Heads do not usually roll in the BVI public service and certainly not for dereliction of duty.  But a head has been demanded over the fiasco of a closed clinic on a sister island that may have contributed to the death of a citizen on 30th August.

But who or what is to blame?  Is it the representative for the district who appears to lack aggression in protecting his community?

Is it the Minister for Health and Social Development who, by his inference, misses his former appointment and may not be as engaged as he should be with his new portfolio?

Is it a scapegoat who happens to sit as Chairman of the Health Services Authority (HSA)?  

Is it the CEO of the HSA who seems not to be able to adequately cover the financial obligations of her empire?  

Or is it a docile and trusting community prone to amnesia?

Whatever it is, the Public Health Service is the direct responsibility of the government of a country, not of a Board.  It ensures a healthy workforce.

The tipping point should have surfaced when the GM of BVIEC began to disconnect clinics for non-payment of electricity bills after incessant pleas.  His balance sheet still runs red to a point north of $3M. 

No citizen or business can get away with such disregard for their financial responsibilities.  Why should the HSA?

What we know for sure is that the Iris O’Neal Clinic on Virgin Gorda, the primary (no pun intended) Health Care Facility, was closed (relocations aside) from 16th August and resumed full operations on 1st September due to the absence of electricity following Ernesto and compounded by a faulty generator.

Residents’ lives were put at risk; one was lost.  We wonder why the generator was never fixed although residents sounded the alarm.  And it baffles that the District Representative did not demand the Minister’s intervention before it came to death.

Complacency?  Disinterest?  

A petition was circulated by residents and a meeting called by the Health Ministry where the issues were heatedly ventilated.  The ‘brass’ including the Health Minister and the Chairman and CEO of the HSA were present.

Virgin Gorda is tired of being the neglected stepchild of the government and should probably agitate, like Nevis, for its own local government.  After all, self-determination can also take place at home.

But that is a different fight.  

Truth be told, the march to this fiasco started about 2 decades ago.  I was in the room.

We made a mistake back in the early 2000’s when we merged primary and tertiary health care.  We expected sweeping improvements and heightened efficiency.  Neither was realized.

Tertiary health care enriches practitioners and gives more immediate results.  It consumes most of the budget to the neglect of the Primary Health Care facilities including the clinics.

When we look back to see how thoroughly we dismantled a well-functioning system, we should be ashamed.  I am.

Our elderly, once looked after through a public health home visiting programme are all but abandoned except for the kindness of people like a retired nurse and her helpers who use their own resources to do what a government should.  

And despite appeals (she will not grovel) the ears of officialdom are blocked.

The BVI Health Care System began in the age of infectious diseases.  Medical doctors, at the time, were assigned as Administrators of government and they were fully in charge.

The quarantine station was upgraded into a small Cottage hospital, the precursor to Peebles Hospital which gave way to the unpainted, unsigned, Dr D Orlando Smith Hospital.

Eventually, BVIslanders were trained, initially as nurses, but preventable infectious diseases still ravaged, especially, the childhood population.

In 1968, Nurse Loucita Hodge of Sea Cows Bay, initiated a research project to study the impact of infectious diseases on the health of children in the BVI and was rewarded with a PAHO Scholarship to pursue studies in Public Health at the School of Public Health in Jamaica. 

When she returned to the BVI in 1969, Hodge, through force of personality, vision, skills, and dedication, launched Public Health services throughout the BVI.  

The public Health Service, upgraded over the years, supported infants and child health; School health; Dental health; Immunization Programmes; Sickle Cell monitoring; Elder care home visits; Workplace health; Ulcer care; Post hospitalization follow up visits; Maternal and child health visits; Health education; Sexual health.  The list was long.

A diabetic clinic was added.  Contact tracing for communicable diseases flourished.  Community Mental Health Nurses were appointed and did exceptional work.

Project Lifestyles in schools ensured that children understood the links between food, nutrition, obesity and lifestyle diseases like hypertension, diabetes, certain cancers and heart disease that are now rampant in the Territory.

And a vibrant Health Education Unit provided the instructions in all things that impacted health including sanitation.

And throughout households in the BVI, for generations, the maxim, “an ounce of prevention is better than a pound of cure’ was often recited.

But the merger of primary and tertiary health care shifted our focus to an institutional approach.  And we moved from ‘health care’ to institutional sick care.

And that is partially why a citizen could ‘die on the doorsteps’ of a closed institution.  The community health apparatus that would have assisted him and sent him early for tertiary treatment was dismantled.

It is time to correct the mistake.  Agreeing a budget alone will not fix such a deep-seated problem.  

Primary Health Care needs, again, to be separated from Tertiary Health Care and restored as the responsibility of the government of the VI, not of a Board.

Something to consider on our Fridays.

Happy Friday!