Editor’s note:This article was published in the Editorial section of the Chronicle Newspaper on July 24,2009.
The Ministry of Health and other relevant authorities should move quickly to upgrade the systems, facilities and personnel available to deal with medical emergencies in rural communities and remote areas.
This month, a young cadet was pronounced dead at the Princess Margaret Hospital after being unable to get emergency medical treatment for several hours when he became seriously ill at a camp in the Castle Bruce area. Persons trying to assist him were reportedly unable to reach key medical personnel at the district health centre and there was no ambulance to transport the stricken cadet to hospital.
This is not an isolated case. A few weeks ago, The Chronicle reported an incident in the same area in which a desperately ill woman nearly died when there was no ambulance to rush her for treatment when a medical emergency arose. In that case also, it was not possible to get appropriate medical treatment for the ailing woman in her rural community or its immediate environs.
These incidents and others make it quite clear that many persons who suddenly get ill or injured in the far-flung regions of Dominica could find themselves in a most dire predicament. Indeed, life-threatening medical emergencies may arise in places where medical help is several hours away and there is no ambulance. In such situations, a multitude of risks and negative consequences inevitably arise.
As a developing nation with a vulnerable economy, Dominica does not have the capacity to put ideal systems, facilities and personnel in place for medical emergencies in remote places. But health officials in Dominica can definitely examine existing medical facilities to see if they are functioning as expected and take steps to upgrade these in the interest of providing the best service possible.
Since Dominica is the nature isle of the Caribbean, its eco-tourism sites are powerful magnets for adventurers from all parts of the world. However, these visitors may arrive here with underlying medical complaints that predispose them to health risks in Dominicaâ€™s rugged hinterland. Therefore, how the nation deals with medical emergencies involving sickness or injuries in remote areas with challenging terrain is an important consideration in the development of the islandâ€™s tourism product.
Dominica is a mountainous, volcanic island that is vulnerable to landslides and flash floods, especially in rural and remote areas. If the island intends to accommodate an ever-increasing number of visitors to eco-tourism sites found in remote areas without easy access by road or waterway, then build the capacity to meet their health, safety and medical emergency needs.
In any case, local residents of rural and remote areas deserve the best medical systems and facilities that the nation can provide with the resources at its disposal. Unfortunately, it seems that the island is not doing as well as it should in this area, even if current economic constraints are taken into account.
The time is ripe for forward-thinking health authorities to move urgently to examine and upgrade Dominicaâ€™s capacity to deal with medical emergencies in country communities and interior locations.
Geez Chris – You posts recently have really asked some hard questions about some hard choices. I don’t have an answer for this one. Even North America and Europe rural/remote areas are plagued with this problem. In your case I would say a quick fix would seem to be a helicopter ambulance system. How to pay for it though is another issue entirely…
Joel and Chris,
Undoubtedly the difficult terrain of Dominica will always pose communication challenges to Dominica, including travel by road. It is true that emergency systems in general on the island (not just health emergencies) are inadequate. This may be due to funding, scope or priority issues and even politics. I do not think it is so much from an issue of lack of knowledge of senior health technocrats about what portends in a modern, healthy society. Like everything else, politics plays a leading role in many governmental actions or inactions.
Also, the island has limited resources. Now, people are paying less service and hospital fees as I understand it, so there is less incoming from fees coming to government coffers. We expect alot from government. But really, where is the revenue to come from and not affect other aspects of provided services? Perhaps we can demand greater accountability for how monies are already being spent.
On the question of revenues, should more or newer fees (eg hospital fees) be asked of a population which may not be able to afford? Should the government take away the free textbooks and transport for high school kids instead and have more full time medical staff on duty and more ambulances and trained paramedics available? Should the government employ less that the 400+ cops on payroll? Should the government reduce foreign borrowing for major capital projects and put this money saved into providing more services? These are hard choices to be made with limited funds. But I too still lament the inadequacy of the system. We expect so much. The reality is that surpluses in the treasury has only been a very recent phenomenom.
It is also possible that our health technocrats are not highlighting the problems and solutions enough and making forcefull cases that can bend the intentions of politicians into helping provide best, urgent medical care to the nation.
I hate to make the comparison, because we are looking at different economies of scale, resources etc, but even in developed countries like the US with the best of care, many many patients are killed by the system too (negligent doctors etc) and also waiting time can be hours in the emergency rooms. Many problems in the medical field are not unique to Dominica. Even a seemingly non-lethal incident like the common flu kills 39,000 people in the US each year. That is half Dominica’s population. I am sure a portion of that may be due to systematic issues.
Again, I take issue with bringing the impact on tourism into the fray. Like I always say, lets take care of Dominica’s own as a priority. Whether its health, education, housing, environment…and the spill offs will benefit the toursism industry as well. It should not be that we have tourism considerations as the incentive to do the right (basic) thing.
Health and education are two major (often overlooked) foundations of any economy and if we put people first, this will be a major investment into the future….Chris, I commend you for highlighting on the issues, but though there is hardly a magic bullet solution, we need to keep the fire lit under the feet of the politicians, technocrats, and decision makers!
You made some great comments with regards to economies of scale. The key to saving lives is the response time after emergency personnel have been notified of an emergency. Adding new ambulance response stations to serve different parts of the island is the key. For example, Layou-Colihaut should have its own fire and ambulance response station. There are major road improvements on the way. This will help greatly with emergency response time.
Unlike like other countries, new housing developments are not planned to coincide with the health care system. For example, there are four main areas with ambulances, capable of responding to medical emergencies. They are, Roseau, which handles pretty much all emergencies in the Roseau area and beyond. There’s Portsmouth, Grandbay and Marigot. Anyone who needs help outside these main areas are own their own.
More ambulance stations are required to respond to medical emergencies in different parts of the island. For example, the Roseau Valley needs its own ambulance station. This new station would allow emergency personnel to respond to emergencies in Louisville, Copthall, Shawford, Wotten Waven, Morne Prosper, Laudat and Trafalgar. This system should be repeated in other parts of the island.