Barbados Queen Elizabeth Hospital – Refurbish or Tear It Down?

Barbados Queen Elizabeth Hospital Washroom

Barbados Queen Elizabeth Hospital Washroom

The government appears to be in two minds about the Hospital.

Should we refurbish or should we build new?

Refurbishment sounds cheaper and quicker and Barbadians have grown weary of big expensive projects, with escalating costs, strong whiffs of corruption and long delays.

But the problem with refurbishing an old hospital, making it compliant with modern safety standards and ready for new equipment is that it can be very expensive. I understand that the basement would require substantial work to allow the installation of new heavy medical equipment. I understand that in the face of a hurricane the existing hospital is poorly located, but I am no expert. Refurbishing can be so expensive that it may make economic sense to build a new one. Refurbishing costs of $400-500m have been bandied around while a new hospital would probably cost $600-700m.

It is also hard to refurbish a hospital with patients in it. I have asthma like many Barbadians. Imagine being in a hospital which is a construction site with an asthmatic attack? We would have to have a transition plan that may add further to the costs.

All this sounds like an argument for new but I recognize that the budgetary seduction of a new hospital financed by the private sector using a commitment from the government’s annual budget (Public Finance Iniatives like BOLT) may be clouding good judgement of the hospital “consultants”. That said, this government is so keen to undo everything the last government did (for good or ill) that as the last government favoured a new hospital, they are probably inclined to prefer refurbishment at whatever cost. Most countries have gone the route of new versus refurbishment. I recall a figure of 40 new hospitals in the UK over the past 20 years using BOLT.

I also think – an excellent point first raised on these pages by Georgie Porgie, who I do not normally agree with – that the issue is not just about the physical infrastructure but also the organization of treatment in Barbados and management of the clinics and hospitals. The sad case of Leslie Barrow who could not get to the hospital in time because there were no ambulances is one aspect of this. Should we upgrade our clinics first, allow them to take some strain off the hospital, and then refurbish? This is partly about education as Bajans think of the hospital as the place to go.

Moreover, many of the expensive spaces in the hospital are taken up by people who are not ill (anymore), but have no where else to go. Do we need to start with a less expensive “ly-ing in” place or consider alternative “treatment” for such people. It would be far cheaper to pay rent and for a part-time nurse than to keep a well person in a hospital bed needed for emergencies.

What do Barbadians think? New, old or re-organisation?

The above article was submitted by a BFP reader… who didn’t say whether or not to publish their name in credit. Let us know at barbadosfreepress@yahoo.com

Further Reading

BFP: Your Child Is Sick: Welcome To Barbados Queen Elizabeth Hospital

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90 Comments

Filed under Barbados, Health

90 responses to “Barbados Queen Elizabeth Hospital – Refurbish or Tear It Down?

  1. Kay

    I think we need a new hospital.
    And it should be slightly out of Bridgetown.
    1. Because it shood be in a more rural, calming setting.
    2. Because traffic going into Bridgetown is so heavy that it would help people to get treatment faster if the hospital was not in the middle of all the gridlock.
    After a new facility was built the QEH could be refurbished to deal with some of the case load, but not emergency situations.
    Then the new hospital could be named for Dame Nita Barrow.

  2. sungirl

    I also agree that we need a new hospital, outside of the Bridgetown Area. Somewhere that is easy to get to and in a much quiter location. Having said that, if there was to be one built, one would hope that it could be done as quickly as possible, not taking years to complete and at the same time, be able to refurbish to an extent the existing hospital for out patient uses for those people living with-in the Bridgetown area.
    (of course then you have to have more doctors and more nurses to service all of those people)

  3. Just Waiting

    The polyclinics need to be upgraded so that they can offer more primary and secondary services to the public.
    The operating hours should be extended and this would ease some of the burden that is presently on the QEH.
    At lesat two of them should be ugraded to handle emergencies and should operate on a 24hr basis. Fees that are reasonable and competitive could be charged to offset the cost of running these “mini” hospitals.

  4. Just Waiting

    Given the amount of refurbishment that would necessary a new purpose built hospital should be considered instead of wasting money renovating a sick and dying one.

  5. Kay

    I think that the point regarding the dust etc. during refurbishment being bad for the patients is also a good point.

  6. Thomas Gresham

    Dear Hants,

    Yes an interesting read. Thank you.

    I guess it is nice to know in a way that our own troubles have not been unique!

    I know you are (rightly) concerned about influence peddling on government contracts and I take it from the web link a little unsure about these Public Private Partnerships (PPPs) used to finance new hospitals. I am a little agnostic about them myself. I read in the Advocate recently that Nexus, a consultancy in hospital financing and a strong advocate of PPPs, was invited down to Barbados to discuss plans for the hospital. Who paid for that trip? Did the government pay? In which case, has there been a tender for this consultancy? I don’t recall seeing one. The consultancy fees on this will be in the millions. Were other consultants invited down? Shouldn’t the consultants be more independent and not already committed to the idea of financing a new hospital with PPP? What do you think?

  7. Just Waiting

    Very intresting indeed. I got a sense of deja vu while reading the above link.
    Funny the way things go, when governments form “partnerships” with private companies to carry out large projects with lots of money involved.

    Why do private clinics and doctors make money in Barbados?
    Why do patients leave the QEH after not receiving
    attention and go to a private clinic or doctor?
    Should doctors who pratice privately be allowed to work\consult at the QEH?

  8. CHURCH MOUSE

    In the final analysis the critical point is not whether we renovate or build a new hospital. it is: will I come back out upright if I am admitted to this hospital. The number of Barbadians whose lives have been prematurely cut short by the delinquency at this institution is staggering.
    The horror stories told by relatives of those who paid the price of admission are well known and many people are afraid of having to go there for treatment. What the government needs to do is not only refurbish or build but ensure that the institution is equipped with the necessary resources, human and otherwise, to do its job.

  9. Coffee & Cream

    I agree with the first post. The QEH has served its time and the government should realize this by now. We definitely need a new hospital, and it should be located in a more rural yet central location, as this would put it out of the mad Bridgetown traffic and noise. I had the ‘honour’ of spending some time at QEH, and it is not an experience I would want to repeat, much less wish it upon my enemies. The staff was good enough, but the conditions are not anything conducive to the recovery of patients. The place is not patient-friendly, and more set up like a battlefield medical facility of the second World War. It is amazing that in the 21st century, this style of hospital exists in a country rated as one of the top developing nations ! In any case, a new state of the art facility should be built out of town, and QEH could then be rebuilt as an ancillary facility as anyone visiting the QEH as a visitor or patient could see that there is a desperate need for another hospital. Patients should not have to be waiting for days in Accident and Emergency because there are no beds available in wards, and that is what’s happening.
    I hope common sense prevails in government and none of the relevant personalities suffer from “Ministeritis”.

  10. memries

    Do folk come out of hospitals in other places upright?

    What evidence do you have that lives of Barbadians have been prematurely cut short by the delinquency at the QEH?

    Are relatives who are medical illterates qualified to opine on medical treatment dispensed? If so, why didnt they treat thier relatives themselves?

