed a grave threat to the well-being of patients there.
Now Ms Syfox’s death has again driven the sobering reality home to Minister Norton. In a September 21st news item in Stabroek News, the Minister is reported as saying when “you are on the outside you don’t understand what is taking place.”
“Now you are on the inside you are seeing it. It is no longer just another mother dying, it is very worrying, it is really sad”.
One step that the Minister and the entire health system can take is to ensure that the rights of patients and their families are respected. The Minister and his ministry should work on a patient’s bill of rights which would ensure that each patient is treated in a manner that accords with acceptable norms such as treatment within reasonable time, full information to patients, their involvement in treatment decisions, the right to appeal and accountability for actions.
One of the serious problems in the health system under the near 23-year tenure of the PPP/C government was the widespread dissatisfaction of families with the explanations offered by staff at public hospitals in relation to deaths, be they maternity or otherwise. Maternity cases have been a key point in question as families are often left devastated as seemingly healthy women enter hospitals for what should be routine deliveries and end up dying. There is a gulf between the expectations of the family and the medical realities of the patient’s condition as in the case of Ms Syfox. For countries like Guyana which have struggled to achieve a three-fourths cut in maternal mortality ratios, Millennium Development Goal number five, the World Bank has highly recommended maternal death audits to help delineate underlying health, social and other contributory factors. Often in the deaths that have occurred generally at public institutions, patients are left to grope for answers and arrive at their own conclusions as the system isn’t forthcoming.
A classic example of this is the death of the healthy child Jaden Mars at the Georgetown Public Hospital in 2014 after he had cut his tongue. In a case that exhibited signs of medical malpractice, his grieving mother has waged an unrelenting campaign to learn the truth about this death and to ensure that there is no recurrence. For the last two years she has gone from pillar to post without any success in the cycle of deceit which was the hallmark of whatever mortality audits were done under the PPP/C’s health system.
Minister Norton would do well if he was to ensure in a reasonable period that all patients entering the public health system are aware of the basic standards of service they can expect and that there is clear accountability for this. In those extreme cases where deaths have occurred, the families of patients are entitled to the fullest information on the cause of death, mistakes or poor care at the hands of nurses and doctors, disciplinary actions that have been taken and the steps that have been implemented to prevent a recurrence. It would be a significant step in boosting confidence in the public health system and ensuring accountability to patients. The public health system would also benefit immeasurably from this sort of openness.
As a means of understanding the depths to which mental care in this country has sunk, the Minister should seek to have published as soon as possible the findings into the death of patient Eda.
