Dear Editor,
Please allow me to comment on a letter by former President, Mr Donald Ramotar, headlined “People are being exploited at medical institutions” (SN: 28/03/2019).
While most of what the former President wrote, I do not agree with, I do concur with one aspect of his letter. We can completely ignore his glorification of the health service under the PPP. We all know that is not true. All the PPP ministers and Presidents over the 23 years sought healthcare overseas because they knew what their Government was providing was worse than a veterinary service. We can also ignore his attempt at criticism to score cheap political points since the PPP had 20 years to address these problems but ignored them or frankly, lacked the know-how on how to address them.
That aside, I will address an aspect of his letter that has some element of truth. Very unusual for a PPP agent. I will begin by providing a snippet of what he wrote verbatim:
“Some of those that manage the Public/ Private Partnership facilities are more interested in money than the patients. Stories abound about how people are treated. I heard of the ordeal of a wife whose husband was on the operating table opened up. He had to pay a few million dollars before the operation was done. While he was being operated on, I am told that they went to the wife who was sitting outside and told her that they found another problem and enquired whether she would pay to get it attended to then or should they close up the patient. The poor woman scrambled around to raise the funds. Even though this is a Public/Private operation it is being operated like a private institution without any appreciation of the public’s contribution in establishing these facilities.”
Mr Ramotar is alluding to the Caribbean Heart Institute (CHI). Mr Editor, does this sound familiar? Yes it does because I’ve been writing about it for nearly a year. This did not start in 2015. I put forward strong medical arguments that many patients do not require invasive and expensive angiograms and stents. In a previous letter, I did the maths and examined the statistics from PAHO and WHO and concluded that it is virtually impossible for a population of less than 800,000 to require over 600 angiograms annually at CHI only, not to mention other medical institutions.
Some of these patients are in their twenties, with no cardiovascular risk factors. That’s impossible. These tests and interventions are not without risk and not cheap. They can cost up to US$6,000. Since I have been writing my letters championing the rights of the poor, suffering patients, I’ve received many complaints from patients and relatives about this exploitation. One patient apparently lay in bed for days with chest pain while the family struggled to find the monies for the medical intervention. She ultimately died after the medical intervention.
I also received a complaint from the nephew of a well-known frequent letter writer who remigrated from America. Apparently he was not happy with the care he was receiving. And the painful list of bad experiences of poor, suffering patients continues.
Mr Editor, to investigate ischaemic heart disease (a type of chest pain), there are cheaper and less invasive tests available to doctors. These include CT coronary angiograms, myoperfusion scans, stress echo, cardiac MRI, among others. To determine what test is best suited for a patient, they are risk-stratified. Only high-risk patients with a high probability score of ischaemic heart disease should have coronary angiograms as the first line test. My expert opinion is supported by the European Cardiology Society, the British Cardiology Society, The American Car-diology Society, The Society of Cardio-vascular Angiography Society and the Canadian Cardiovascular Society.
The fact is that only angiograms and stents are being done, both at the CHI and a private hospital, because they provide a greater profit margin. The other cheaper and less dangerous tests are being ignored. I raised this point on multiple occasions. The fact is that none of them care about the serious risks involved with the unnecessary angiogram test, including death. It’s all about the money. Many patients do not need any test apart from a few blood tests, a simple ECG and a reassuring hug.
In my opinion, specialists from overseas are being kept out since they may unearth the unethical practices at CHI.
And there are bigger issues at the CHI. International standards strongly recommend that angiograms and stents should be supported by cardiothoracic backup. Simply put, sticking wires into patients’ hearts can go horribly wrong. When that happens, which is a distinct possibility, then a cardiothoracic surgeon will need to literally split the patient’s chest open to correct this. Without this, the patient will have a painful death. One private hospital, to their credit, recognises this, hence they have cardiothoracic backup.
But the exploitation of poor patients to make money continues. The private hospitals are no different. They are all a pack of thieves dressed in white coats. The sad reality is that those thieves in both the private and public institutions investigate and protect each other. Again, this is not new. This has been happening under the PPP. They had 20 years to address this. I will be on this Government’s case until they do. I became a doctor to do my best for poor patients. That’s my passion. Rich patients can pay their way for the best healthcare. Because of my passion, I spoke out and the PPP-aligned medical council tried to deny me my registration. This, among other acts, caused me to leave but my passion for the poor Guyanese patients is still there.
I now hope that with the intervention of Mr Donald Ramotar, Guyanese will recognise that I did not have an ulterior motive with my letters. I have a genuine concern. I trust the Government addresses this. I am confident they will.
Yours faithfully,
Dr Mark Devonish MBBS MSc
MRCP (UK) FRCP (Edin)
Consultant Acute Medicine
Nottingham University Hospital
UK