    All people should be afraid to go to ANY hospital. People who end up in hospitals are usually ill, and more likely to die than those who dont.

    When the government ensures that the QEH is equipped with the necessary resources, human and otherwise, to do its job, will people not still die in the hospital.

    Do people die in hospitals elsewhere where as you suppose there are the necessary resources, human and otherwise to do the job?

  11. Tony Hall

    I said in a previous post that a new hospital should be built and I was vilified and called all sort of names by certain individuals. It is better to build a new hospital. Too much money to refurbish a product.

  12. ru4real

    A new hospital would be the best thing.
    More central and access able for all of the country.

  13. Ivan Taylor

    I have read most of the comments here and I will agree that Barbados needs a new hospital. My worry about the whole thing is that is this going to be cared for or left to deteriorate after 40 years.

    I am not quite sure that we as a people care what we have it is evident that buildings in use by public servants keep falling into disrepair, the old eye hospital, the old child care board, ministry of health, the NIS building, the treasury, the Barbados public library, the fairchild street bus terminal, to name a few. We have this thing about SICK BUILDINGS or is it sick people? Can we realise that and move forward and maybe try to remedy the situation.

    The transport Board where 100 of the 300 buses not working, water authority loosing millions and falling apart, no strides in the Garbage industry and a way to recycle, when Barbados is only 21 x 16 and in some countries the size of a garbage dump.

    I am not straying but my dad always had a saying that read “prevention is better than cure” but this never seems to happen.

    We definitely need to up our health care system but when we build this beautiful hospital what next, do we care it or will it just stand for 40 years and then we build another one. Would this be like the NIS building which is still an eyesore in Bridgetown.

    There are hospitals in Britain that are in building over 100 years old and still functioning and still clean. Why cant we put proper systems in place to maintain these buildings and people who care.

    The fairchild street bus terminal, what a disgrace, areas like these should function clean and efficient, just like other countries, we always talk about the rest of the world and progress so why don’t we look beyond and lead rather than follow.

    Whats wrong with the picture, we have to face it we like new and not old.

    But hey we do need to address the system which sucks at this present time.

  14. Peltdownman

    If we build a new hospital, won’t it be “deja vue all over agian”? So much money will be spent in replacement, and nothing spent on maintenance, as in all government buildings, and we will be back to square one within 10 years. I agree that a new hospital away from Bridgeyown is desirable, but only if sufficient funds are budgeted to keep it as state of the art.

  15. Coffee & Cream

    Memries, you do have a point. Not long ago there was a piece on “60 Minutes” about the actor Dennis Quaid and his wife, whose infant twins were nearly killed by a nurse administering incorrect medication in a top recommended hospital in the US, and their research thereafter discovered that this happens thousands of times yearly in the US alone. They were not called immediately when the incident happened, but found out the next morning when they showed up and found a ‘Damage Control’ team (hospital lawyers) in the room. Many medical errors are covered up over there.
    I would not say the QEH staff is incompetent. We do have some very good practitioners and nurses, however, the conditions under which they have to work are less than ideal, not to mention some of their simple methods are less than up to date (as one member admitted). Another said a lot could be improved, and it would take money. However, there is also quite a bit of politics at the institution, and this coming from a former department head. It is also a ‘training hospital’, and this might be necessary for the bringing forth of new doctors and nurses, but I have seen the concern and even fear it has put on patients who are conscious enough to see what is being done to them if not done correctly the second, or third time. The situation is not unique here, but the issue really is about the hospital itself. A new location and building is needed, as is a new approach to the way the system is run.

  16. 329.18

    Wunnuh got Trinidad money, I see.

    Barbados broke as RH
    and wunnuh talking bout new hospital like wunnuh got oil money.

    Any idea what a new hospital gyne COST?
    $ 187,000 ? yeah?

    Look.. try en fix de ole ting dat done bought and paid for.
    If wunnuh did know bout maintenance,
    it wun’t stand how it is now
    but maintenance is a bad word.

    Wunnuh prefer to mashup en buy back.

    Taxes gyne up to pay for wunnuh wishful thinking new hospital.
    De guvment en gyne afford it,
    coz YOU gyne afford it
    but wunnuh doan see it dah way,somehow.
    Strange.

  17. The scout

    The QEH and the old Hilton were built around the same time. Government found it more sensible to implore the Hilton and build anew, why then should we accept a patched up QEH? Also most of the QEH is built of clay bricks which makes it difficult to renovate, plus the old hospital can’t stand the vibrations of the equipment nowin use. Let’s stop playing politics about such a serious issue. Let us as soon as possible get the new hospital project off the ground.

  18. memries

    Will a new hospital or renovated hospital solve our Health Problems?

    Should the focus be on the hospital, or on improving health care in Barbados in general?

    Will the building of a new hospital improve health care?

    What exactly is the role of a hospital in the scheme of healthcare in a populace?

  19. The scout

    There is need for a comprehensive restructuring of the health care in Barbados, I agree but foremost to that issue, is a well equipped modern hospital that can cope with the rigors of modern day equipment. Some serious and important decisions has to be made concerning the administration of the QEH, this can be made in conjunction to a new falcility. We must leave the politics out and make decisions in the interest of the country

  20. memries

    So Scout do you have any idea how the health care system should be comprehensively restructured?

    How can you fix the hospital before you fix the healthcare system?

    I notice your take is to put the emphasis on a modern hospital and modern equipment and administration of the hospital.

    Are these things really to be at the forefront? In a modern age?

  21. really really

    Re I also think – an excellent point first raised on these pages by Georgie Porgie, who I do not normally agree with – that the issue is not just about the physical infrastructure but also the organization of treatment in Barbados and management of the clinics and hospitals.

    How can it be possible that Georgie Porgie can make any excellent points? HOW?
    He believes in God and the Bible, understands Biochemistry and does not take dinosaurs seriously.

  22. really really

    Scout wrote
    The QEH and the old Hilton were built around the same time. Government found it more sensible to implore the Hilton and build anew, why then should we accept a patched up QEH?

    So if GOB imploded the Hilton, it should implode the QEH too?

    You all are too funny though.

  23. CHURCH MOUSE

    Memries, the issue is not whether other hospitals are perfect (as you seem to think). The issue is that a large number of Barbadians have little confidence in the Q.E.H and some are actually scared to have to go there. The evidence that you ask for is all there. Obviously you did not hear the VOB Brass Tacks some time back when Barbadians reported their own horror stories about loved ones lost at Q.E.H. Maybe all these people were just medical illiterates, but the fact is that they all felt something was not quite what it should have been. When an elderly man survives an operation and dies from bed sores at Q.E.H we have to question the quality of care there.
    Let us stop trying to cover up ineptitude and seek instead seek to influence positive change.

  24. memries

    Read ALL my questions again and see if you get the point of any of them.

    At no point have I said that other hospitals are perfect.

    Because a large number of Barbadians have little confidence in the Q.E.H and some are actually scared to have to go there, does this mean that a NEW hospital is the solution?

    You say that the folk who spoke on VOB Brass Tacks felt that something was not quite what it should have been. Great. Did they or can they identify that “something”?

