Local health system has had successes but still has a long way to go

Dear Editor,
She died on August 11, 2011 at 04:30 hrs. When her daughter, Roseanne, went to the hospital at 6 o’clock that morning, her bed was empty and the mattress turned down. She instinctively knew what that meant. Upon enquiring from the nurse in charge she was told that her mother was dead; she had died a couple of hours before.

In many ways Janet Mohamed, aka Maamie, was a victim of a combination of circumstances:  the relatively limited training of the doctors in Guyana; a health care system still struggling to achieve professionalism and a sizable population of poorly educated patients.

Maamie had been complaining of pain in the lower abdomen for a while. She was admitted to the Mahaicony Hospital and given painkillers and the ever present saline, and told she had gallstones. She also suffered from high blood pressure and high cholesterol which the doctors told her prevented her from being operated on. Meanwhile, she had to bear the pain. She had to have her blood pressure and cholesterol lowered before they could operate. The day she was discharg-ed she was readmitted again because of pain – the sedatives and painkillers had worn off.  This cycle of hospital admittances and discharges – sometimes self discharges – continued for a couple of months.

She went through the same routine at the Fort Wellington Hospital. She was admitted for pain, was given saline, painkillers and sedatives and the usual complement of medications to treat high blood pressure and high cholesterol. When she thought she was better she obtained a discharge and went home. That same evening she went back to the Mahaicony Hospital.  The pain was too much.  By this time the Cuban trained doctors were at their wits end trying to figure out what to do.  They received a call from Beverley Harper from Rotary in Georgetown.  Beverley had contacted Dr Bheri Ramsaran, the Junior Minister of Health who in turn lit a fire under the doctors at Mahaicony.  This caused the doctors to promptly refer her to the Georgetown Hospital.

At the Georgetown Hospital Maamie was admitted to the psychiatric ward, allegedly as a result of the referral letter from Mahaicony, so she decided to go to a private hospital. She went to St Joseph’s Mercy in Georgetown.  She was told she had to spend a week there in order to diagnose her condition. After about five days she was prepped for surgery. Moments before the surgery the doctor notified her that he could not operate because she only had a fifty-fifty chance.  She was sent home again. Total cost: over $150,000. Her life savings were slowly becoming depleted and she had the prospect of having to pay the private doctor for each clinic visit.

Next stop: Balwant Singh‘s Hospital.  Same routine: admission; hospital bill; discharge. She finally ended up at Mahaicony Hospital. Her money had run out. After a few days she was discharged again. Her final admission was to the Georgetown Hospital.  She spent a few days there and was discharged in a body bag.

Maamie left behind a husband, nine children, one of whom has a heart defect and needs care for the rest of her life, and two adopted children who were orphaned when her brother died of poisoning. She had had a limited education, and her own parents could not read and write. She worked hard digging coconuts.

Her hardened demeanor was a result of her hard life. She developed an abrasiveness that was her defence mechanism. Yet, despite such a front, she was a true mother.

Even though Guyana’s health care system has made tremendous strides over the past two decades, it is not enough to match those of its sister Caribbean nations. According to the World Health Organization, Guyana spends $133US per capita on health care. While this is small when compared to Barbados at $1,041US, there has been an improvement since 1990 when health care spending was far less.  Add to this the difficult terrain that one has to traverse to reach the rural communities, then this per capita spending is just a drop in the bucket.

In 2006 President, Bharrat Jagdeo signed an agreement with Cuba whereby Cuba would assist in building and running a set of five health facilities in Guyana. Cuban doctors were to run these facilities while Guyanese scholarship recipients were being trained as doctors to take over. Five years later the doctors are back and attached to the various hospitals in the country.  If Mahaicony is to be used as a measurement of the success of this programme then it must be admitted that improvements have been made. For the first time the Mahaicony Hospital has its own X-ray department, its own ultrasound department, its own lab to perform blood tests, an improved emergency and ICU department, Cuban trained Guyanese doctors, and if the increase in patient load is a measurement of success, then Mahaicony has improved, with patients leaving the long waiting lines in Georgetown for this health facility. .

However, the three or four doctors are general practitioners, and their salary is not becoming of a doctor. They catch the hire car to and from work just like any other public employee. For most of them the opportunity to study to be a doctor via a fully paid scholarship was a lifetime opportunity they could not pass up. And now they are in Guyana as a result of their scholarship contracts. The opportunities for professional development are mainly limited to local sessions. They cannot join the brain-drain that has been leaching this country for the past 40 years, therefore they stay and attend to the masses like Maamie.

Maamie’s death certificate listed her direct cause of death as cardiopulmonary arrest (heart attack). An antecedent cause of death was listed as chronic renal failure (kidney failure). It should be noted here that her feet were beginning to swell about one month before her death and nothing noticeable was done to assist in alleviating this. Her other significant conditions contributing to death were listed as diabetes mellitus and hypertension. For most of us looking in it may as well be lack of education, lack of proper diagnoses, lack of professional doctors who can sit a patient down and explain her condition, and most of all a lack of will among the masses to demand a health care system that despite its enormous successes, still has a long way to go to avoid deaths such as that of Janet Mohamed.
Yours faithfully,
Sharir Chan

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