THE STATE OF ST LUCIAN HEALTH­CARE, IN-DEPTH

The end of one year and start of a new one al­ways brings with it new res­o­lu­tions and plans. To many peo­ple in busi­ness, com­mon new year goals for the growth of a com­pany or pro­gres­sion in one’s ca­reer are of­ten ac­com­pa­nied by very per­sonal ones, like the

The Star (St. Lucia) - Business Week - - FRONT PAGE - BY ED KENNEDY, STAR BUSI­NESS­WEEK COR­RE­SPON­DENT

Ul­ti­mately, health and hap­pi­ness will al­ways be tied to­gether, and the abil­ity to have the lat­ter will al­ways be in­formed by the for­mer. But it’s a re­al­ity that for much of the past year, ob­servers would have found plenty to be un­happy about when it comes to the state of health­care in Saint Lu­cia. Then, news of a new be­gin­ning

ar­rived in the later months of the year. So what is the state of Saint Lu­cia’s

health­care at the end of 2018? And what can we ex­pect for the sec­tor in the year ahead? Let’s look now in-depth.

SAINT LUCIANS IN 2019

Saint Lucians will be cheered to know that this is­land’s res­i­dents are liv­ing longer. Life ex­pectancy has grown in re­cent years. Any Saint Lucian boy born in 2018 who

has a life of good health can ex­pect to see his 73rd birth­day. Any girl can ex­pect to

see be­yond that, with a life ex­pectancy of 78 years.

While the longer life­span is cer­tainly good news, the com­mend­able work done by au­thor­i­ties in tack­ling Saint Lucians’

na­tional health is­sues sur­round­ing in­fec­tious dis­eases has been re­placed by a rise in chronic non-com­mu­ni­ca­ble dis­eases such as heart dis­ease and di­a­betes. These trends are mir­rored among many

na­tions world­wide but treat­ment for these dis­eases lo­cally is re­liant upon this na­tion’s health­care sec­tor ex­clu­sively. And within the health­care sec­tor, where there are lit­eral bat­tles be­tween life and death, it’s been a tough year.

THE ROAD OF RE­CENT HIS­TORY

Early to mid-2018 saw the state of Saint Lucian health­care pub­licly crit­i­cised by the

Saint Lu­cia Nurses As­so­ci­a­tion, the Vieux Fort Con­cerned Cit­i­zens Coali­tion for Change (VF4Cs), the Saint Lu­cia Med­i­cal and Den­tal As­so­ci­a­tion (SLMDA) and the Civil Ser­vice As­so­ci­a­tion (CSA).

Crit­i­cisms were broad and di­verse but poor in­fra­struc­ture and re­source al­lo­ca­tion — where re­sources were avail­able — was com­mon. The ap­par­ent wait­ing time of up

to four days for a hos­pi­tal bed proved a light­ning rod for cri­tique. The Novem­ber open­ings of three

up­graded health­care fa­cil­i­ties across the is­land — in Mon Re­pos, Des­ruis­seaux and Belle Vue — can be seen as a clear step

for­ward.

None­the­less, these re­cent months show that the ef­forts in ear­lier years to im­prove ad­min­is­tra­tive health­care pro­cesses na­tion­wide —by de­cen­tral­is­ing man­age­ment, in­te­grat­ing multi-level care,

and greater col­lec­tion of data to be used in ev­i­dence-based pol­icy-mak­ing — ul­ti­mately need a new ex­am­i­na­tion, given the breadth of crit­i­cism lev­elled.

In late Septem­ber the World Bank an­nounced it would ap­prove US$20 mil­lion to­wards the im­prove­ment of Saint Lu­cia’s pub­lic health­care sec­tor. The pro­vi­sion of

funds via the In­ter­na­tional De­vel­op­ment As­so­ci­a­tion was put for­ward with the spe­cific tar­gets of im­prov­ing ef­fi­ciency, ac­ces­si­bil­ity and re­spon­sive­ness among the na­tion’s key health­care ser­vices.

How this pro­ceeds in the new year will be in­ter­est­ing to ob­serve; also the plans of the Chas­tanet gov­ern­ment for the con­struc­tion of a new wing at the ex­ist­ing St. Jude hos­pi­tal com­plex in Vieux Fort.

Ex­pec­ta­tions of rapid-fire im­prove­ments via new in­fra­struc­ture alone would be short­sighted, but no fair mind can be blind to the sim­ple maths that more beds should equal more care.