    On whose part is the ineptitude Sir? The doctors? The Nurses? The Hospital Administration? The MOH? All of the above?
    If any or all of these are at fault, how will a NEW hospital fix things?

    What exactly is positive change, and how will we influence it?
    There is much chatter and rhetoric hear, but very little substance. Don’t you think?

  25. Anonymous

    Recently a spot inspection was run at the QEH. They tested every defibrillator trolley. Every single one failed Dont get sick in Barbados

  26. memries

    May I suggest that you brilliant luminaries go to BU and read all the postings on the National Healtcare System and take it from there.

    Now I know that he doesnt believe in dinosaurs or evolution, but believes in God and his salvation plan, and that many on this blog thinks he is an idiot. But so far on these blogs, he has made the most sense on this issue, simply because he alone has offered a plan.

  27. memries

    Anonymous

    Recently a spot inspection was run at the QEH. They tested every defibrillator trolley. Every single one failed
    ===================================

    So then they ought to fix the defibrillators or buy new ones BEFORE they build the new hospital, dont you think?
    ==================================
    Dont get sick in Barbados

    Are you saying that ALL Bajans who get sick in Barbados must go to a hospital? Are you saying that caring for the sick means going to a hospital only?

  28. memries

    Why you wont you post my post.

    There is a point to what I am saying.

    And I do know what I am saying.

  29. Kay

    memries
    Why don’t you post suggestions rather than just critiques all the time?
    The differance between the Hilton and the QEH is that the people who stay in one pay and not at the other.
    We have been taught to expect free health service, free education etc.
    Wake up Barbados, nothing is really free!

  30. Hants

    Have any of the bloggers here ever worked on a Hospital project?

    I have. 4 to be exact. 1 new and 3 Refurbish existing and add a New wing.

    1. Consultant does study to determine needs of Hospital.

    Consultant hires Architects to do “planning and concept” drawings.

    Hospital board approves planning and concept drawings.

    Architectural firms are invited to make a Design proposal based on the planning concepts.

    Architectectural firm is selected and commissioned to do the project design.

    Construction of Project is then put out to public tender.

    Barbados has all the qualified people required to solve the hospital issues whether it is Build new,refurbish, or a combination.

    There is also the issue of what is happening today.
    All the complaints I am hearing appear to be an indifference to patients and their concerns and well being.

    More barbadians living in Canada are becoming snowbirds so as to keep their Canadian citizenship and hospital coverage safe.
    Winter in Barbados and spring,summer and fall in Canada.

  31. memries

    @ Kay
    Why don’t you post suggestions? You are a know it all?
    I am not critiquing anything.
    I am asking pertinent and poignant questions?
    The answers to my questions might just be the answer to the question.
    Havent you done any research about this question yet?
    Are there no answers to this problem on the net or in journals?

    Hants why dont you tell them what to do.
    You have actually been involved.

  32. Kay

    Hants
    Not everyone can get Canadian or other citizenship so that they can take advantage of another countries healthcare.
    So we need to do the best with what we have got.
    In all fairness I have found the staff of the QEH to be caring and dedicated. But they are working under less than ideal conditions.
    And the question posed was should the QEH be refurbished or a new hospital built. I am sure that before the change of government I read in the newspaper that consultants had done a study on just that.

  33. memries

    Are you telling us Hants that the best answer might be to REFURBISH EXISTING & BUILD (A) NEW WING (S)?

    Hurray! Come to the head of the class! I am sure you didnt get that answer on Google or in a journal.

    But how will you get them to see that HEALTHCARE IS NOT PRIMARILY ABOUT HOSPITAL?

    How many folk for example are admitted to hospital before they are age 50- especially males?

    Do folk need healthcare to PREVENT thier hospitalisation before age 50?

    Has not all this been taught by GP on BU this year and details given about the same? Eh?

  34. Georgie Porgie

    memries

    Why dont you go and watch the US open, nuh. Stop meking sport at the people man.
    You out of your league here, man.

  35. Hants

    memries
    August 25, 2008 at 7:35 pm
    Are you telling us Hants that the best answer might be to REFURBISH EXISTING & BUILD (A) NEW WING (S)?

    Yes. That would be my choice.

    In all the projects I was involved in,New wings were built,some equipment transferred and the old wing was converted to be used differently.
    eg. New surgical wing built and the old surgical wing converted to IC unit.

    Anyhow, doan mine me. I was not involved in the decision making process but just an employee of one of the companies involved.

  36. Thomas Gresham

    Those of you who read “Random” would know that I made the original submission. Reading the posts suggests to me that there is a strong consensus developing that we need a new Accident & Emergency Hospital. Concern has also been voiced that (a) new hospitals are expensive and we don’t have the money and (b) we tend to focus too much on “hardware” like buildings and not enough on “software”: management, organizations, quality of staff, building maintenance. I agree.

    The international consensus (just) is that a new hospital is best delivered through some kind of BOLT/PPP/PFI where the government earmarks its annual expenditure on health including depreciation, and awards it for 20 years to a private consortium who in return commit to Build, Operate, maintain a new hospital and at the end of 20 years, Transfer it to the public sector. There are agreed quality standards and if they are breached various things flow from that such as an end to the government’s commitment and sometimes immediate transfer of the property. (Agreements differ, though the lawyers always make money.)

    BOLTs are also great for bankers and construction companies. The experience of users has been mixed. There have been disasters on service quality. Governments have sometimes found themselves in commitments to a hospital whose purpose is no longer required. But to be fair for every problem there have been also been successes. Hundreds of hospitals have been built which would not otherwise have been. I think it is possible to argue that past experience has improved the underlying contracts and there are more success stories now.

    A careful examination of the failures show that they are also failures of planning, management and organization. Software again. Getting the right building is the easy part. Delivering health to those who need it is the hard bit.

  37. Regular and proper maintenance could have prevented the disaster that QEH is now.
    To refurbish the old would be costlier in the long run.

  38. memres

    What is an accident and emergency hospital?
    Where is the consensus that we need such a species?
    How will this work?
    How will it relate to THE hospital? whether new refurbished or otherwise?
    What is the relationship of an accident and emergency department of a hospital and the rest of a hospital, and why?

  39. Thomas Gresham

    Accident and Emergency departments are the most expensive departments of a hospital. Private hospitals generally dont do them they are so expensive. The main function of our main hospital should be accident and emergency. More and better equipped clinics can take on some of the less emergency health care and other types of care may be provided for those who are in a bed in hospital because they have no where else to go.

  40. memres

    Gresham
    It seems that when you cant find the answers in a journal or in Google you got goadies ya!

    FYI The main function of A hospital should NOT be accident and emergency.

    The main function of A hospital is TERTIARY CARE- which may neither be accidents or emergencies. A lot of “accidents and emergencies” can be treated outside of hospital and they are!

    More and better equipped clinics can take on MOST (80-90%) of the emergency health care.

    Since a large percentage of hospital admissions tend to come via Accident and Emergency departments, the ER tends to be connected to hospitals.

    But you might find a journal or two that says otherwise.

  41. marvin bareback

    I agree with the majority here, fix up the polyclinics and get more health care workers and better quality facilities closer to the populations they serve. The main hospital should be for critical care and surgical units. QEH could be renovated into hospice care for the chronically ill and a new hospital built closer to the newer traffic corridors. The old Glendairy prison used to have some land near Waterford junction for growing vegetables on. If the government still owns it, that would be a convenient spot for the vast majority of the island.

  42. memres

    Marvin
    Well done! We are getting there!
    Perhaps we could touch it up a little bit thus…

    We need to expand the function of the polyclinics so that they become EMERGENCY CENTERS, providing both primary and secondary care closer to the populations they serve. This might include normal deliveries, minor surgery, observation wards and asthma bays.

    Each of these centers ought to have at least two ambulances for use within its zone, and perhaps another one for use to ferry patients to the main ER at the hospital.

    These centres will be the pivotal point for health in specified zones, and will have their public health inspectors and the MOH in charge should commandeer the garbage disposal trucks for the zone.

    We need to train more health care workers and provide better quality facilities closer to the populations they serve.

    “QEH could be renovated into hospice care for the chronically ill and a new hospital built closer to the newer traffic corridors.”

    The new hospital should be for critical care and surgical units.

    Did you find this in one of the main journals Sir?

  43. memres

    Marvin you and Hants can report to the MOH to help Dr Jackass the Incompetent to run the Ministry. You guys make me proud.
    Simple fellas with simple workable solutions like GP!

  44. Kay

    Memres
    How many polyclinics are there?
    How many ambulances do we have at the QEH now?

  45. memres

    Q#1 MBPC in St Peter; BRPC in Black Rock, WPC at Warrens, Edgar Cochrane in Wildey, SWCP on Jemmotts Lane, Randall ?? at Oistins, Glebe Polyclinic, in St George, Six Rds Clinic in St
    Philip.
    Q#2 I dont have a clue.

  46. Thomas Gresham

    Dear Memres,

    I am not sure why you are trying to pick a fight, especially when I went out of my way to refer to GP’s points in the original submission – I didn’t have to. You appear to be smarting over the thread on religion as if you feel you lost the argument. Move on. I do think that when I wrote that the majority of people on this post had supported a new hospital. But that was merely a casual observation.

    I think If we have expanded the polyclinics they can relieve the hospital in certain areas and it would be more focused on accident and emergency and highly specialized care, both of which are best done at one centralized place with the resources for the latest equipment. However, I do not cling to this idea and am open minded about another form of organization, but I suspect you are mistaken if you think major accident and emergency can be taken out of the hospital and put into the poly clinics. The kind of equipment, specialized staff and back up required for a major A&E department is the kind we would probably only afford to put in one place.

    I always remember a friend telling me that while in London they thought they would go to the primary private hospital for maternity – The Portland – but they were told by the doctors that if there were complications they would be sending off to the major public hospital with the fully fitted out A&E department. My brother, a consultant doctor, once spent some time in the A&E at John Hopkins Hospital in Baltimore – a rough neighbourhood when they would regularly get people coming in with gunshot wounds and were regularly saving lives. A real life “ER”. Not something you can do easily when your resources are spread amongst a dozen or more different polyclinics.

  47. memres

    Thomas Gresham

    You do not know me and I have never interacted with you before.

    I am not picking a fight, nor have I been on any thread on religion with you OK? I happen to be visiting my boy GP in FL and I did see your reprehensible and total disrespect for the man’s scholarship in Biochemistry – just because you don’t disagree with the man’s Theological views.The man is a respected conference speaker in Bible especially in Eschatology.

    At no time did he disrespect you or your views, but you treat the man like he is an ass. And now talking bout you didn’t have to go out of your way to mention him in your silly post this morning, as though your silly comments is manna from heaven, or as he would say gain him a place “at the glassy sea with the four and twenty elders.” .

    I am sure that GP is not sitting around waiting on your mentioning his excellent ideas as expressed on BU and elsewhere. He cant carry your silly little note anywhere and get a job or anything.. He wrote his notes presented on BU in a few minutes for fun, some months a go, to show me how he would finish the work that he began in1985, when he was a junior.

    And he did not depend on second hand information from anyone, or any journals in 1985 or this year.

    Here you are again with your second hand information, and a disregard for people’s experience as if you know it all. You do not know all about everything! And you obviously know very little about medicine, else you would be pomposetting on this thread too.

    What your friend told you might be rocket science to you, but basics to real doctors! It happens every day all around the world, including Barbados. That’s why the men hang out in Jemmotts Lane and Belleville in Barbados man. Go figure! We knew about that 30 years ago OK?

    I and others (including GP) KNOW that if the polyclinics were expanded in certain ways that they can relieve the hospital in many areas. We know that patients can be triaged and patients can be stabilized, and that some “lumps and bumps” that take up valuable operating time at QEH can be done in the periphery without a lot of equipment, because we have our selves done them in our offices at some time.

    We know that a lot of out patient work can be transferred from QEH. We know that with the third UWI medical school coming on stream, that there must be some creative way of dealing with the extra doctors, that we don’t want to lose to the brain drain.

    FYI I was working with GP as a junior 20 years ago when there was a major accident at a major junction near a Polyclinic, when the man went out there and started setting up drips etc till the Fire Dept and ambulance came from Bridgetown.

    With minimal Xray facilities we can reduce fractures. We can treat and observe asthmatics, and concussions, suturing lacerations etc. There is a lot that can be done with out a lot of fancy equipment, once there is a will. It is done all over the world. We have done certain things in our offices, and we know what can be done in proper set up mini ER’s. Will we do nothing in the north while we are transporting folk to Bridgetown, when suitably trained doctors can do the same at Maurice Byer or a refurbished St Joseph’s?

    We know, because we have been there. We didnt read it in peer reviewed journals, or got it second hand from our consultant brothers or friends– we have lived it!

    Who said that major accident and emergency can be taken out of the hospital and put into the polyclinics? NO ONE! Definemajor accident and emergency. Define accident? Define emergency?

    Again you are trying to say that I (who you think is GP) is an ass?. You pontificate as though we would not know what kind of equipment, specialized staff and back up is required for a major A& E Department or as though we have not worked in such a Department in our training or otherwise. We do know! You pontificate as though we would not know what kind of cases can be seen, and where. We do know!

    Months a go the same man that you think is an ass opined on BU that the QEH ER should be for major accidents and emergency, and used for training the whole cadre of national accident & emergency personnel and teams in rotations.

    The solution to the issue revolves initially not about buildings but around
    THINKING
    TEACHING
    TRAINING

    While all these interesting buildings are being built including this new accident and emergency hospital, we need to think about

    how we will use what we have,
    where we will put what we need and
    when we will act- i.e in what stages will we implement our programs.

    We need to start teaching the children in school that the old Bajan thing of rushing to the “horsepital” for everything done! Serious preventive medicine must also be taught in schools clubs etc The public must be taught what are considered REAL emergencies. …from little children to grey haired ex professors who know all, and have read all the journals.

    Personnel must be trained and some retrained. So that they can be transferred to any unit at a moments notice as necessary.