LO­CAL AND GLOBAL BEN­E­FITS

Im­prove­ments to the health­care sec­tor will not only be ben­e­fi­cial to Saint Lucians at home, but also for Saint Lu­cia’s brand abroad. While Saint Lu­cia is not alone as a na­tion that has bat­tled with the no­to­ri­ous Zika and Chikun­gunya viruses, even one re­port of an iso­lated case can cause rep­u­ta­tional (and eco­nomic) havoc, as would-be trav­ellers to our touris­mde­pen­dent na­tion might fear an is­land-wide out­break is im­mi­nent.

In re­al­ity, one re­port does not nec­es­saruly mean that the whole is­land is af­fected, but the up­grad­ing of Saint Lucian health­care of­fers a two-part ben­e­fit. Firstly it pro­vides

a path for the more im­me­di­ate treat­ment of any cases that arise lo­cally; se­condly it projects to the world that the na­tion’s health­care sec­tor can be quickly mo­bilised to rapidly treat any mal­ady en­coun­tered while trav­el­ling.

AR­TI­FI­CIAL AND AC­TUAL: THE LIM­I­TA­TIONS OF FU­TURE TECH IN HEALTH

Go­ing into 2019 and be­yond, global health­care will con­tinue to ad­vance through

the greater use of tech­nol­ogy. Around the world, many hos­pi­tals and health­care sec­tors have al­ready be­gan to in­cor­po­rate emerg­ing tech­nolo­gies into their op­er­a­tions. There is the Ar­ti­fi­cial In­tel­li­gence (A.I.)

part­ner­ship be­tween Univer­sity Col­lege Lon­don Hos­pi­tals and the Alan Tur­ing

In­sti­tute in the United King­dom, and the Eastern Euro­pean na­tion Es­to­nia’s use of blockchain for its e-health na­tional data­base of med­i­cal records. As the ca­pa­bil­ity of tech in­creases, so too can the ex­pec­ta­tion that it will play a great role in ef­fi­cient health­care ser­vices. This not­with­stand­ing, health­care

re­mains at some­thing of a dis­tance from the im­me­di­ate ben­e­fits that emerg­ing tech of­fers. Un­doubt­edly, A.I., blockchain, and sim­i­lar phe­nom­ena can aid in more ef­fi­cient ad­min­is­tra­tion and ba­sic ser­vice de­liv­ery, but the need for face-to-face in­ter­ac­tion be­tween a med­i­cal pro­fes­sional and their pa­tient will re­main cen­tral. This should not de­ride the good work

of tech­nol­o­gists, nor dis­miss the ben­e­fits of fu­ture tech, but this sec­tor is one where re­liance on ad­vances of to­mor­row to ad­dress the prob­lems of to­day would be es­pe­cially un­for­tu­nate. Cer­tainly, look­ing ahead is al­ways pro­duc­tive but the only cer­tain fix for the prob­lems of here and now is the work done to ad­dress them here and now.

A CLEAN BILL OF HEALTH

Iden­ti­fy­ing the right path be­tween im­prove­ment of pro­cesses and up­grade of in­fra­struc­ture will be es­sen­tial, es­pe­cially with a recog­ni­tion of the lim­i­ta­tions of tech. Those hop­ing for the med­i­cal field to be

‘hacked’ and get a dis­rup­tor like Uber or airbnb to come along will likely be wait­ing a very long time. Like the hu­man body, Saint Lu­cia’s health­care sec­tor is com­plex. Like any other

in the world, it has its share of is­sues and idio­syn­cra­sies. Yet when so many stake­hold­ers level such high crit­i­cism, as seen in 2018, it’s clear that many will not lament say­ing good­bye to 2018, and will wel­come an op­por­tu­nity to be­gin afresh in 2019 — with a hope that lo­cal health­care will ob­tain greater fit­ness.

The go-again, stop-again St Jude’s re­con­struc­tion project has come to epit­o­mize Saint Lu­cia’s in­ad­e­quate ca­pac­ity to de­liver sat­is­fac­tory health­care to the is­land’s cit­i­zens. Ac­cord­ing to the gov­ern­ment, new work on the hos­pi­tal is slated to be­gin in early 2019

While new and in­creas­ingly so­phis­ti­cated tech­nol­ogy like ar­ti­fi­cial in­tel­li­gence and telemedicine pose an op­por­tu­nity to com­ple­ment health­care de­liv­ery and de­crease the costs of health­care ad­min­is­tra­tion, those who be­lieve that new tech is a panacea for the fun­da­men­tal is­sues that plague the is­land’s health­care sec­tor are sorely mis­taken

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