    Instead of some new accident and emergency hospital, we need several strategically placed emergency centres throughout specified zones in the country.
    .
    Each ER centre should have an asthmatic bay, provision for admitting persons for observation such as those with “borderline acute abdomens, mild head injuries” and provision for doing minor operations (various lumps and bumps, suturing lacerations)etc

    Re
    The kind of equipment, specialized staff and back up required for a major A&E department is the kind we would probably only afford to put in one place.

    Certain equipment yes. All the staff must be trained to a specific standard. For one thing such training helps with motivation.

    Here you go with your second hand experience again. Who cares about what your consultant doctor brother once did in Baltimore. Do you know what we are doing now and where we are, and what has colored our thoughts? You think that our initial experience at UCHWI was easy?. Do you know that they are rough up there too? And that we were seeing gun shot wounds from early too?

    You do not know what resources are required for use at peripheral clinics- and the plan I am told does not call for a dozen or more polyclinics.

    Go read your damn journals and look for articles by the experts on A PLAN FOR RENOVATING HEALTH CARE SPECIFICALLY FOR BARBADOS FOR 2008 & BEYOND.

    Good night!

  48. Thomas Gresham

    I think I hear the sound of cages being rattled.

  49. The scout

    I thought I would never have to go into the QEH until earlier this year when I was hospitalised with a serious ailment. It so happened I had to return and I do have to return again within the next three months. Ihave learnt to respect and appreciate the work done my the staff there. I was once like most of you, I detested having to go there even to visit some-one. It is not the Hilton and I’ve told my wife if anything happens to me take me back to the QEH as oppose to Bayview.

  50. Kay

    Memres
    With 8 polyclinics having 3 ambulances each plus at least 3 still at the QEH, would we not have alot of them and their personnel sitting idle for much of the time? And how would you propose that calls be dealt with? At one centre, which could monitor 24/7 where every ambulance was located? For instance if I was in Charnocks would I call the polyclinic in Six Roads, Oistins or a central emergency station? Or would areas be zoned?
    I agree wholeheartedly that the polyclinics need to be working 24/7 to deal with the asthmatics, sprains and other ailments that require trained persons more than equipment. And yes that would cut down on the the traffic through the A & E.

  51. Hants

    Prehaps properly trained Paramedics and well equipped ambulances would compensate for the time it takes to get to the QEH.

    Bajans can also change their lifestyles,spend more time exercising,eat healthier and spend less time in hospital.Easier said than done.proper pork,fry chicken and macaroni pie too sweet.

    Most importantly, we must all keep talking and giving our opinions for the betterment of Barbados.

  52. Hants

    @ Kay

    Modern day communications allow a central command centre to be in contact with all ambulances,the QEH and the polyclinics.

    They would direct the nearest available ambulance to the “accident location”.

  53. Kay

    I would tend to agree with you but the earlier suggestion of decentralising A & E made me ask.

  54. Thomas Gresham

    Dear Hants,

    I think these are sensible solutions.

    One of our medics and an inspiration to me is Sir Ken Stuart who has long argued that we need to find ways of incentivising people to go back to our healthier way of life – perhaps through lower medical insurance or some other device. One of our problems is that the heathiest things are free: walking, drinking water and swimming. But as our commercial world cannot easily make money from those things it encourages us to spend money on other things.

  55. ru4real

    What TG says is true.
    The big public hospitals are the ones that have the best and most experienced teams of doctors and surgeons.
    At the end of the day when you are sick this is what you need.

  56. ru4real

    @Hants

    Eating macaroni pie is practically a passport to diabetes.
    The

  57. memres

    @ Kay
    Areas would be zoned as noted in the notes on BU.

    Q With 8 polyclinics having 3 ambulances each plus at least 3 still at the QEH, would we not have a lot of them and their personnel sitting idle for much of the time?

    A The ambulances maybe. The personnel; not necessarily. But I hear many of them are idly now anyway. They dont work! LOL

    Maybe we don’t need/cant afford so many. But as zones increase in population we can see the need. And we don’t want anyone to be deprived. I don’t think you want to hear our ambulance is on the road, or has gone to QEH. Can you wait half hour? (Before we make plans to plant you)

    The general idea is that the zonal ambulances work within their respective zones. You should definitely not have to wait for an ambulance to come from Bridgetown to Charnocks if you were in status asthmatic . The way I understand it, I think that Oistins would be the place for you to call as Randall Phillips is the proposed clinic for upper highway 7 and environs.

    You raise, however, the question I think of Six Roads being nearer? Worth discussion. One may have to rethink the zones?

    You add to the proposal the idea that a central call center might /should know where every ambulance is located at every time. Brilliant!

    You seem to be proposing that calls be made at one center. This is indeed the best ploy, just as Hants has set it out ……. Modern day communications allow a central command centre to be in contact with all ambulances,the QEH and the polyclinics.
    They would direct the nearest available ambulance to the “accident location”.

    .
    But bear in mind the idea is for the nearest ambulance and emergency response team to be available to ferry you to the nearest point for triage or stabalization or treatment.
    I think the idea is not to have the zonal ambulances out of zone except maybe for a real local disaster. I think that the general plan can be fine tuned and that your suggestions are worthy and most thought provoking.

    Re I agree wholeheartedly that the polyclinics need to be working 24/7 to deal with the asthmatics, sprains and other ailments that require trained persons more than equipment. And yes that would cut down on the traffic through the A & E.

    I AGREE TOO. IT’S A BRILLIANT IDEA BY MY BUDDY GP. TO GO WITH HIS WORK IN 1985. JUST NEEDS SOME FINE TUNING & TESTING. PERHAPS WE SHOULD DELINEATE ONE ZONE. AND TEST IT!.

    @ Hants
    We do need properly trained Paramedics and well equipped ambulances as I understand the current situation to be. The reason for the stress on TRAINING. But it does take half hour to get from the periphery of the island to Bridgetown even on Sunday mornings at 5.30.

    That’s a lot of time for asthmatics, persons with an ectopic pregnancy and other scenarios.

    Your other comments relate to TEACHING & THINKING! I agree.

  58. Kay

    So we have to look at how much it would cost to have the call centre, the ambulances and personnel in each zone, the personnel at the polyclinics etc. running 3 shifts a day plus some extras for covering holidays, sickdays, ongoing training days etc.
    It all adds up very quickly.
    Can we afford to offer this as a free service?
    Probably have to only have some clinics open 24/7 and some open 16/7 only.
    And then we have to look at which clinics would have more traffic, as these would be the obvious ones to have open 24/7.

  59. Georgie Porgie

    @ Kay

    Again you have asked reasonable questions that need to be addressed.

    Some of the answers to your questions might be ascertained by choosing a zone, putting the ideas to the test and seeing how it works.

    You asked “:Can we afford to offer this as a free service?” Probably not……………………….but

    When I proposed that the NHS for Barbados be run from a system of polyclinics in 1985, rather than the format of from GP offices as is the case in the British NHS, which was even then reeling under the high cost of drugs (which was not a factor when they started in 1948), I did not think that we could afford to offer it to the entire populace then for free . ……………….BUT we have!

    I suggested then that it be offered
    1- to the elderly, because I felt they deserved it (inter alia) plus the elderly are most likely to be ill as apoptosis (programmed cell death) sets in.

    2- to the children say 12 and below, since we want to give them a firm foundation.

    It was my view that by so doing, we would have got an idea of what it would cost. On September 1, we can now say what it has cost every year for the last 23 years.

    BTW ongoing training days are normal working days. You would just do a transfer/exchange and attend at the main A& E Dept for a rotation.

    Yes consideration has been given to open 16/7 only, and opening some clinics 24/7 on alternate days, but this might cause some confusion.

    Your suggestion that we should look at which clinics would have more traffic, as these would be the obvious ones to have open 24/7, is also a good one.

    The hope, however, is that what ever is done that we would have a more responsive and effective service that is affordable to individuals or nationally. But dont hold your breath!

    My ideas are just quick general thoughts based on my experiences in different areas of practice at home, and my perceived needs. Clearly some, perhaps much modification is warranted.

    Clearly too, you are a great thinker!

  60. Thomas Gresham

    Dear Kay,

    I agree with you. There are many things on our list of “nice to haves”, like A&E departments in every Parish, but what are the “need to haves” and what can we afford.

    The public sector has to provide a good A&E service – the private sector will not, partly because it is too expensive. The private sector is also not very good at preventative care and mental health – not good businesses. I am sure there are others. The free polyclinics need to be at the heart of preventative care, as well as dealing with routine procedures that do not need the full force of a hospital in terms of staff and equipment – the kind of things that good nurses can do rather than expensive Hospital Consultants (in the medical sense of the word). They can do more of this than they do today. In Mexico there has been a revolution in public health in poor communities by paying people to attend polyclinics with their kids for regular vaccinations. Interesting.

    There is a lot in the middle that could be mixed with the private and public sector. There are things that can be “publicly funded but privately delivered” which is the essence of the French system and some new ideas on mixing public money with health insurance for non-A&E and preventative stuff. Kay, you have raised the issue of the consequences of making things free and mixing public money with insurance may help to correct some of the bad incentives of making everything free. “Free” services can create spurious demands which overburden the system. I recall and old report that said the majority of visits to the National Health GPs in the UK are from perfectly healthy people. And many ailments today, as Hants has pointed out, relate to self-inflicted problems. People are concerned that the NHS in the UK spends billions dealing with ailments related to smoking and diet.

  61. Georgie Porgie

    @ Kay
    Again you have asked reasonable questions that need to be addressed.
    Some of the answers to your questions might be ascertained by choosing a zone, putting the ideas to the test and seeing how it works.

    You asked “:Can we afford to offer this as a free service?” Probably not.

    When I proposed that the NHS for Barbados be run from a system of polyclinics in 1985, rather than the format of from GP offices as is the case in the British NHS, which was even then reeling under the high cost of drugs (which was not a factor when they started in 1948), I did not think that we could afford to offer it to the entire populace then for free .
    I suggested then that it be offered
    1- to the elderly, because I felt they deserved it (inter alia) plus the elderly are most likely to be ill as apoptosis (programmed cell death) sets in.
    2- to the children say 12 and below, since we want to give them a firm foundation.

    It was my view that by so doing, we would have got an idea of what it would cost. On September 1, we can now say what it has cost every year for the last 23 years.

    BTW ongoing training days are normal working days. You would just do a transfer/exchange and attend at the main A& E Dept for a rotation.

    Yes consideration has been given to open 16/7 only, and opening some clinics 24/7 on alternate days, but this might cause some confusion. Your suggestion that we should look at which clinics would have more traffic, as these would be the obvious ones to have open 24/7, is also a good one. The hope, however, is that what ever is done that we would have a more responsive and effective service that is affordable to individuals or nationally.

    My ideas are just quick general thoughts based on my experiences in different areas of practice at home, and my perceived needs. Clearly some modification is warranted.
    .

  62. memres

    ru4real
    You are missing the point!
    We are talking about preventing people from going to the hospital, and about bringing as much primary, secondary and emergency care to the periphery, for convenience, with a view to saving lives now lost because of having to travel a longer distance to the hospital, for reducing a lot of pain and suffering on the part of anxious relatives.. In some cases relatives suffer more pain and anguish than the patient because of their ignorance of what is going on/or not going on..

    We think that this needs to be done so that “the best and most experienced teams of doctors and surgeons” don’t have to be overworked at the “big public hospitals” and thereby increasing the likelihood of making errors. It will allow extra time perhaps for training. (Note that training not only entails knowing that a disease exists and its symptoms, but more so in seeing the various ways it might often present unlike what the text book says!)

    We are talking about improving health care for everyone in the street from the bottom up.
    We are yet to fully get in to discussing the what, why, how where when etc of hospital care.
    WE REPEAT HEATHCARE DOES NOT NECESSARILY MEAN HOSPITAL CARE.
    Many persons who get very ill DO NOT NEED TO BE HOSPITALIZED. However, if primary and secondary care is poor MORE PEOPLE WILL/MUST BE HOSPITALIZED!

    At the end of the day when you are sick WHAT YOU NEED IS APPROPRIATE CARE FOR THE ILLNESS YOU HAVE WHETHER PRIMARY, SECONDARY OR TERTIARY. Often you might not need a high powered doctor or medical team.

    Sometimes the proper or appropriate care is just TEACHING or REASSURANCE or DOING NOTHING

    FYI diabetes is now being considered as an autoimmune disease. Eating macaroni pie is NOT a cause. Some juvenile diabetics are diagnosed before they start to even eat mashed pumpkin.

  63. JC

    If you all want the hospital run well. I suggest that some one beg georgie porgie from BU to come back HOME!

    he had some great suggestions and they made SENSE!

  64. Doc

    Great to note this ongoing discussion. It is correct that a country as developed as Barbados needs a small, well-quipped level 4 Hospital to service the residents, the hundreds of thousands of tourists that visit yearly and to manage major accidents and natural disasters that may occur from time to time. Having noted that this is a wise choice, it is also important to bear the following facts in mind:

    1. In the 21st Century, state of the art health care has little to do with “hospital care”. Quality health care in today’s environment is best delivered in a decentralized model, with state-of-the-art Community Clinics backed up by a well functioning, centrally located hospital.
    2. It is literally impossible (and foolhardy) to “renovate” an old hospital. The required hospital infrastructure for 2010 is a world apart from the infrastructure of the 1950′s. Retrofitting is really not an option.
    3. Many of the state of the art Health Care facilities that are needed by a small island nation like Barbados can now be bought “off the shelf” and re-assembled in Barbados. Maintenance contracts can be put in place with the vendors to solve the problem of “upkeep” that plagues many of the facilities in the Caribbean.
    4. Every additional month of procrastination in solving this health problem will cost additional millions of dollars and result in needless morbidity and mortality for Bajans.
    5. Barbados is fortunate to have an adequate volume of well trained health care professionals that can staff state of the art health care facilities. These facilities will be certain to attract more high quality health care professionals to the island.
    6. Investment in state of the art health care facilities could trigger the development of a viable “health tourism” sector in Barbados that would offset some of the initial government investment.

    This has been a great discourse. Please keep it up.
    Doc

  65. Thomas Gresham

    Dear Doc,

    I agree and envy your succinctness.

  66. Lymph Node

    Doc’s observations are good. Is it possible to set up an Economic Zone to stimulate medical tourism? This could help pay for infrastructure and preventative health maintenance programmes.

  67. memres

    @ JC
    Reasonable people would agree with you.

    @Doc

    It is noteworthy that in your first point that you have essentially confirmed that the proposals put forward by my old mentor GP is the way to go! You also agree with him that “healthcare” and “hospital care” are not necessarily the same. Permit us to quote your first point which is the foundation of GP’s proposal

    “ In the 21st Century, state of the art health care has little to do with “hospital care”. Quality health care in today’s environment is best delivered in a decentralized model, with state-of-the-art Community Clinics backed up by a well functioning, centrally located hospital.”

    Your point #4 has also been addressed in the discussions on BU, where GP opined that the decision that we both agree with, ought to have been made since January, and much of the planning phase, and some implementation done.

    We tend to disagree (as has been alluded to on this very thread) that we still have an adequate volume of well trained health care professionals that can staff state of the art health care facilities, since we now need to import nursing staff of dubious quality.

    Most of our senior nurses who would normally now move in to public health nursing have emigrated and the experienced ones are retired or set to retire.

  68. memres

    The last line above should read ” the remaining experienced ones are retired or set to retire.

  69. memres

    Now that we have a good idea of WHAT we need to do and WHY, the question now is HOW should be proceed?

    We cant just tear down the QEH. Because we cant build a new one over night, even if we had all the funds. So what will we do in the interim?

    Some say build new. Some say renovate. Some say renovate and extend. WHICH of these options is the best. Which of these will be employ?

    HOW should be proceed?

    WHERE should we build or do our extensions?

    Can we have any succinct answers from anyone that actually knows anything about the subject? No journal answers please.

  70. confused

    Mr Gresham
    With regard to your last post where you say to Doc

    I agree and envy your succinctness.

    Doc has added very little to the debate that was not presented by GP in BU or here in this chat and in detail.
    All Doc has added is this nonsense about health tourism. But he has not told us how this will be done.
    But GP and memres have both certainly explained every thing that they propose very simply so that even the most ignorant person like me can understand.

    All you seem to do is name call as though you sort of bright and important and know everything, but you have added little to the debate of substance. You talk about Sir Ken Stuart, Public Finance Iniatives like BOLT, Public Private Partnerships (PPPs), your friend in London and your consultant doctor brother in the A&E at John Hopkins Hospital in Baltimore.

    But I have learned nothing from all your irrelevant ramblings.

    My wife and I are wondering why we should find it interesting that

    In Mexico there has been a revolution in public health in poor communities by paying people to attend polyclinics with their kids for regular vaccinations.

    And we are totally confused concerning the relevance of this paragraph below to the fine teaching by mamres and GP.

    There is a lot in the middle that could be mixed with the private and public sector. There are things that can be “publicly funded but privately delivered” which is the essence of the French system and some new ideas on mixing public money with health insurance for non-A&E and preventative stuff. Kay, you have raised the issue of the consequences of making things free and mixing public money with insurance may help to correct some of the bad incentives of making everything free. “Free” services can create spurious demands which overburden the system. I recall and old report that said the majority of visits to the National Health GPs in the UK are from perfectly healthy people. And many ailments today, as Hants has pointed out, relate to self-inflicted problems. People are concerned that the NHS in the UK spends billions dealing with ailments related to smoking and diet.

  71. Computer Analyst

    One person posting here under many names.

    But I think you figured that out already, Thomas.

  72. Thomas Gresham

    Dear Lymph Node,

    We could design a regulatory “regime” (rather than a zone) that makes it attractive for health tourism. It could be that a condition of receiving the benefits of the regime, that there was local access, thereby improving the capacity of our heath system as well as employment and revenues.

    I don’t believe the issue is tax, but about making it easy for institutions with the right standards in terms of patient treatment, doctors and nurses, to set up and operate in Barbados. You can imagine a host of employment, medical practice and visa issues. There was a project to bring a firm that treats US patents in a chain of private hospitals in India, to establish a hospital near Warrens. I understand local and foreign investors were due to receive significant tax concessions – I am not sure if this is still going ahead. While there are positive synergies with local heath care, health tourism is not the solution to our health care issues.

    My reading of what people are saying is that we need to do three things: (1) improve and expand the polyclinics – in part so that they can take some of the pressure off the hospital, (2) build a new hospital, while paying sufficient attention to maintenance and staff training and (3) develop heath tourism in a way that helps to build capacity for our local health provision as well as the other economic benefits. I think that makes sense.

    Can we afford a new hospital? The reason why govenrment’s like arrangements where the private sector Builds, Operates, Leases and Transfers (BOLT) a hospital to the public sector is that there is no new capital expenditure “merely” a commitment of existing annual outlays. Modern BOLTs take care of building maintenance and staffing, though I think the unions would not accept the latter. Barbadians feel ill at ease with BOLTS and there would have to be competitive tenders and transparent standards and deadlines with real consequences if they are breached. Over to the Minister of Health.

  73. Hants

    Doc says,
    “It is literally impossible (and foolhardy) to “renovate” an old hospital. The required hospital infrastructure for 2010 is a world apart from the infrastructure of the 1950’s. Retrofitting is really not an option.”

    Surely the QEH would not be renovated and upgraded without an analysis by “qualified professionals”.

    The obvious”best” solution is to build a new billion dollar Hospital but Barbados cannot afford that so prehaps a more conservative approach that includes renovation of the existing and addition of New facilities should be considered.

    When I read today about a shortage of cancer drugs it really puts things in perspective.

    Barbados is not the UAE or Kuwait.

  74. Lymph Node

    Thomas, thank you for your thoughtful answer, I generally agree with a multifaceted approach that would provide outreach healthcare throughout the island, and a new hospital. Let me ramble:

    If the self-interests behind development of these facilities are not encouraged to deliver multi-tiered services to wealthy and poor patients alike, I fear that this effort could end up as another skim-off-the-top capital scheme.

    To keep the integrity in long term operations, investors, both public and private, must be vested in the delivery of services, not just in the capital investment.

    Perhaps one idea is to develop a scheme that would ensure the national interest. A “Barbados Medical Investment Trust” incentive programme could encourage long-term investment/operational partnerships between local and overseas physicians. Like other western countries, physicians often “refer” their patients to an overseas facility in which they (the physicians) have a financial interest. Successful hospitals rely on such networks, in addition to clinical trials, specialty training and monitoring services, testing, etc.

    Perhaps for certain government-sponsored incentives, the “boutique” and polyclinic subcontract groups would provide specific and audited services to those who could not afford them.

    Anyway, these ’boutique’ facilities could supplement the funding and operations of the main hospital with specific equipment and services subcontracts.

    The new hospital could also house the Government Laboratory. It’s my understanding that the Lab could well be a certified regional testing facility that could generate revenues from elsewhere in the Caribbean. Speculative? Yes. But there are examples of testing services being outsourced to the US from Barbados, because the National Lab is not certified.

    Rather than isolate the unions, I would embrace them and enter a long term training and operations agreement that would promise labour stability. Workers and public and private investors alike are vested in both capital and operations, everyone wants this assurance. It can be a win for everyone.

    Any BOLT arrangement needs to be based on a compound and combined economic, political and services framework.

    The Prime Minister desperately needs solutions right now. I think the Barbados health care system can be rendered world-class with thoughtful, imaginative and socially-conscious policy and procurement efforts.

  75. Georgie Porgie

    @ computer analyst, Gresham, lymph node

    We know that the Prime Minister desperately needs solutions right now. We feel sorry for him cause Estwick aint got a clue!

    We know that the Barbados health care system can be rendered world-class. GP and memres have been saying that all along.

    We agree that health tourism is not the solution to our health care issues.

    I have three questions
    1- Are you saying that you will amalgamate the Government Laboratory which does forensic stuff inter alia with the Hospital Lab and the Public Health Lab, and put all in one place?
    2-Is it not true that the private labs are already generating revenue from elsewhere in the Caribbean.
    3- Is it not true that there are examples of testing services being outsourced to the US from Barbados, because of lack of equipment and training.

    Despite your two long rambles, a simple uneducated man like me still wants to hear the answer to memres questions thus…….

    Now that we have a good idea of WHAT we need to do and WHY, the question now is HOW should be proceed?
    We cant just tear down the QEH. Because we cant build a new one over night, even if we had all the funds. So what will we do in the interim?
    Some say build new. Some say renovate. Some say renovate and extend. WHICH of these options is the best. Which of these will be employ?
    HOW should be proceed?
    WHERE should we build or do our extensions?

    Can you answer these questions in simple terms that the layman in the street can understand like GP does?

  76. Computer Analyst

    I think someone forgot to change their handle :)

  77. Kay

    If the health care professionals that we are training are leaving to go and work in other countries leaving us to import some of this labour,
    would it make sense to look at setting up a large training facility? Could this bring in foreign exchange to help fund our own health care?

  78. Georgie Porgie

    Not at all man………not at all.
    Often use third person against the Americans in VMD blog. Cant change handle in that blog or you get banned for life.

  79. Georgie Porgie

    Kay

    You have again asked a good question.

    The problem for us is that there seems to be an insatiable need for nurses in the US now that the “baby boomers” are aging. They are always advertising for nurses and recruiting nurses. We cannot compete with them in terms of what they pay their nurses. Some of their nurses are paid more than some doctors at home.

    We have to continue training our people, however.
    I suppose that our folk remit some of their wages to Barbados, but I don’t think that this what you mean by “bring in foreign exchange to help fund our own health care.”

    The rape of trained health care personnel from developing countries by the developed countries remains a major problem, especially at times when young women in the developed countries think that they are other things that they can do, besides the hands on care of the sick.

    Here in Central Florida, for example, there do not seem to be many facilities for training nurses. Rather the emphasis seems to be training for paramedical jobs like medical billing, medical transcription etc

    It is, however, harder for doctors to get into the US system

  80. Computer Analyst

    is that you georgie? or is it memres? is it confused? are you confused? is everyone confused? am I confused?

    LOL

  81. Georgie Porgie

    LOL
    LMAO
    Think the answer is A & E

  82. Georgie Porgie

    no pun intended

  83. Kay

    No, I was thinking along the line of people coming from overseas to train here to be nurses. Both from the region and outside of the region. And if our local nurses take up posts in the US and Britain not only do they remit funds but if we improve our healthcare facilities they may return and bring a different perspective, which could benefit our services again.

  84. ru4real

    @Doc
    A brilliant post.
    I hope someone forwards it to the Ministry of Health.

  85. Computer Analyst

    Thomas, did you have a good chuckle at this thread?

  86. Doc

    Enjoyed reading your comments. Agree that we need to continue to upgrade the existing health system while we carefully consider the options for putting a new and/or modified system in place. What do you think of the following suggestions?

    1. Start by investing in upgrading the existing Polyclinics one at a time (equipment, staffing and infrastructure), to begin to take pressure off the QEH. The goal here would be to increase the ability of the existing Polyclinics to manage most of the minor accidents, injuries and illnesses (that now clog up at the QEH) at the “periphery”, so that the QEH staff and facilities are not overburdened. You may well find that this pays dividends in terms of cost-effectiveness and efficiency of the health system.
    2. Treat the existing nursing situation as an “opportunity” rather than a “problem”. I think we can all agree that over the years, Barbados has benefited greatly from investing in education. My recollection is that in the remote past Barbados trained teachers and supplied them to many of the other islands without negatively impacting our own educational system. The Nursing shortage in the US will only become more acute over the next two decades as the baby boomers age (demand). Should we consider investing in training larger quantities of nurses (supply) for continued export, with enough left to fill our needs rather than worry about how many nurses we are losing? The economists on this blog will have to tell me how we get repaid for the investment in training the nurses.
    3. Public-Private partnerships should certainly be considered to decrease the front-end government investment and encourage the establishment of state of the art health care facilities. Much of the equipment that would be needed to provide state of the art health care in a small island nation like Barbados can now be bought “off the shelf”.
    4. I agree with the earlier blogger that the health care Unions should be involved in implementing these changes. I have an old mantra that “the best way to make a Conservative is help them to create some assets to conserve”

  87. Georgie Porgie

    @ Doc

    With all due respect man, your first point has been on the market on BU since January with my compliments. Nothing new there. If the Ministry of Health had any serious officers, or the GOB had any one with an inkling of what to do, most of this should be well on the way to implementation.

    The Nursing situation is a serious problem, and will remain so for a number of reasons. The main reason is that having reached the status of a “developed” nation in some respects, the same set of girls who are not studying to be nurses in the developed countries, are not doing so in Barbados either. The brightest of our girls who once became teachers and nurses, now go to University and are doctors and lawyers, and economists and accountants etc. Every crop of nurses that we train that are harvested by the developed countries rapes our “bench” as they would say in sport. Our cupboard is becoming worse than Mother Hubbard”s with respect to girls to train to become nurses.

    The only repayment we get for the investment in training the nurses we lose to developed countries like the US & the UK, is from their remittances to their relatives in Bim.

    I don’t think I am properly qualified to comment on your last two points.

    Now I personally think that we should extend the hospital. This allows us to do some needed renovation without too much disruption of services. I know that many additions have been made to the initial building, and I am not necessarily thinking of adding more thereto, as there may not be many places where this can be done. But we can move some departments out of the existing hospital (for example the Pharmacy, Private Consulting, UWI office, the Medical Library etc) and create spaces to improve function of other departments. We can also reposition some departments such that they provide a more timely service in terms of the flow of delivering patient care.

    The questions we really need to consider are
    1) where should we do the extensions. The old Enmore area? Part of the old hospital area closest to River Rd?
    2)What services or departments would be housed in such an extension.

  88. Dr. Persaud

    I agree with the Doc 100%.

    As regards expanding nurse training, this could be part of initiatives on education tourism. Overseas nurses would have to pay for the courses and certifications and they would also spend money while they are here, adding to our economy, like any non-Barbadian students at UWI.

  89. Pingback: » “Dead” Man Escapes from Morgue? Keltruth Corp.: News Blog of Keltruth Corp. - Miami, Florida, USA.

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